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Francisco Machado 1998

Incidence

Anorexia nervosa (AN) 0.5 - 1 % increased in compet enviroment e.g. boarding school

Bulimia nervosa (BN) 1-2%

Milder forms in all women 5%

Female:Male 10:1

AN increased in SEC I

Causes

Mulitifactorial in cause and effect

Psycho, social and physical

1. Concerns about developmental anxieties and body change

2. Social pressures

3. Previous overweight due to comfort eating

4. Oversensitive, obsessional, perfectionist often have low esteem

5. Family may be split in the way they deal with problem especially in young adolescents

Recognition

Both AN & BN have:

• disturbed dietary restraint and self esteem
• body image problems

• biological effects

Symptoms

AN

• intense fear of becoming obese even when underweight
• disturbance of body image
• refusal to maintain a reasonable body weight achieved by severe dietary restriction
• calorific control - exercise, purging, vomiting
• amenorrhoea in women

BN

• pre-occupation with food
• bingeing
• a sense of a lack of control
• phobic fear of fatness and an overvaluation of body shape as a severe of self esteem

The two may mix and may develop into each other

Medical complications

AN

• Reduced BMR, hypothyroidism

• reduced cardiac output associated with bradycardia and cold intolerance
• neutropenia resulting in infection
• lanugo hair
• tired, depression, impaired concentration and reduced interests
• constipation and impaired renal function
• ovarian dysfunction leading to amen, associated with poor growth and osteoporosis

BN

• dental erosions

• parodititis
• oesophagitis
• abrasions lips and fingers
• menstrual disorders
• hypokalaemia

Management

• The patient is often brought by a IIIrd person. Need to acknowledge the concerns about the patient

• Can start by addressing these concerns with the pt
• need to find out what the pts concerns are and try and build upon this. e.g. the patient may complain of being TATT or cold intolerance
• Address:

1. severity and duration
2. wt hx min and max
3. menstrual hx
4. complications
5. depression
6. life events
7. consider sex abuse

Need to:

1. regular eating although some concentrate on Cal content.
2. encourage the pt to understand the illness in terms of a psychological response to pressure
3. Dietary advice
4. self help groups
5. monitor wt, BMI, Hb, U/E, BP, pulse

Refer

1. mild not responding to treatment
2. moderate
3. amen > 3/12
4. AN > 15 % wt loss
5. medical complications
6. depression
7. disruptive to life

Psychological approach

• family approach in children at GOS in london

• cognitive approach in BN

Drugs very little role

• anti dep if depressed

• prozac if overeating

May take 3-6/12 before any treatment

Prognosis

AN

• 50% recover

• 33% mild problem
• 20% severe
• 25% BN
  • 5-10% RIP infection, hypovolaemia, suicide

BN

• chronic relapsing

• self injury
• alochol
• concealed

Francisco Machado 1998

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