Anorexia nervosa - causes, symptoms, diagnosis, treatment & pathology

Summary

Anorexia nervosa, often referred to as anorexia, is a serious eating disorder marked by an extremely low body weight relative to an individual's height and age, an overwhelming fear of gaining weight, and a distorted self-image of one's body. There are two primary subtypes: the restricting type, where individuals severely limit their food intake, and the binge-eating/purging type, where individuals may consume large quantities of food and then purge to prevent weight gain. The disorder has severe physiological and psychological effects, impacting multiple body systems and requiring comprehensive medical and psychological treatment plans for recovery. Causes are multifaceted, involving genetic, hormonal, and societal influences. Early intervention, therapy, and medical oversight are critical in treating anorexia and addressing its complex underlying causes.

Highlights

• Anorexia nervosa can start as bulimia but evolve into severe weight loss disorder 🤷‍♀️.
• Body Mass Index (BMI) is crucial in determining the severity of anorexia 🏋️.
• Anorexia can cause serious heart issues, such as bradycardia and low blood pressure ❤️.
• Electrolyte imbalances and refeeding syndrome are critical concerns during treatment 📉.
• The disorder often hits during teen years, significantly affecting mental health 🌱.

Key Takeaways

• Anorexia nervosa involves extremely low body weight and a distorted body image 😲.
• There are two main types: restricting and binge-eating/purging 🤔.
• Anorexia can cause severe physical health issues across multiple body systems 🏥.
• Causes include a mix of genetic, hormonal, and societal factors 🌐.
• Early intervention and multi-faceted treatment approaches are key to recovery 🌟.

Overview

Anorexia nervosa is a complex, multifactorial disorder characterized by abnormally low body weight, intense fear of weight gain, and distorted self-perception. The disorder primarily manifests in two forms: restricting, where individuals consume very few calories, and binge-eating/purging, similar to bulimia but with notable weight loss.

The impacts of anorexia are widespread and severe, affecting the cardiovascular, endocrine, and skeletal systems. It not only leads to physical symptoms such as heart rate disturbances and bone fragility but also psychological effects like depression, anxiety, and obsessive-compulsive tendencies.

Treatment of anorexia requires a comprehensive approach, combining medical, nutritional, and psychological strategies. Psychotherapy, particularly cognitive behavioral therapy, plays a central role in addressing the underlying psychological issues and distorted thought patterns that fuel anorexic behaviors.

Chapters

• 00:00 - 00:30: Introduction to Osmosis Prime The chapter 'Introduction to Osmosis Prime' introduces the wide range of educational resources available on the Osmosis Prime platform. It highlights the inclusion of over 700 videos covering diverse topics such as pathology, physiology, pharmacology, and clinical reasoning. Additionally, it features an offer to try the service for free. The chapter briefly touches on the health condition anorexia nervosa, describing it as a disorder characterized by very low weight and a constant fear of weight gain.
• 00:30 - 01:00: Understanding Anorexia Nervosa The chapter titled 'Understanding Anorexia Nervosa' discusses the perception issues and behaviors associated with anorexia nervosa. Individuals suffering from anorexia often fear gaining weight and have a distorted view of their body weight, considering themselves overweight even when underweight. The disorder has two main types: the restricting type, where individuals drastically reduce food intake, and the binge-eating/purging type, where individuals consume large amounts of food in a short period and then purge using vomiting or laxatives.
• 01:00 - 02:00: Types of Anorexia Nervosa This chapter distinguishes between anorexia nervosa and bulimia nervosa primarily by the individual's weight, with those experiencing anorexia being underweight, whereas those with bulimia are typically normal or overweight. This can lead to someone initially developing bulimia and later transitioning to anorexia. Anorexia nervosa is also categorized by severity levels, determined by the individual's Body Mass Index (BMI), where a BMI between 18.5 and 24.9 is considered healthy, but someone with anorexia would have a lower BMI.
• 02:00 - 03:00: Severity Levels in Anorexia This chapter discusses the severity levels in anorexia based on BMI (Body Mass Index). It outlines the classifications: mild (BMI 17-18.5), moderate (BMI 16-17), severe (BMI 15-16), and extreme (BMI less than 15). Additionally, it introduces the concept of atypical anorexia nervosa, where individuals meet anorexia criteria but remain within or above normal weight after significant weight loss.
• 03:00 - 04:00: Psychological and Behavioral Signs This chapter, titled 'Psychological and Behavioral Signs,' discusses the various psychological and behavioral characteristics commonly associated with individuals suffering from anorexia. These individuals are not only characterized by a low Body Mass Index (BMI) but also a deep-seated fear of gaining weight. They exhibit an obsessive focus on the caloric and fat content of food, which often results in restrictive eating habits, purging, excessive exercising, and frequent weight monitoring.
• 04:00 - 05:00: Physical Health Consequences **Physical Health Consequences**: Anorexia can lead to severe physical changes impacting every body system, serving as diagnostic clues. It often results in widespread muscle loss, evidenced by low creatinine levels and fatigue from weakened muscles, including the diaphragm, causing breathing difficulties. Notably, cardiac muscle loss can result in bradycardia.
• 05:00 - 06:00: Electrolyte and Vitamin Deficiencies This chapter discusses the impacts of a weak heart, particularly highlighting symptoms such as bradycardia (less than 60 heartbeats per minute), hypotension (blood pressure below 90/50), and orthostatic hypotension, which occurs when blood pressure falls upon standing. Additionally, it delves into how a weakened heart can lead to congestive heart failure, where protein deficits in the blood can cause edema, particularly in the feet. Moreover, the discussion extends to serious electrolyte imbalances, including low potassium, magnesium, and phosphate levels, which can have significant health implications.
• 06:00 - 07:00: Effects on Blood and Bone Marrow This chapter discusses the effects of nutritional deficiencies on blood and bone marrow. It highlights issues such as vitamin deficiencies, with a specific mention of thiamine (Vitamin B1) deficiency. In women, this can lead to amenorrhea, which is the absence of menstruation. Prolonged food restriction impacts the gastrointestinal tract, causing symptoms like bloating, nausea, and constipation. Additionally, severe nutritional deficiency can lead to bone marrow suppression, resulting in reduced white blood cell production.
• 07:00 - 08:00: Effects on Skin and Hair The chapter titled 'Effects on Skin and Hair' discusses the impact of anorexia on different parts of the body. It explains that this condition can lead to a weaker immune response, a decrease in red blood cells resulting in lower energy levels, and a reduction in platelets causing easy bleeding and bruising. It also highlights how anorexia may cause osteoporosis, making bones fragile and prone to fractures. Additionally, anorexia affects the skin and hair, leading to dry and scaly skin, brittle hair that falls out easily, and the growth of soft body hairs called lanugo. Another symptom mentioned is halitosis or bad breath, particularly from repeated vomiting.
• 08:00 - 09:00: Neurological and Brain Effects This chapter focuses on the neurological and brain effects of certain medical conditions, emphasizing the occurrence of brain atrophy and encephalopathy. These conditions can lead to serious symptoms such as ataxia, confusion, and in severe cases, death. Furthermore, the chapter highlights the concept of refeeding syndrome, a condition that occurs when refeeding initiates insulin secretion, resulting in the uptake of already low levels of critical electrolytes like potassium, magnesium, and phosphate into cells, thus dangerously lowering their serum levels.
• 09:00 - 10:00: Complications and Refeeding Syndrome This chapter discusses the complications and risks associated with refeeding syndrome, particularly in patients with anorexia. It explains how electrolyte imbalances can lead to severe heart arrhythmias and potentially cardiac death. As a result, patients with anorexia undergo extensive medical evaluations and are closely monitored with ECGs during the refeeding process. The chapter also touches on the complexity in identifying the exact causes of anorexia, suggesting it involves interactions between genetic, hormonal, and hunger signaling factors.
• 10:00 - 11:00: Potential Causes of Anorexia The chapter titled 'Potential Causes of Anorexia' discusses various factors that may contribute to the development of anorexia. These include feelings related to hunger and fullness, as well as social and environmental influences such as peer groups and popular culture. The chapter identifies a connection between anorexia and emotional challenges like low self-esteem, loneliness, and sensitivity to peer pressure, with a perceived need for approval from others. It is noted that individuals suffering from anorexia often exhibit perfectionist behaviors and have a heightened reaction to stress, seeking control over aspects of their life, particularly their weight. Additionally, the prevalence of anorexia is higher in cultures that prize thinness.
• 11:00 - 12:00: Social and Cultural Influences The chapter explores the influence of social and cultural factors on anorexia, highlighting how societal standards of beauty, particularly as portrayed in media, contribute to the onset of the disorder, especially among teenagers and young adults. It notes the higher prevalence of anorexia among those with greater media exposure and acknowledges that while the condition is more prevalent among women, men are also affected. In both genders, the disorder is frequently observed among athletes and professionals.
• 12:00 - 13:00: Demographics and Associated Conditions This chapter discusses the demographics and associated conditions of individuals who are particularly focused on their body weight and percent body fat due to activities like dancing, modeling, and wrestling. It highlights the common association of anorexia with other conditions such as obsessive-compulsive disorder, depression, and anxiety, which share overlapping symptoms and risk factors. The chapter also touches on treatment options, emphasizing the importance of medical treatment with careful weight gain and the role of psychotherapy and cognitive behavioral therapy in managing these conditions.
• 13:00 - 14:00: Treatment Approaches The chapter "Treatment Approaches" discusses therapeutic interventions focusing on the individual and sometimes their family to treat anorexia. These treatments aim at enhancing self-esteem and teaching strategies to better manage stress and social pressures, as well as identifying harmful thought patterns influencing the illness. The chapter highlights that although anorexia can severely impact almost every body system, with careful management, treatment, and healthy eating patterns, many of the complications and issues can be reversed.

Anorexia nervosa - causes, symptoms, diagnosis, treatment & pathology Transcription

• 00:00 - 00:30 On our Youtube channel, you’ll find a limited selection of pathology and patient videos. With Osmosis Prime, you'll get access to over 700 videos including complete coverage of pathology and physiology and a growing collection of pharmacology and clinical reasoning topics. Try it free today. Anorexia nervosa, which is often just called anorexia, is a disorder that is characterized by very low weight (typically less than 85% of normal body weight), a constant fear of
• 00:30 - 01:00 gaining even the slightest amount of weight, and having a distorted view of their own body weight or shape, often believing that they are overweight, while actually being underweight. Now there are two main types of anorexia. One form of the disorder is the restricting type, where people reduce the amount of food they eat in order to lose weight. Another form of the disorder is the binge-eating and then purging type, where individuals eat large amounts of food in one sitting and then purge that food through vomiting or by taking laxatives.
• 01:00 - 01:30 This can be confused with another eating disorder—bulimia nervosa, but the main distinction between these two disorders has to do with an individual’s weight. Individuals with bulimia are usually normal weight or overweight, whereas individuals with anorexia are underweight. Because of this, people can potentially start out with bulimia, and then develop anorexia over time. Anorexia can be further split by levels of severity. A body mass index, or BMI, between 18.5 and 24.9 is considered healthy, someone with anorexia
• 01:30 - 02:00 though that has a BMI between 17 and 18.5 is considered mild, a BMI of 16-17 is considered moderate, a BMI of 15-16 is severe, and having a BMI of less than 15 is considered extreme. People who meet all the criteria for anorexia except that they are within or above the normal weight range after significant weight loss can be diagnosed with atypical anorexia nervosa.
• 02:00 - 02:30 Now in addition to having a low BMI, individuals with anorexia are typically fearful of weight gain, and often have a psychological obsession with the caloric and fat content of food, often leading to food restrictive behaviors, purging, exercise, and frequent weight checks. They might perform specific food rituals, like cutting food into small pieces, or eating foods in a specific order. They might refuse to ever eat in front of people, or cook elaborate meals for others, but then not eat themselves. Like a dinner party host who’s unwilling to eat his/her own food.
• 02:30 - 03:00 Anorexia literally starves the entire body and can cause a number physical changes affecting every body system, which can end up being clues to the diagnosis. There is often a loss of muscle tissue throughout the body, reflected by a low creatinine level and symptoms of fatigue from weak muscles throughout the body, including a weak diaphragm which can cause difficulty breathing. Even the heart can lose muscle, and this loss of cardiac muscle tissue can lead to bradycardia—less
• 03:00 - 03:30 than 60 heart beats per minute, and hypotension—a blood pressure below 90/50, as well as orthostatic hypotension when blood pressure falls when a person goes from a lying down position to a standing position. A weak heart can lead to congestive heart failure and combined with low protein levels in their blood can cause significant edema or swelling, especially in the feet. There may also be serious electrolyte abnormalities like low potassium, magnesium, and phosphate
• 03:30 - 04:00 level, as well as key vitamin deficiencies such as thiamine also known as Vitamin B1. Women can have amenorrhea, where either the normal menstrual cycle stops or menstruation doesn’t start by age 15. Prolonged food restriction can also make the gastrointestinal tract unable to handle normal meals which causes terrible bloating and nausea as well as constipation. Also, the bone marrow can start shutting down—so you get fewer white blood cells which leads
• 04:00 - 04:30 to a dampened immune response, fewer red blood cells which leads to lower energy levels, and fewer platelets which leads to easy bleeding and bruising. Anorexia can also cause osteoporosis where the bones become weak and susceptible to fractures. The skin can change, with symptoms like dry scaly skin, and also the hair on their head can become brittle and fall out easily, and soft hairs called lanugo covering their body. Some people might also have halitosis or really bad breath from repeated vomiting.
• 04:30 - 05:00 Finally, it can affect the brain, which causes atrophy and encephalopathy, which can cause symptoms like ataxia, confusion, and even death. In addition to these complications, there’s also something known as refeeding syndrome where refeeding stimulates secretion of insulin, which causes cells to take in already low levels of potassium, magnesium, and phosphate, which causes levels in the serum to be dangerously
• 05:00 - 05:30 low, and these deficits in electrolytes can lead to severe heart arrhythmias and even cardiac death. This is why patients with anorexia typically get an exhaustive medical workup and are carefully monitored with ECGs as they are slowly refed and brought back up to a healthy weight. Pinpointing the exact cause of anorexia is tough right? Because it’s likely a complex interaction of various factors like genetic and hormonal factors, for example abnormalities in the signals that convey information about hunger
• 05:30 - 06:00 and fullness, as well as social/environmental factors like peer groups and popular culture. In addition, anorexia is associated with low self-esteem, loneliness, sensitivity to peer pressure, and feeling a need for approval. Individuals with anorexia might also chronically over-react to stressful situations, and they might exhibit perfectionist behavior, and might feel the need to have control of specific parts of their life—like their weight. There are also higher rates of anorexia in countries where thinness is valued, which
• 06:00 - 06:30 could reflect an internalization of societal standards of beauty. Anorexia typically starts in the teen years or in young adulthood—a time when individuals usually start to pay attention to the media, and rates of anorexia are higher for individuals who have higher exposure to media. Also, although anorexia is more common in women, it’s worth mentioning that men suffer from anorexia as well, and in both genders it can often be seen among athletes and professionals
• 06:30 - 07:00 who are keenly focused on their body weight and percent body fat, such as in some types of dancing, modeling, and wrestling. Finally, anorexia is also commonly associated with other conditions like obsessive-compulsive disorder, depression, and anxiety, all of which have overlapping symptoms and risk factors. As far as treatments go, medical treatment with careful weight gain is important, there is an important role for psychotherapy and cognitive behavioral therapy for both the
• 07:00 - 07:30 individual and sometimes the family as well. These therapies focus on improving self-esteem and teaching strategies to better cope with stress and social pressures, as well as identify the patterns of thought that may be influencing their illness. So we’ve seen that anorexia can affect nearly every body system in profound ways, but careful management and treatment and ultimately a healthy pattern of eating can reverse a lot of these complications and issues associated with anorexia.