Eating Disorders: Anorexia nervosa - Symptoms and Signs

 Eating Disorders are defined as a group of abnormal eating habits associated to a person preoccupation weight, involving either insufficient or excessive food intake.
Anorexia nervosa
Anorexia nervosa is a type of eating disorder usually develop in the teen years and effect over 90% of female, because of excessive food restriction and irrational fear to become fat due the wrongly influenced media as attractiveness is equated to thinness.

II. Symptoms and signs
A. Most common symptoms
1. Weight loss, sometime severe as a result of malnutrition.

2.  Refusal to maintain a normal or minimally above normal body mass index for their age and Dieting despite being thin or dangerously underweight
Dr. Evelyn Attia and B. Timothy Walsh, in the article of Anorexia Nervosa indicated that Anorexia nervosa is a serious mental illness characterized by the maintenance of an inappropriately low body weight, a relentless pursuit of thinness, and distorted cognition about body shape and weight(1).

3. Intense fear of gaining weight and primary or secondary amenorrhea
In the study Eating disorders. A review and update by Haller E. at the University of California indicated  Anorexia nervosa is diagnosed when a person refuses to maintain his or her body weight over a minimal normal weight for age and height, such as 15% below that expected, has an intense fear of gaining weight, has a disturbed body image, and, in women, has primary or secondary amenorrhea(2).

4. Obsession with calories and fat content of food and and try to avoid eating altogether. They deny hunger and will usually avoid eating around others as well as avoiding situations where food might be present(3).

5. Disturbance to body image the person hold of him/herself
In the study of  Eating disorders. A review and update, Dr E Haller indicated that , Anorexia nervosa is diagnosed when a person refuses to maintain his or her body weight over a minimal normal weight for age and height, such as 15% below that expected, has an intense fear of gaining weight, has a disturbed body image, and, in women, has primary or secondary amenorrhea(4).


8. Becomes intolerant to cold and frequently complains of being cold due to fat loss as a result of malnutrition(9)

9. Swelling cheek
Swelling cheek is considered Gradual onset of anorexia due to  enlargement of the salivary glands caused by excessive vomiting

10. Abdominal pain and distention
Anorexia nervosa is also associated abdominal and with  a sensation of elevated abdominal pressure and volume. There is a report of a 26-year-old female with anorexia nervosa binge/purge subtype, who presented with abdominal pain and nausea after a binge episode. Abdominal radiography and computed tomography showed a grossly dilated stomach measuring 32 cm × 17.9 cm consistent with acute gastric dilatation. She underwent exploratory laparotomy with gastrotomy and gastric decompression, and recovered uneventfully. Initially, the patient denied the binge episode, as many patients with eating disorders do, but later revealed an extensive history of anorexia nervosa binge/purge subtype. This case stresses the importance of obtaining a thorough history of eating disorders and maintaining a high index of suspicion for acute gastric dilatation in young women who present with abdominal pain and distention(5).

11. Bad breath
The associated of  bad breath and Anorexia nervosa are of the result of from vomiting or starvation-induced ketosis. In the study of Maintaining women's oral health, Dr. McCann AL and Dr. Bonci L. stated that adolescent women are more prone to gingivitis and aphthous ulcers when they begin their menstrual cycles and need advice about cessation of tobacco use, mouth protection during athletic activities, cleaning orthodontic appliances, developing good dietary habits, and avoiding eating disorders(6).

12. Swollen joints
There is a case of anorexia for the past 10 years have never experienced swollen joints, but now that too is becoming a problem and is explained as Electrolyte Imbalances(7)

13.  Lanugo hair

In the study of  Dr. Judith M. E. Walsh and the research team posted in the Journal of General Internal Medicine, indicated that detection requires awareness of risk factors for, and symptoms and signs of, anorexia nervosa (e.g., participation in activities valuing thinness, family history of an eating disorder, amenorrhea, lanugo hair)(8)

14. Etc.

B. Secondary symptoms
1. Leg pain, fatigue and general weakness
Anorexia nervosa is a disease with high prevalence in adolescents and carries the highest mortality of any psychiatric disorder, but there is a case of a 52-year old woman with longstanding anorexia nervosa was hospitalized due to progressive leg pain, weakness, and fatigue accompanied by marked weight loss. On physical examination she was cachectic but in no apparent distress. She had fine lanugo-type hair over her face and arms with an erythematous rash noted on her palms and left lower extremity.(9)

2. Depression and anxiety
Depression, anxiety and obsessive-compulsive disorder (OCD) frequently co-occur with Anorexia Nervosa (AN). In the review of all the studies done to investigate psychological factors in relation to malnutrition in AN using the keywords "Anorexia Nervosa", "depression", "anxiety", "obsessive-compulsive disorder" and "malnutrition". Only articles published between 1980 and 2010 in English or French were reviewed. From the articles on AN and depression, anxiety, and/or OCD, only the ones which investigated on the relation with malnutrition were kept(10).

3. Sleep disorder
Night eating is linked with a reduced consciousness and sleep disorders, mainly somnambulism. Patients never experience hunger, abdominal pain, nausea or hypoglycemia. Night-eating takes place invariant across weekdays, weekend and vacations. Patients consumed high caloric foods and fluids but never alcohol and purging does not occur. Diurnal bulimia is frequently associated with the sleep-related eating disorder(11)

5. Etc.
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Sources
(1) http://ajp.psychiatryonline.org/article.aspx?articleID=99258
(2) http://www.ncbi.nlm.nih.gov/pubmed/1475950
(3) http://drsandie.com/Eating.html
(4) http://www.ncbi.nlm.nih.gov/pubmed/1475950
(5) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966577/
(6) http://www.ncbi.nlm.nih.gov/pubmed/11486666
(7) http://answers.yahoo.com/question/index?qid=20100712185150AAciPvv
(8) http://www.springerlink.com/content/f7m6m410h608g046/
(9) http://www.ncbi.nlm.nih.gov/pubmed/15257758
(10) http://www.ncbi.nlm.nih.gov/pubmed/20920829 
(11) http://www.ncbi.nlm.nih.gov/pubmed/11760692