Introduction
Anorexia nervosa is the most common cause of admissions to child and adolescent psychiatric wards.
Epidemiology
- Incidence: 37.00 cases per 100,000 person-years
- Peak incidence: 20-30 years
- Sex ratio: more common in females 5:1
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Clinical features
Anorexia nervosa is associated with a number of characteristic clinical signs and physiological abnormalities which are summarised below
Features
Physiological abnormalities
Features
- reduced body mass index
- bradycardia
- hypotension
- enlarged salivary glands
Physiological abnormalities
- hypokalaemia
- low FSH, LH, oestrogens and testosterone
- raised cortisol and growth hormone
- impaired glucose tolerance
- hypercholesterolaemia
- hypercarotinaemia
- low T3
Diagnosis
Diagnosis is now based on the DSM 5 criteria. Note that BMI and amenorrhoea are no longer specifically mentioned:
- 1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- 2. Intense fear of gaining weight or becoming fat, even though underweight.
- 3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Management
For adults with anorexia nervosa, NICE recommend we consider one of:
- individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
- Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
- specialist supportive clinical management (SSCM).
In children and young people, NICE recommend 'anorexia focused family therapy' as the first-line treatment. The second-line treatment is cognitive behavioural therapy.
- individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
- Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
- specialist supportive clinical management (SSCM).
In children and young people, NICE recommend 'anorexia focused family therapy' as the first-line treatment. The second-line treatment is cognitive behavioural therapy.
Prognosis
The prognosis of patients with anorexia nervosa remains poor. Up to 10% of patients will eventually die because of the disorder.