Anorexia Nervosa (AN)

Approx 1 in 100 adolescent girls 3rd most common chronic illness for adolescent girls in Australia (after obesity and asthma) 10 x more females than males onset usually ~ 16-17 yrs old

Anorexia Nervosa is characterized by an inability to maintain a minimally normal body weight. Aetiology Multifactorial, causes may include a collection of the following: Genetic predisposition shown by twin studies History of feeding disturbances in infancy Disturbances in motherchild relationship, individual needs are subverted to what the mother thinks is appropriate, patient is slavishly compliant, no self-respecting identity Family psychopathology displaced onto patient Social influences and expectations set a climate conducive to the development of eating disorders Cultural obsession with thinness and emphasis on low-fat diets and exercise, reinforce the relentless pursuit of thinness

Various changes associated with the development of Anorexia Nervosa: Physical Changes: - Amenorrhoea - Dry skin, Laguno hair - Hypotension, bradycardia, dizziness - Hypersensitivity to light & noise - Fatigue, reduced strength, poor motor control - Hypothermia, decreased tolerance for cold - Oedema, polyuria and disturbed body chemistry Disturbances in psychological function include: - Disturbance of body image of delusional proportions. - Disturbance in the accuracy of perception or cognitive interpretation of stimuli occurring within the body, with failure to recognise signs of nutritional need. - A paralysing sense of ineffectiveness pervading all thinking and activities. - Act only in response to demands of others Cognitive Impairment in: - Concentration - Judgement - Alertness - Comprehension More generally,

Depression and apathy Anxiety Irritability, mood swings Obsessional thinking and increased perfectionism Anger often covert

Treatment :
Three Pronged Approach 1. Stabilise physical status 2. Nutritional prescription and counselling 3. Psychosocial Interventions 4 main principles of correctional therapy: 1. Assist patient in realising that they need help and to maintain their motivation to improve thereafter due to their reluctance to change, this is crucial 2. Weight restoration reversal of malnutrition via managed feeding (can be done in outpatient, day-patient or inpatient basis according to circumstances surrounding the problem) 3. Address patients over-evaluation of their weight and shape, eating habits and general psychosocial functioning usually achieved through family-based therapy in adolescents; cognitive behavioural therapy (CBT) may be employed as an alternative for older sufferers 4. Enforcement of compulsory treatment should only be used in the most extreme cases (not applicable to majority of patients) At present, there are no drugs effective in treating anorexia in promoting weight gain