Anorexia Nervosa
• It is usually seen in girls during puberty.
• The main feature is to feel fat and to lose weight by dieting.
• Body mass index is significantly lower. It is below the expected healthy values.
• Excessive mental preoccupation with body weight and shape, excessive fear of gaining weight, and a strong desire to be thin.
• Amenorrhea is very common in women. However, it was excluded from the diagnostic criteria in DSM S.
Clinical Symptoms
The patients' body image may be distorted and the person believes that he/she is too fat even though he/she is extremely thin.
It has two subtypes:
Restrictive type: They only apply an overly restricted regime.
Bulimic type: In addition to the restricted regimen, there may be episodes of binge/self-vomiting from time to time. The difference from bulimia nervosa is that the body weight is lower than the healthy value it should be.
leptin
In addition to being an anti-obesity hormone, it has an important role in the regulation of several physiological processes activated by the fasting state. In the acute phase of anorexia nervosa, leptin concentrations are lower in serum and CSF compared to healthy controls.
Prognosis
Approximately 1/5 of the patients recover completely, in 1/5 the disease continues by maintaining its severity, while the remaining 3/5 progresses with partial improvement with fluctuations in the form of chronicity or exacerbation-recovery.
18% mortality is seen. It is the most deadly of mental disorders.
Treatment
Psychosocial approaches are at the forefront of treatment.
The effectiveness of antidepressants drugs is not clear. They are more beneficial for the treatment of comorbid mental disorders.
Bulimia Nervosa
• Follows up with compensatory behaviors (eg, vomiting oneself) to prevent binge eating and subsequent weight gain in attacks.
• Loss of control against eating is very evident in patients.
• Patients are usually normal or overweight.
• Large amounts of food are consumed during episodes, with calorie intake above 2000; for example, a pot of pasta, a whole cake, a packet of biscuits, a box of jam.
• Initially, there is relief from the feeling of tension; but this relief is soon followed by guilt and self-hatred, disgust and regret.
• As a result, behaviors such as forcing oneself to vomit and taking laxatives are observed.
• Depressive symptoms are more intense than anorexia nervosa and probably develop secondary to an eating disorder.
• Major depression is detected in the majority of patients (36-70%).
• As the eating disorder improves, depressive symptoms disappear.
• Selective serotonin reuptake inhibitors are used together with psychotherapy in the treatment.