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Anorexia nervosa – AN is a disease syndrome consisting in deliberately restricting food intake in order to achieve a slim body shape with gradually increasing weight loss. Anorexia is accompanied by a disturbed self-assessment of the body.
Anorexia nervosa – diagnosis and symptoms
Currently, the diagnosis of AN is based on the criteria established by the American Psychiatric Association and included in the fourth version of the Diagnostic Criteria (DSM-IV-TR) in 2000 [6]. According to this classification, the diagnosis of AN is based on the following symptoms:
- Refusal to maintain weight at or below the minimum value for age and height (i.e. weight loss leading to less than 85% of the ideal weight), or failure to gain weight while growing, leading to weight less than 85% of the ideal weight.
- Strong fear of weight gain or obesity despite weight deficiency.
- Disturbances in the perception of one’s own body, its shape or size; excessive influence of body weight or shape on self-esteem; denying or downplaying the importance of your low body weight.
- Amenorrhea – in menstruating women, the absence of at least three consecutive menstrual cycles (also when menstruation occurs only after administration of hormonal drugs).
According to the DSM -IV -TR, there are two subtypes of AN:
1. Restrictive type – without regular bouts of bulimia and cleansing behavior (vomiting, overuse of laxatives and / or diuretics).
2. Bulimic-cleansing type – with regular bouts of gluttony and cleansing behavior. AN is significantly more common in girls. Only about 1-2% of patients with this diagnosis are boys. The prevalence of this disease in the population of girls in adolescence and young women is estimated at 0,3-1% [7].
Anorexia nervosa – Causes
It is still unknown why, out of the very large number of dieters, only some of them suffer from anorexia nervosa. Attempts to look for a single causal factor have been largely abandoned. In considering the etiology of anorexia nervosa, both biological, psychological, family and social elements are taken into account. The combination of these factors constitutes the predisposition to develop anorexia nervosa.
Anorexia nervosa – An image of the disease
The basic picture of anorexia nervosa is included in the DSM-IV diagnostic criteria. The fear of obesity should be considered the axial symptom of this disease. The desire to be slim is for the patient an idea of over value, to which he is able to subordinate all his activities. From my own observations, however, it seems that the dominant feature of anorexics is not so much being thin as the constant desire to be even thinner; at the moment of achieving the originally intended body weight, the patient immediately begins to achieve even lower body weight. The very process of weight loss is the primary driving force behind their operation; a process by which they become self-satisfied and improve their self-esteem.
Patients maintain good mental fitness for a relatively long time and show enormous physical activity, despite increasing exhaustion. Most of the symptoms of anorexia nervosa are considered to be the effects of starvation, weight loss and the body’s adaptation to caloric deficiency.
Rybakowa (1993) divided the development of the disease into three phases depending on the clinical and psychological symptoms.
- Phase I
- Clinical signs: menstrual arrest and weight loss.
- Mental symptoms: agitation, increased activity, insomnia, anxiety, reluctance to eat.
- Phase II
- Clinical symptoms: progressive weight loss, constipation, oliguria, decreased muscle strength, chilling.
- Psychological symptoms: increased fatigue, emotional lability, running away from the environment, anorexia
- Phase III
- Clinical symptoms: cachexia, low blood pressure, slow heart rate, peripheral edema, vomiting.
- Mental symptoms: depression, apathy, catatonia.
- Clinical signs: menstrual arrest and weight loss.
- Mental symptoms: agitation, increased activity, insomnia, anxiety, reluctance to eat.
- Clinical symptoms: progressive weight loss, constipation, oliguria, decreased muscle strength, chilling.
- Psychological symptoms: increased fatigue, emotional lability, running away from the environment, anorexia
- Clinical symptoms: cachexia, low blood pressure, slow heart rate, peripheral edema, vomiting.
- Mental symptoms: depression, apathy, catatonia.
Source: A. Cajdler-Łuba, S. Mikosiński, A. Sobieszczańska-Jabłońska, I. Nadel, I. Salata, A. Lewiński: “FUNCTIONAL DIAGNOSTICS OF HORMONAL DISORDERS WITH ELEMENTS OF DIFFERENTIAL DIAGNOSTICS; Czelej Publishing House