Anorexia Nervosa

Question 1

History: Anorexia Nervosa (AN)

Answer 1

Early descriptions evident in medieval times - “Green sickness”
1870s: considered it as a loss of appetite due to mental illness

Question 2

Diagnostic Criteria for AN

Subtypes?

Severity levels?

Prevalence?

Answer 2

A. Restriction of energy intake leading to significantly low body weight in context of age, developmental trajectory and physical health

B. Intense fear of gaining weight or persistent behaviour that interferes with weight gain

C. Disturbance on the way on’es body weight/shape s experienced, undue influence of body weight or shape on self-evaltuation, or persistent lack of recogntion of its seriousness

Periods of starvation reduce responsiveness of psychosocial treatment due to brain being starved

Restricting type: During the last 3 months, the individual has not engaged in recurrent binge eating or purging. This subtype described presentations in whch weight loss is accomplished primarily through dieting, fasting and/or excessive exercise.

Binge-eating/purging type: During last 3 months, engaged in recurrent binge eating or purging (use of laxatives, diuretics, or enemas)

Severity levels are detemrined by BMI (Mild-Moderate-Severe-Extreme)

Prevalence:
4% of AUS population have an eating disorder
.5% have AN
More prevalent in women (10:1 ratio)
Onset typical in adolescence

Question 3

Treatment for AN?

Answer 3

Must monitor for refeeding syndrome

Child/adolescent: FBT - Under 19 years of age <3 years illness duration
Parents take charge of child recovery in the home setting
Phase 1 - intense refeeding
Phase 2 - Transition to adolescent control (fortnightly)
Phase 3 - Adolescent issues

Adult
1. CBT-E Variation of CBT, helps identify and modify thinking patterns and unhelpful behaviours around exercise, diet, weight and shape, possibly perfectionism

2. Specialist supportive Clinical management (SSCM)
   - Psychoeducation
   - Encourages normal eating patterns and weight restoration
   - Collaborative goal setting
   - Supportive counselling
   - Still limited evidence base
   - Both have adaptations for SE-AN which focus on improving QoL and weight recovery being a secondary priority