Anorexia nervosa: symptoms and features Flashcards
(8 cards)
Three key symptoms (A01)
1) Restriction of energy intake
-Significantly low body weight for age, sex, though the DSM-5 does not specify how low.
2) Fear of weight gain/ Interfering behaviours
- ‘Intense fear of gaining weight or becoming fat’ (DSM-5)
-May behave in ways to prevent gaining weight (not just avoiding fattening foods)
- ICD-10 includes self-induced vomiting and/ or purging, excessive exercise, using appetite suppressants etc.
3) Disturbed experience of body weight/shape
-Cognitive element, ICD-10 calls it ‘body-image distortion
-weight and/or shape has disproportionate influence on self-evaluation
-May fail to recognise how serious their low body weight is
Subtypes
Restricting subtype - no bingeing or purging in three months before diagnosis ,weight loss is achieved through dieting and/or excessive exercise.
Binge-eating/purging subtype - Bingeing and/or purging in the previous three months
Severity
The DSM-5 also allows for assessment of severity in terms of BMI.
Categories of AN are:
Mild - (BMI>17)
Moderate - (16-16.99)
Severe - (15-15.99)
Extreme- (BMI<15)
Features of AN
-Lifetime prevalence rate for females, 1.7- 3.6% (0.1% in males)
-Incidence in 16-20 year age group, 6.05 new cases per 10,000 every year, female incidence much higher than male.
-Prognosis- six times as many deaths expected for females with AN
-Being younger and staying longer in hospital during first hospitalisation predicts better outcomes
A strength is evidence that diagnosis of AN using DMS-5 is reliable
Sysko et al assesed participants by telephone interview using the DSM-5 criteria for AN, and repeated this with a different assessor a few days later.
The extent of agreement across the two occasions (test-retest reliability) was described by the researchers as ‘excellent’
This suggests that trained assessors can reliably diagnose AN using the DSM-5 criteria
Competing argument
However, this finding does not necessarily support the view that DSM-5 criteria for AN are reliable. Thomas et al point out that many studies go beyond the DSM-5 criteria in operationally defining AN.
For instance, many use a researcher-defined cut-off point for ‘significantly low weight’ because none is specified in the DSM-5. This means reliability estimates in research studies are higher than they would be in real-life clinical practice (because it is easier to achieve agreement between raters when criteria are defined in detail).
A weakness is that the DSM-5s severity ratings may lack validity
Smith et al looked at the validity of the four severity specifiers
In 109 adults diagnosed with AN, higher BMI (low severity) was linked to greater eating disorder psychopathology - the opposite of the expected outcome.
This is an issue for the DSM-5 severity specifiers, as they fail to distinguish accurately between people and therefore lack validity.
Case studies for AN
CAROL- is a typical 16-year old in most ways but she has AN. She almost always makes some reference to her body size and shape when she talks about herself. She pays a lot of attention to details, and this includes her weight which she is always ‘keeping an eye on’ She avoids ‘fatty foods’. But this includes foods she knows are goos for her but ‘make her feel fat’. She frequently skips meals, eating rice cakes to fill her up and continuing to lose weight. She doesn’t see It but CAROL is actually really thin. Her friends tell her she is too skinny but she takes no notice and thinks they are just ‘jealous’ Her hair is falling out, she bruises easily and has no energy.
JOAN developed anorexia when she was 29 years old. She lived with her parents after her marriage broke up, and they looked after her and her son Charlie. This made JOAN feel more like charlies sister than his mum. After a disastrous relationship with an alcoholic JOAN started a strict diet to lose some weight. She has a cup of coffee with a muffin during the day and then very little for dinner with her parents. She regularly use laxatives after eating. She still thought about food constantly, and would cook elaborate meals for the family. JOAN weighed just 45 kilos but still felt overweight and developed an overwhelming fear of getting fat. She still felt her weight was the only thing in her life she could control.
