psychiatric disorders
Anorexia Nervosa
Symptoms and Signs of Anorexia Nervosa
Anorexia nervosa may be mild and transient or severe and persistent. Even though underweight, most patients are concerned that they weigh too much or that specific body areas (eg, thighs, buttocks) are too fat. They persist in efforts to lose weight despite reassurances and warnings from friends and family members that they are thin or even significantly underweight, and they view any weight gain as an unacceptable failure of self-control. Preoccupation with and anxiety about weight increase even as emaciation develops. Anorexia is a misnomer because appetite often remains until patients become significantly cachectic. Patients are preoccupied with food: They may study diets and calories. They may hoard, conceal, and waste food. They may collect recipes. They may prepare elaborate meals for other people. Patients often exaggerate their food intake and conceal behavior, such as induced vomiting. Binge eating/purging occurs in 30 to 50% of patients. The others simply restrict their food intake. Many patients with anorexia nervosa also exercise excessively to control weight. Even patients who are cachectic tend to remain very active (including pursuing vigorous exercise programs). Reports of bloating, abdominal distress, and constipation are common. Most women with anorexia nervosa stop having menstrual periods. Patients usually lose interest in sex. Depressive Disorders occurs frequently. Common physical findings include bradycardia, low blood pressure, hypothermia, lanugo hair (soft, fine hair usually found only on neonates) or slight hirsutism, and edema. Body fat is greatly reduced. Patients who vomit frequently may have eroded dental enamel, painless salivary gland enlargement, and/or an inflamed esophagus. 