Psychiatry – Anorexia Nervosa: By Megen Vo M.D. & Sara Buckelew M.D.

Psychiatry – Anorexia Nervosa: By Megen Vo M.D. & Sara Buckelew M.D.


The DSM-5 diagnostic criteria for Anorexia
include: Restriction of energy intake resulting in
significantly low body weight, taking into context the individual patient’s age, sex,
and previous growth trajectory. There is intentionally no strict cutoff for
“significantly low weight”, meaning your clinical judgment is important. Some adult studies use 17kg/m2 or 18.5kg/m2. An intense fear of gaining weight or being
fat, or persistent behaviour that interferes with weight gain. A disturbance in the way the patient experiences
their own weight or shape, or excessive influence of weight or shape in self-evaluation, or
a lack of recognition of the seriousness of their current low weight. Anorexia nervosa can be categorized into either
restricting caloric intake, or binging and purging. Purging can refer to vomiting, or using diuretics
or laxatives to prevent weight gain. Get a history of the patient’s highest and
lowest weights, a diet history, exercise history, and assess for other psychological or psychiatric
symptoms such as anxiety, depression, suicidal ideation, and substance use. Physical signs primarily result from malnutrition,
which can affect all organ symptoms. When doing a physical exam, pay attention
to vital signs, as you may see bradycardia, orthostatic heart rate and blood pressure
changes, and/or hypothermia. Plot the patient’s height, weight, and BMI
and compare to their historical growth curves to help determine the degree of malnutrition. Other exam signs include: Evaluate mucous membranes for dehydration
and teeth for dental erosion from vomiting; Look for bradycardia and arrhythmias;
Look for masses or organomegaly; it is very common to have hypoactive bowel sounds and
constipation with malnutrition; Lanugo, Russell’s sign, which is callousing
of the dorsal hand/fingers from self-induced vomiting, and signs of self-injurious behaviour;
GU: Tanner staging; Complete fundoscopic exam, as elevated ICP
can cause loss of appetite. Treatment should include medical monitoring,
nutrition counselling, and psychological support. In cases of severe malnutrition, inpatient
admission for medical stabilization may be necessary. Criteria for admission include weight

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