Mental Anorexia Study Handouts

MENTAL ANOREXIA It is always very difficult, even illusory, to define any psychiatric condition in a few words. With this reservation, we can consider anorexia nervosa as a refusal to eat linked to a disturbance in the perception of body image. Epidemiology Impact-It has increased in recent decades, particularly among subjects considered to be at risk (ballet dancers, models). The annual incidence is approximately 14.6/100,000 in girls, 1.8/100,000 in boys. Prevalence-It is around 1% in women. Age at diagnosis-Anorexia nervosa mainly affects women between the ages of 12 and 24, with two frequency peaks around 13-14 years and 16-17 years. It is rare after 40 years. Sex ratio-It is very disadvantageous to women (10 to 1). Ethnic factors-White women are much more affected than Asian or black women. Socio-economic factors-The disease is more common in middle or high socioeconomic classes. The prevalence of anorexia nervosa is also approximately 10 times greater among girls aged 16 to 18 attending a private school than among those of the same age attending a public school. Etiology The exact etiology of anorexia nervosa is unknown (individual or family psychopathology? Biological mechanism linked to serotonin, catecholamines or neuropeptides?), but some findings are of indisputable importance: - anorexia nervosa is very rare in situations of genuine food shortage; numerous studies demonstrate the impact of the cult of thinness on young girls: research carried out among 1,800 18-year-old girls with normal weight and height revealed that 80% of them want to lose weight, 23% follow diet, 15% have bulimic episodes, 8.2% vomit from time to time and 2.4% take “diet pills”. - genetic factors are involved (higher concordance in homozygous twins than in heterozygotes), but not identified. Diagnostic The diagnosis of anorexia nervosa is classically based on the triad of weight loss-anorexia-amenorrhea, to which is added a certain number of specific psychological attitudes. Weight loss-It can be very significant, up to 50% of normal weight depending on age. The appearance is very evocative: melting of superficial and deep fat reserves (effacement of female forms: breasts, hips, buttocks), muscle wasting, dry and dull hair (even alopecia), ridged and brittle nails, hypertrichosis with appearance of lanugo, circulatory disorders (low blood pressure, bradycardia, cold and clammy extremities), constipation, enlarged salivary glands making a round face which contrasts with the thinness of the rest of the body. The diagnosis of anorexia nervosa typically requires that the weight be less than or equal to 85% of the weight considered normal. Anorexia-It is established under the pretext of a diet and is associated with a whole ritual regarding food: collection of recipes, sorting of foods according to personal criteria, endless chewing, merycism, potomania (the latter two being considered as gravity factors). Amenorrhea-It is constant (either primary if the girl had never been menstruated before, or secondary otherwise), usually coincides with the start of food restriction and readily persists for some time after weight rebalancing. The amenorrhea of anorexia nervosa is said to be spontaneous (i.e. it disappears after administration of estrogens) and must, according to some, be observed over at least 3 successive cycles. Sexuality-She is completely disinvested, both physiologically and in her dimension of desire (the anorexic does not masturbate). On the other hand, seductive behaviors are not rare (control dimension), as well as a tendency towards voyeurism/exhibitionism. Intellect-Intellectual overinvestment is classic, but the results are better for learning than for creativity. Restrictive type or with hyperphagic attacks?-Anorexia nervosa and bulimia are two distinct pathologies, but they nevertheless have some common characteristics. It is therefore appropriate to specify the type of anorexia: - restrictive type: during the period of anorexia nervosa, the subject has not, on a regular basis, experienced hyperphagic attacks nor resorted to induced vomiting or - the abuse of purgatives (laxatives, diuretics or enemas); type with hyperphagic attacks: during the period of anorexia nervosa, the subject has regularly experienced hyperphagic attacks and/or resorted to induced vomiting or the abuse of purgatives (laxatives, diuretics or enemas).