Diagnostic Criteria For Anorexia Nervosa Research Articles

Eating Disorders in Adolescents with Cystic Fibrosis

Nutritional disorders and delayed physiological maturation are commonly seen in patients with cystic fibrosis. In our consultation work with a pediatric pulmonary service, we identified a series of 13 adolescents with cystic fibrosis and an atypical eating disorder. They did not fully meet the diagnostic criteria for anorexia nervosa, but they demonstrated marked weight loss, food avoidance, amenorrhea, and body image and bodily function distortions in the face of either normal gastrointestinal function or adequate pancreatic enzyme replacement therapy. They also demonstrated significant depressive symptomatology associated with their eating disorder. We review the presenting characteristics of these patients and the case histories of two adolescent girls with this syndrome. The psychosocial literature on cystic fibrosis is briefly reviewed with a focus on factors associated with cystic fibrosis that may predispose patients to the development of eating disorders. The authors also hypothesize that adolescents with other chronic illnesses may likewise be vulnerable to the development of eating disorders.

Progress in the diagnosis of anorexia nervosa

CURRENTLY ACCEPTED diagnostic criteria for anorexia nervosa are unduly rigorous and their use counterproductive since they recognise the disorder only in its most severe forms. More flexible alternative diagnostic criteria encourage anorexia nervosa diagnosis in the early stages of the disorder when intervention is more likely to be fruitful. The Eating Attitudes Test (EAT 26) offers a convenient and reliable method for assessing the psychological com ponent of this complex disorder of psyche and soma.

Definition of a gastric emptying abnormality in patients with anorexia nervosa.

Upper gastrointestinal symptoms may be prominent in anorexia nervosa. This study is an investigation of the gastric emptying of solid and liquid meal components in 16 female patients (mean age 20.0 years, range 14-40 years) who met accepted psychiatric diagnostic criteria for anorexia nervosa. The results were compared with those of gastric emptying studies in 10 normal females of ideal body weight (mean age 25.4 years, range 20-35), 13 normal persons (12 males), and six patients (mean age 12 years, range 9-14 years) with weight loss (less than 90 percent ideal body weight) secondary to Crohn's disease with no psychiatric symptoms. A dual-isotope technique using chicken liver intracellularly labeled with technetium-99m (99mTc) bound to sulfur colloid as the solid-phase marker, and indium-111 (111In) -labeled water as the liquid-phase marker was used. Gastric emptying was monitored for 2 hr by gamma camera. In 13 of the 16 anorexia nervosa patients (80%), gastric emptying of solids was slower than the range in the two groups of normal subjects, and mean gastric emptying was significantly slower (P less than 0.05) than in the weight-loss patients. Liquid emptying (water) in anorexia nervosa was normal and similar to the control groups studied. In 11 of the anorexia nervosa patients with delayed gastric emptying, intramuscular metoclopramide, 10 mg, significantly (P less than 0.05) accelerated the mean gastric emptying from 60 through 120 min after the meal. We conclude that in anorexia nervosa patients who are symptomatic and seeking medical care: gastric emptying of solids is significantly delayed when compared with female subjects of similar age and normal body weight and with patients of less than 90% ideal body weight but without psychiatric disorder; these data are consistent with an antral motility disturbance, either primary or secondary; and metoclopramide, a gastric prokinetic agent, accelerates (delayed) gastric emptying.

Body Image Disturbance, An Issue Of Anorexia Nervosa

Opposing views as to the validity of body image disturbance as a diagnostic criterion for anorexia nervosa are discussed in relation to diagnosis, prognosis, and the treatment mode. The various methods used to assess body image disturbance are examined and a recommendation that the occupational therapy literature should be investigated to enable a proposal for treatment of the more severe instances of anorexia nervosa.

The clinical features of bulimia nervosa.

The clinical features of 35 patients with bulimia nervosa are described. All the patients came from the Oxford area and each fulfilled conservative operational diagnostic criteria. Standardised assessment procedures were used including a structured interview designed to assess the psychopathology characteristic of patients with eating disorders. It was confirmed that these patients have grossly disturbed eating habits accompanied by morbid beliefs and values concerning their shape and weight. Although the majority had a weight within the normal range, a history of weight disturbance was common. There was a high degree of psychiatric morbidity with depressive symptoms being particularly prominent. A quarter of the sample had previously fulfilled diagnostic criteria for anorexia nervosa, and this group closely resembled those patients with no such history.

Excessive weight loss in the athletic adolescent: A diagnostic dilemma

Differentiating anorexia nervosa (AN) from excessive weight loss in the otherwise healthy, athletic adolescent may be difficult. We report the maximal work capacity, hormonal secretory patterns, and psychological assessment of a 14-year-old male runner who induced excessive weight loss and partially recovered. At 17% below previous body weight (28% below ideal weight for height), he had significant resting bradycardia (38 bmp), low maximal heart rate (167 bpm), depressed VO2 max, and prepubertal 24-hour LH and testosterone secretory patterns in the presence of late pubertal genital development. The diagnostic dilemma of excess weight loss due to food aversion in the normal athlete versus anorexia nervosa with running as a symptom was resolved by psychiatric evaluation. A disturbed body image, marked feelings of inadequacy, and depression were discovered, which are findings consistent with AN. Diagnostic criteria of AN and the possible implications of a subnormal maximal heart rate are reviewed.

Self-induced vomiting and bulimia nervosa: an undetected problem.

Six hundred and twenty women who were currently practising self-induced vomiting to control their weight were identified with the help of a women's magazine. Nineteen women (3.1%) fulfilled diagnostic criteria for anorexia nervosa. Of the remainder, 499 (83.0%) fulfilled diagnostic criteria for bulimia nervosa, a recently described eating disorder. Of these, 56.1% practised self-induced vomiting at least once daily; the mean duration of vomiting was 4.5 years. Most women were of normal body weight. On standardised measures, 68.1% of women showed pronounced psychiatric morbidity and 89% had profoundly disturbed attitudes to food and eating. 56.4% thought they definitely needed medical help, though only 30.1% had ever discussed any aspect of their eating difficulties with a doctor. This study highlights the secrecy that surrounds bulimia nervosa and suggests that it is an important undetected source of psychiatric morbidity.

Subclinical anorexia nervosa.

The Eating Attitudes Test (Garner & Garfinkel, 1979) was administered to 578 students (446 females and 132 males) at a College of Technology and to 14 "control" subjects fulfilling strict diagnostic criteria for anorexia nervosa. Although no male students scored highly, a total of 28 female students (6.3% of the female student sample) scored in the "anorexic" range. These "high scorers", together with a random control group of 28 "non-high scorers", were subsequently interviewed. Interview revealed that the symptoms of anorexia nervosa were common in the high scoring group but virtually absent in the student control group. It is concluded that a substantial proportion of post-pubertal females (approximately 5%) develop a subclinical form of anorexia nervosa. The implications of these findings are discussed in relation to the aetiology, prevention and treatment of disturbances in eating behaviour.

Cyproheptadine in Anorexia Nervosa

In three hospitals 81 female patients satisfying rigorous diagnostic criteria for anorexia nervosa were randomly allocated to one of four treatment combinations of cyproheptadine and placebo with behaviour therapy and no behaviour therapy. Cyproheptadine was found to be effective in inducing weight gain in a subgroup of anorexia nervosa patients who (a) had a history of birth delivery complications, (b) had lost 41-52 per cent weight from norm and (c) had a history of prior outpatient treatment failure. This subgroup may represent a more severe form of anorexia nervosa.

Diagnosis of Anorexia Nervosa: A Critical Reappraisal

Diagnostic criteria for anorexia nervosa developed from our clinical experience are compared with those of two other groups, chosen as accepted and representative investigators. The three sets of criteria were applied to 30 successive patients admitted to the Psychosomatic Unit with the presumptive diagnosis of anorexia nervosa. Considerable variation was found in the percentage of patients diagnosed anorexia nervosa by each set of criteria. The discussion focuses on the inclusiveness of the three sets of criteria, anorexia nervosa as a developmental deviation of adolescence, and out concept of the essential psychopathology which differs from that of other investigators.

Nocturnal hormonal profiles in massive obesity, anorexia nervosa and normal females

Eating disorders (EDs) are severe, life-threatening mental illnesses characterized by marked disturbances in body image and eating patterns. Attempts to understand the neurobiological basis of EDs have been hindered by the perception that EDs are primarily socially reinforced behaviors and not the result of a pathophysiologic process. This view is reflected by the diagnostic criteria of anorexia nervosa and bulimia nervosa, which emphasize intrapsychic conflicts such as “inability to maintain body weight,” “undue influence of body weight or shape on self-evaluation,” and “denial of the seriousness of low body weight” over neuropsychological measures. The neuropsychological constructs introduced within the research domain criteria (RDoC) matrix offer new hope for determining the neural substrate underlying the biological predisposition to EDs. We present selected studies demonstrating deficits in patients with EDs within each domain of the RDoC and propose a set of behavioral tasks in model systems that reflect aspects of that deficit. Finally, we propose a battery of tasks to examine comprehensively the function of neural circuits relevant to the development of EDs.