Anorexia nervosa
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Anorexia nervosa is a complex condition characterised by low body weight and body image distortion with an obsessive fear of gaining weight. It commonly occurs in adolescent girls and young women, but as many as 10% of those affected are adolescent boys and young men [1]. Patients tend to become socially withdrawn during the course of the illness. The patients own willingness to disclose his or her motives, symptoms and behaviors can be an obstacle to diagnosis. The diagnosis is made on the basis of the history and examination, supported if possible by a collateral history from a relative or friend. Engaging the patient in a supportive, empathic assessment interview is crucial to enabling the patient to reveal fears around weight, dieting behaviour and any purging or any other maladaptive behaviours.
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Deliberate weight loss (sustained below 15% expected or below 17.5 kg/m2)
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Secondary endocrine and metabolic changes and disturbances of bodily function
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Under nutrition of varying severity
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Dread of fatness and flabbiness of body contour
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Self imposed a low weight threshold
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Restricted dietary choice
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Induced vomiting and purgation
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Use of appetite suppressants and diuretics
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Excessive exercise
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Diagnostic Interviewing
- Deliberate weight loss (sustained below 15% expected or below 17.5 kg/m2)
- Secondary endocrine and metabolic changes and disturbances of bodily function
- Under nutrition of varying severity
Weight and measure the patient and carry out a full physical examination.
‘Have you recently lost any weight… has this been intentional…?’
'Has anyone commented on your weight? What did they say?'
'Have you started your periods? Are you periods regular?'
'How are you energy levels? Are you doing as much as you would normally?'
- Dread of fatness and flabbiness of body contour
'What do you think of your weight / ‘body image’ at the moment?'
‘How would you like your body to look?’
'How has your weight been in the past? Where you happy with that?
‘If you gained some weight how would you feel about that?’
- Self imposed a low weight threshold
'What is your target weight / ‘body image’?'
‘Do you have a maxim weight threshold?’
- Restricted dietary choice
'Are you controlling what you eat at the movement? How are you doing this?’
'Are there any foods you will not eat? Why?'
'Do you control the calories you eat in one day? Do you check calories in all the food you it?'
‘If you feel like you have eaten too much how does that make you feel?’
- Induced vomiting and purgation
- Use of appetite suppressants and diuretics
- Excessive exercise
'Have you taken measures to ensure you reach your target weight quicker to avoid gaining weight? What measures?'
‘Have you ever made yourself vomit in order to stop weight gain?’
‘How often do you exercise? What type of exercise do you do?’
'Have you ever felt like you have eaten too much? What do you do afterwards?'
‘Have you ever used any medications to control you weight?’
'Have you ever used excessive exercise, induced vomiting appetite suppressants or diuretics to bring down your weight?'
1. "The Numbers Count: Mental Disorders in America". The National Institute of Mental Health. Retrieved on Sept 2008.
