Eating Disorders

F50 EATING DISORDERS
F50.0 Anorexia nervosa

A.   Weight loss, or in children a lack of weight gain, leading to a body weight of at least 15% below the normal  or expected weight for age and height.
B.   The weight loss is self-induced by avoidance of "fattening foods".
C.   A self-perception of being too fat, with an intrusive dread of fatness, which leads to a self-imposed low weight threshold.
D. A widespread endocrine disorder involving the hypothalamic-pituitary-gonadal axis, manifest in the female as amenorrhoea, and in the male as a loss of sexual interest and potency (an apparent exception is the persistence of vaginal bleeds in anorexic women who are on replacement hormonal therapy, most  commonly taken as a contraceptive pill).
E.   Does not meet criteria A and B of Bulimia nervosa (F50.2).

Comments: The following features support the diagnosis, but are not necessary elements: self-induced vomiting; self-induced purging; excessive exercise; use of appetite suppressants and/or diuretics.If onset is pre-pubertal, the sequence of pubertal events is delayed or even arrested (growth ceases; in girls  the breasts do not develop and there is a primary amenorrhoea; in boys the genitals remain juvenile). With recovery, puberty is often completed normally, but the menarche is late.

F50.2 Bulimia nervosa
A.   Recurrent episodes of overeating (at least two times per week over a period of three months) in which large  amounts of food are consumed in short periods of time.
B.   Persistent preoccupation with eating and a strong desire or a sense of compulsion to eat (craving).
C.   The patient attempts to counteract the fattening effects of food by one or more of the following:
(1) self-induced vomiting;
(2) self-induced purging;
(3) alternating periods of starvation;
(4) use of drugs such as appetite suppressants, thyroid preparations or diuretics. When bulimia occurs in diabetic patients they may choose to neglect their  insulin treatment.
D. A self-perception of being too fat, with an intrusive dread of fatness (usually leading to underweight).

Patients with eating disorders have in common the core psychopathology of extreme concerns about body shape and weight.

  • There are two specific diagnoses:
  • Anorexia nervosa
  • Bulimia nervosa

Anorexia nervosa

  • It is a misnomer there is never a decrease in appetite (it is self induced anorexia)
  • Common in teen age girls
  • Fear of becoming obese, even though under weight 
  • Body image disturbance
  • Significant loss of weight, less than 85% of ideal body weight
  • Amenorrhea in 100%
  • Lanugo hairs
  • Bulimic episodes
  • Hyperactivity
  • Treatment fluoxetine

Hospitalization; 20% below expected weight  

  • Bulimia nervosa
  • Common in early teens or adolescents
  • Persistent pre occupied with eating
  • Irresistible craving for food
  • Binge eating
  • Self induced vomiting, purgative abuse period of starvation & use of appetite suppressants

Treatment  : fluoxetine

Differentiating points b/w Anorexia Nervosa & Bulimia nervosa is failure to maintain body weight 85% of the normal weight Amenorrhoea in 100% cases