Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

Anorexia Nervosa 129

Anorexia Nervosa....................................

JOSE R. MALDONADO, MD

history & physical

Demographics

■Lifetime prevalence: 0.5 & 1%

■Females > males (90% occur in females)

■Peak onset usually during adolescence, rarely before puberty

■Mean age of onset: 17 y

■Genetics:

➣Concordance rate: 70% monozygotic & 20% for dizygotic twins

➣Anorexia 8-fold more common in relatives of anorexics

History

■Individual’s refusal to maintain minimal normal body weight

■Pts usually weigh <85% of ideal body weight for age & height

■Intense fear of gaining weight

■Perception of being fat even at low weight

■Amenorrhea (due to abnormally low estrogen levels)

■In childhood & early adolescence, failure to make expected weight

gains instead of weight loss

■Degree of weight loss & fatigue usually denied

■Initial visit usually prompted by family concern

■Few pts present w/ secondary physical complaints (ie, stress frac-

tures, joint problems, or cardiac problems)

■Low body weight achieved through relentless pursuit of thinness

through:

➣Dieting or food restriction

➣Excessive exercise

➣Purging

➣Diuretic misuse

➣Laxative misuse

➣Thyroid hormone misuse

Subtypes:

■Restricting type: weight loss accomplished mostly by dieting, fasting,

or excessive exercise, w/o binge eating or purging

■Binge-eating/purging type: frequent binge eating or purging, or both