CHAPTER 12 Mental Health^465
Anorexia Nervosa
Anorexia nervosa is a disease process that exists within the developed world,
where access to adequate amounts of nutritious food is not an issue. An unrealis-
tic expectation of body size may be part of the process, due to society’s expecta-
tions as depicted in the media. There is an alteration of normal eating behaviors,
resulting in a refusal to maintain body weight at or above that which is minimally
expected.
WHAT WENT WRONG?
Patients have a fear of gaining weight, even though they appear underweight to
those around them. Patients may restrict the intake of calories or binge and purge
to rid the body of the calories consumed. Anorexia affects females much more fre-
quently than males, with onset typically in the teen or preteen years. The patient
has an altered perception of body image.
PROGNOSIS
There is an increased mortality rate for patients with untreated anorexia nervosa.
The majority of these patients succumb to cardiovascular or renal problems. Patients
may need to be treated periodically for electrolyte disturbances, cardiac rhythm
disturbances, or renal dysfunction. The medical management of the patient needs
to be incorporated with the cognitive behavioral therapy to best meet the needs of
the patient. The symptoms of disease may recur.
HALLMARK SIGNS AND SYMPTOMS
- Disturbance in self-perception of body shape
- Refusal to maintain minimal normal body weight
- Abnormalities in eating behaviors
- Electrolyte imbalances due to nutritional deficiency
- Amenorrhea (absence of menstrual flow) or oligomenorrhea (very light men-
strual flow) due to lack of body fat - Dental caries or periodontitis due to nutritional deficiency
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