What is anorexia nervosa?
One type of eating and psychological disorder. a
condition that goes beyond out-of-control dieting.
The weight loss becomes a sign of mastery and
The drive to become thinner is actually secondary
to concerns about control and/or fears relating to
one's body. The individual continues the endless
cycle of restrictive eating often to a point close to
starvation in order to feel a sense of control over
the body. This cycle becomes an obsession and is
similar to any type of drug or substance addiction.
Who is at risk for anorexia?
 95% of those affected by anorexia are female,
 It typically begins to manifest during early adolescence,
but also seen in young children and adults.
 In the U.S. about one out of every 100 adolescent girls
has the disorder.
 Caucasians are more often affected than people of other
racial backgrounds,
 more common in middle and upper socioeconomic
 According to the U.S. National Institute of Mental
Health (NIMH), an estimated 0.5% to 3.7% of women
will suffer from this disorder at some point in their lives.
Who is at risk for anorexia?
 Many experts consider people for whom thinness
is especially desirable, or a professional
requirement (such as athletes, models, dancers,
and actors), to be at risk for eating disorders such
as anorexia nervosa.
a famous model with anorexia
A poor self-image compounds the problem.
What causes anorexia?
 At this time, no definite cause of anorexia nervosa
has been determined. However, research within
the medical and psychological fields continues to
explore possible causes, e.g.:
 demands from society and families,
 For many individuals, the destructive cycle
begins with the pressure to be thin and
 A poor self-image compounds the problem.
What causes anorexia? (cont.)
 Some studies suggest that a genetic (inherited)
component may play a role in determining
susceptibility to anorexia. Researchers are currently
attempting to identify the particular gene or genes
 Although no organic cause for anorexia has been
identified, some evidence points to a dysfunction in
the part of the brain (hypothalamus) which regulates
certain metabolic processes. Other studies have
suggested that imbalances in neurotransmitter levels
in the brain may occur in people suffering from
How is anorexia diagnosed?
 Anorexia nervosa is a complicated disorder to diagnose.
 Individuals with anorexia often attempt to hide the
 Denial and secrecy frequently accompany other C/O.
 The individual typically does not accept that she or he
has a problem (denial).
 In many cases, the actual diagnosis is not made until
there are other medical complications.
How is anorexia diagnosed? (Cont.)
 family members seek medical help only after a
marked weight loss has occurred.
 Anorexics often lack insight into their problem
despite being severely malnourished and may be
unreliable in providing accurate information.
(So, it is often necessary to obtain information from
parents or other family members in order to
evaluate the degree of weight loss and extent of the
There are four basic criteria for the diagnosis
of anorexia nervosa that are characteristic:
1)The refusal to maintain body weight at or above a
minimally normal weight for age and height. Body
weight less than 85% of the expected weight is
considered minimal.
2)An intense fear of gaining weight or becoming fat,
even though the person is underweight.
3)Self-perception that is grossly distorted and weight
loss that is not acknowledged.
4)In women who have already begun their menstrual
cycle, at least three consecutive periods are missed
(amenorrhea), or menstrual periods occur only
after a hormone is administered.
 Two subtypes of anorexia nervosa:
 In the binge-eating/purging type, the
individual regularly engages in binge eating or
purging behavior which involves self-induced
vomiting or the misuse of laxatives, diuretics,
or enemas during the current episode of
anorexia (Bulimia).
 In the restricting type, the individual severely
restricts food intake but does not engage in the
behaviors seen in the binge eating type.
What are anorexia symptoms and signs
 Anorexia can have dangerous psychological and
all aspects of an individual's
life and can affect other family members as well.
 The individual can become seriously underweight, which can lead to depression and social
 Irritability and easy upset, difficulty interacting
with others.
 disrupted sleep and fatigue during the day.
 Most individuals with anorexia become obsessed
with food and thoughts of food (think about it
constantly and become compulsive about eating
 Additionally, they may exhibit other obsessions or
compulsions related to food, weight, or body shape
that meet the diagnostic criteria for an obsessive
compulsive disorder.
 Other psychiatric problems are also common in
people with anorexia nervosa, including affective
(mood) disorders, anxiety disorders, and
personality disorders.
 Generally, individuals with anorexia are compliant.
Sometimes, they are overly compliant, to the extent
that they lack adequate self-perception.
 They usually do well in school and may often
overextend themselves in a variety of activities.
 The families of anorexics often appear to be "perfect."
Physical appearances are important to them.
Performance in other areas is stressed as well, and they
are often high achievers.
 All of these features can negatively affect daily
activities. Diminished interest in previously preferred
activities can result.
 Some individuals also have symptoms that meet the
diagnostic criteria for a major depressive disorder.
 For some Anorexics, weight loss is so severe that
there is a loss of menstruation.
 Medical complications for individuals with
Anorexia Nervosa can be severe and even life
threatening (emaciation, bradycardia,
hypotension, hypothermia, impaired renal
functioning and gastrointestinal problems).
If Anorexia Nervosa is left untreated, it
can be fatal.
What are anorexia symptoms and signs (physical)?
Most of the medical complications of anorexia nervosa result
from starvation. Few organs are spared the progressive
 Heart and circulatory system: Although not lifethreatening, an abnormally slow heart rate
(bradycardia) and low blood pressure (hypotension)
are frequent manifestations of starvation and are
commonly associated with anorexia.
 Of greater significance are disturbances in the heart
rhythm (arrhythmia) as prolonged QT interval.
 A reduction in the work capacity of the heart is
associated with severe weight loss and starvation.
 Gastrointestinal complications:
Constipation and abdominal pain are the commonest
Slow rate of food absorption.
Starvation and overuse of laxatives can seriously
disrupt the body's normal functions involved in the
elimination process.
Liver damage
 The glandular (endocrine) system in the body is
profoundly affected by anorexia with serious
 Disturbances in the menstrual cycle are frequent and
can affect not only fertility but also bone density, which
is very important to a woman's health as she ages.
 Continual restrictive eating can trick the thyroid into
thinking that the body is starving, causing it to slow
down in an attempt to preserve calories.
 Kidney (renal) function may appear normal. However,
potassium deficiency, increased or decreased urination
may occur.
 Anorexics who use a large quantity of laxatives or who
frequently vomit are at great risk for electrolyte
imbalance, which may be life-threatening.
 Anemia is frequently found in anorexic patients.
Suppressed immunity and a high risk for infection
are suspected, but not clinically proven.
 Physical symptoms:
 dry, flaky skin that takes on a yellow tinge. Fine,
downy hair grows on the face, back, arms, and
Despite this new hair growth, loss of hair on the
head is not uncommon.
Nails can become brittle.
Frequent vomiting can erode dental enamel and
eventually lead to tooth loss.
 Anorexia may be treated in an outpatient setting, or
 For an individual with severe weight loss that has
impaired organ function, hospital treatment must
initially focus on correction of malnutrition, and
intravenous feeding may be required.
 A gain of between one to three pounds per week is a safe
goal when malnutrition must be corrected.
 Different kinds of psychological therapy have been
employed to treat people with anorexia. Individual
therapy, cognitive behavior therapy, group therapy,
and family therapy have all been successful in
treatment of anorexia.
 Those with anorexia can be treated by a medical
doctor, a clinical psychologist, or both.
 While no medications have been identified that can
definitively reduce the compulsion to starve
themselves, some of the selective serotonin reuptake
inhibitor (SSRI) antidepressant drugs have been
shown to be helpful in weight maintenance after
weight has been gained, and in controlling mood
and anxiety symptoms that may be associated with
the condition.
 Anorexia is among the psychiatric conditions with the
What is
the prognosis
of anorexia?
rate, (6%(outcome)
of anorexia victims
from complications). The most common causes of
death in theses people are medical complications of the
condition including cardiac arrest and electrolyte
imbalances. Suicide is also a cause of death.
 Early diagnosis and treatment can improve the overall
prognosis. With appropriate treatment, about half of
those affected will make a full recovery. Some people
experience a fluctuating pattern of weight gain followed
by a relapse, while others experience progressively
deterioration over many years and still others never
fully recover. It is estimated that about 20% of people
with anorexia remain chronically ill from the condition.
 As with many other addictions, it takes a day-today effort to control the urge to relapse. Many
individuals will require ongoing treatment for
anorexia over several years, and some may require
treatment over their entire lifetime.
The anorexic girl, aged 19, was admitted to hospital & placed under treatment Two months
later, she had returned to her normal body weight & had established good eating habits
PEARLS for Anesthetists
 While anesthetizing Anorexic patients, we have to pay
attention to:
1- Hypotension, bradycardia and arrhythmias.
2- Hypokalemia, hypomagnesaemia, hypocalcaemia and
acidosis with other electrolyte disturbances and their
subsequent effects.
3- dehydration and hypoglycemia.
5- complications and end organ damage as: starvation
ketosis, anemic heart failure , renal and liver failure.
To summarize!
 Anorexia nervosa is an eating disorder and a psychological disorder.
 The cause of anorexia has not been definitively established, but self-
esteem and self-image issues, family dynamics, societal pressures, and
even genetic factors may each play a role.
Anorexia affects females far more often than males and is most
common in adolescent females.
The disorder affects about 1% of adolescent girls in the U.S.
People with anorexia tend to show compulsive behaviors and may
become obsessed with food.
The extreme dieting and weight loss can lead to a potentially fatal
degree of malnutrition.
Other possible consequences of anorexia include heart-rhythm
disturbances, digestive abnormalities, anemia, and hormonal and
electrolyte imbalances.
The treatment of anorexia must focus on more than just weight gain.
The prognosis of anorexia is variable, with some people making a full
recovery. Others experience a fluctuating pattern of weight gain
followed by a relapse, or a progressively deteriorating course.
As with many other addictions, it takes a day-to-day effort to control
the urge to relapse, and long-term treatment may be needed.