Anorexia Nervosa (307.1

onset of the disorder include emotional problems, social difficulties, or certain physical

illnesses. The prevalence is about 25-35 percent in normal children and higher in children with

developmental delays or disturbances.

Risk factors that precipitate ARFID include autism spectrum disorder, anxiety disorders,

obsessive-compulsive disorder, and ADHD. Environmental risk factors include familial anxiety

and having a mother with an eating disorder. Various GI disorders, such as reflux and vomiting,

may precipitate ARFID. Choking on food can be a risk factor for ARFID. Comorbidities include

anxiety disorders, OCD, autism spectrum disorder, ADHD, and intellectual disabilities.

This disorder may be treated with psychoeducation and cognitive behavioral therapy that

challenges the patient’s beliefs about fears of choking, food aversions, and other cognitive

distortions related to food and eating. There is family tension associated with ARFID and, when

it occurs in children, it can affect the parent-child interactions. Certain infants will display

fussiness in their temperament that persists through childhood and adulthood.

ANOREXIA NERVOSA (307.1)

Anorexia nervosa has been included in previous Diagnostic and Statistical manuals. The person

has a preoccupation with having a low body weight and who exhibits many behaviors that

contribute to having a low body weight. The person will restrict food intake and will even

starve themselves of all food in order to avoid gaining weight. They may impulsively exercise

on a frequent basis. A simple explanation is that they fear gaining weight but there are

complexities to this simple explanation. There can be specific events or social pressures to be

thin that predispose the individual to anorexia nervosa. The male to female ratio is 10:1 with an

incidence of 0.4 percent per year.

Although these patients go to great lengths to hide evidence of their condition, the typical

symptoms that can be identified include the following:

A. Obsession with the caloric and nutritional content of food

B. Using appetite suppressants or laxatives to control weight

C. Having a distortion of body image

D. Denying being of a low weight

E. Being extremely thin or emaciated

F. Eating very little or skipping meals

G. Weighing oneself obsessively or constantly checking body shape in the mirror

H. Vomiting after meals

I. Having dizziness, physical problems, and dry skin

Symptoms that develop over time include hair loss or brittle hair, growth of lanugo hair over the body, osteoporosis, muscle wasting/weakness, anemia and low blood pressure,

constipation, infertility, fatigue, lethargy, brain damage, and organ failure.

To meet the disorder, there needs to be three criteria met: 1) having a significantly low body

weight as expected by their height; 2) having an intense fear of being fat that doesn’t go away

with weight loss; and 3) having a distorted view of their own body size and shape, pointing out

areas that they believe are fat. The patient will have OCD tendencies, insomnia, social

withdrawal, and depression, and will be obviously underweight.

Laboratory and physical findings include serum chemistry abnormalities, decreased WBC count,

mild anemia, decreased thyroid hormone levels, osteopenia, and a slowed heart rate. There

are two subtypes, depending on how they present themselves. Some are restrictive, others are binge/purging types, and others may be mixed in presentation. Those who fast, diet, and/or

exercise are considered “restrictive,” while those who overeat and use vomiting and laxatives are “binge/purge” subtypes.

There are many biological, psychological, and environmental causes that contribute to getting

anorexia nervosa. These include the following:

Psychological factors include excessive fear about the future, anxiety and depression, poor

stress management, difficulty expressing emotions, OCD feelings, having perfectionistic

tendencies, and being phobic about being fat. Environmental factors include hormonal changes

at puberty, pressure or stress to be thin, bullying about body weight, bereavement or other