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Anorexia Nervosa: Correct Terminology and Core Features

The correct term is anorexia nervosa — not "anorexia norversa." It is a serious eating disorder with the highest mortality rate of any psychiatric illness.

Diagnostic Criteria (DSM-5)

  1. Restriction of energy intake relative to requirements → significantly low body weight (context: age, sex, development, health).
  2. Intense fear of gaining weight or becoming fat, or persistent behavior interfering with weight gain.
  3. Disturbance in body weight/shape experience: Undue influence on self-evaluation, denial of seriousness of low weight.

Subtypes

  • Restricting type: Weight loss via diet, fasting, exercise. No binge/purge.
  • Binge-eating/purging type: Recurrent binge eating and/or purging (vomiting, laxatives, diuretics, enemas).

Medical Complications (Systemic)

  • Cardiac: Bradycardia, hypotension, arrhythmia, QT prolongation, sudden death.
  • Endocrine: Amenorrhea (hypogonadotropic), low T3, low IGF-1, cortisol dysregulation, bone loss (osteoporosis).
  • GI: Gastroparesis, constipation, superior mesenteric artery syndrome, hepatotoxicity.
  • Electrolyte: Hypokalemia, hyponatremia, hypophosphatemia (refeeding syndrome risk).
  • Hematologic: Anemia, leukopenia, thrombocytopenia.
  • Neurologic: Brain volume loss (partially reversible), cognitive impairment, seizures.

Treatment

  • Multidisciplinary: Medical stabilization → nutritional rehabilitation (refeeding protocol) → psychotherapy (FBT for adolescents, CBT-E for adults, specialist supportive clinical management).
  • Weight restoration is primary medical goal; psychological recovery follows.
  • Medications: Limited role. Olanzapine (weight gain, anxiety), antidepressants (comorbid depression/OCD) — not for core AN.

Prognosis

  • ~50% full recovery, 30% partial, 20% chronic.
  • Early intervention (≤3 years) → better outcome.
  • Mortality: 5–10% (suicide, cardiac, electrolyte).

Anorexia nervosa is a biologically based, serious mental illness — not a choice or lifestyle. Compassionate, evidence-based care saves lives.

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