1. ANOREXIA NERVOSA
THE PSYCHOSOMATIC disorder
by- Deepak vekaria
UNDER GUIDANCE OF-
Ms. Vikas upadhyay

2. INTRODUCTION
 DO U THINK THIS IS
COOL???
 IS IT PLEASANT IN
ANY WAY???
 THEN WHY TRY TO
ACQUIRE SUCH
LOOKS???

3. TERMINOLOGY
The term anorexia is of Greek origin: an -: privation or
lack of and orexis -: appetite. thus is meaning a lack
of desire to eat. A person who is diagnosed with
anorexia nervosa is most commonly referred to as
an anorexic.
The term "anorectic" can also refer to any drug that
suppresses appetite.

4. CAUSES (multifactorial)
OTHER
FACTORS
LIFESTYLE
CCF
DISORDER
SATIATION
DRUGS
CAUSES

5. CAUSES
 SATIATION
 DISORDERS-: cancer, depression, dementia, AIDS,
chronic renal failure, altitude sickness.
 DRUGS-: stimulants, narcotics, antidepressants
(side effect), phenethylamine (decrease appetite).
 CONGESTIVE CARDIAC FAILURE (congestion of
liver with venous blood).
 LIFESTYLE

6. OTHER CAUSES
• PHYSIOLOGICAL FACTORS- GENES
Genetic factors contribute to 50% of the
variance for the development of eating
disorder.

7. OTHER FACTORS
 NEUROBIOLOGICAL FACTORS-
Serotonin is strongly related to mood, sleep,
emesis, sexuality and appetite.

8. serotonin
lower
tryptophan
levels
Anxiety, mood,
impulse
control
starvation
Low serotonin
levels
Reduce
anxiety
temporarily

9. OTHER FACTORS
 NUTRITIONAL FACTORS-
Zinc deficiency causes a decrease in
appetite due to hypogeusia.
Also deficiency of nutrients like tyrosine,
tryptophan, and thiamine decrease
appetite.

10. OTHER FACTORS
 PSYCHOLOGICAL FACTORS
 NEUROPSCHOLOGICAL FACTORS

11. TYPES
ANOREXIA
NERVOSA
PURGING
RESTRICTING

12. TYPES
American Psychiatric Association's Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV-TR)
classifies Anorexia as-:
I. RESTIRICTING TYPE -: the person has not regularly
engaged in binge-eating or purging behavior (that is,
self-induced vomiting, over-exercise or the misuse of
laxatives, diuretics, or enemas).
II. BINGE EATING OR PURGING TYPE -:the person has
regularly engaged in binge-eating OR purging
behavior.

13. CERTAIN FACTS
 90% of people with anorexia are females.
 15-19 yr olds make up to 40% of anorexics.
 10% of the anorexics die due to related
causes, highest suicidal rates and hence
highest mortality rates in psychiatric
disorders.
 50% recover fully,34% improve and the rest
remain chronically ill!

14. DIAGNOSIS
 Refusal to maintain body weight at or above
a minimally normal weight for age and height
(at or below 75- 80% of the normal weight).
 Intense fear of weight gain or becoming fat.
 Distortion of body image (constant feeling of
being fat).
 Widespread endocrine disorders involving
hypothalamic-pituitary- gonadal axis.

15. DIAGNOSIS CONTD….
 Amenorrhea in women and loss of sexual
activity and potency in males.
 Elevated levels of GH, raised cortisol levels,
changes in peripheral metabolism of thyroid
hormone and insulin secretion abnormalities.

16. DIAGNOSIS –lab tests
Laboratory tests give limited aid-
 Tendency towards depression of gastric acid
and blood sugar.
 Glucose tolerant curve is flat.
Eliminate all other causes of anorexial
symptoms such as hypothyroidism, pituitary
cachexia, Addison’s disease etc.

17. SIGNS AND SYMPTOMS
COMMONLY PRESENT
IN PATIENTS BUT NOT
DIAGNOSTIC.

18. SIGNS AND SYMPTOMS
PHYSICAL
BEHAVIORAL
EMOTIONALPSYCHOLOGICAL
INTERPERSONAL

19. PSYCHOLOGICAL SYMPTOMS
 Distorted Body Image.
 Poor insight.
 Self evaluation of shape
and weight.
 Perfectionism.
 OCD.
 Preoccupation or obsessive
thoughts about food and
weight.

20. EMOTIONAL
 Low self esteem &
efficacy
 Clinical depression or
chronically low mood
 Mood swings
 Intense fear of
becoming overweight.

21. INTERPERSONAL & SOCIAL
 Poor, deteriorating
performance.
 Withdrawal from
previous relations.
 Deterioration in
relationships with the
family.

22. BEHAVIORAL
 Excessive exercise
 Fainting
 Secretive
 Possible self harm ,
substance abuse or suicide attempts
 Sensitive about body references
 Become angry when forced to eat forbidden
food.

23. PHYSICAL 1
 Extreme weight loss and stunted growth.
 Pins and needles and purple extremities.
 Endocrine disorder.
 Decreased libido, impotence in males.
 Starvation symptoms- reduced metabolism,
bradycardia, hypotension,
hypothermia, anemia, low BMR.

24. Physical 2
 Growth of lanugo hair
on the body.
 Reduction in WBC
count.
 Reduced immunity.
 Zinc deficiency.
 Abnormalities of
minerals and electrolyte
levels in the body .

25. Physical 3
 Body mass index less than 17.5 in adults, or
85% of expected weight in children.
 Pallid complexion and sunken eyes.
 Creaking joints and bones.
 Tooth erosion.
 Collection of fluid in ankles
during day and around eyes
during the night.
 Constipation.

26. PHYSICAL 4
 Malnutrition – dry & chapped lips,
headaches.
 Thinning of hair.
 Brittle nails.
 Dry skin.
 Easily bruised.
 Nerve deterioration causing movement
difficulties.

27. Effects on body

28. TREATMENT- PSYCHOTHERAPY
 First line treatment of anorexia is restoration
of 90% of the weight of the patients.
 Severe cases may need hospitalization but
most are treated as outpatients.
 People involved are-clinical psychologists,
psychiatrists.
 Most effective though different people need it
differently.
 For adolescents- Family therapy

29. PSYCHOTHERAPY contd
 Success of a psychotherapy is determined
by the weight gain
 Every 5-6 days 300 cals in the diet are
increased in the form of proteins & vits’.
 Continue till the daily intake is 3400-3600 cal.
 All the while strict watch should be kept on
the patient that she/he does not resort to any
behavior that hinders therapy.
 Follow up.

30. APPETITE STIMULANTS
 ZINC
 DOSE-14mg/day.
 The oldest treatment -since
1979.
 Doubling of body weight.
 MOA- increased
neurotransmission in brain
including amygdala.

31. Appetite stimulants contd…
 MAGESTEROL ACETATE
 Effective appetite stimulant.
 85% weight gain due to fat due to
progestational steroid effect.
 Can produce hypogonadism.
 Decreases lean mass gain.
 Not beneficial in healthy weight gain.

32. OTHER APPETITE STIMULANTS
TETRA HYDRO- CANNABINOL
 Modest appetite stimulant.
 Significant CNS effects.
 Weight gain through modulation of hunger satiety
peptides- leptin, ghrelin and cholecystokinin.
 Herbal appetite stimulants-caraway seeds,, Black
Currant Chicory, Dandelion,, Garlic, Ginseng,,
Ground Ivy, Horseradish, Mugwort, Oat straw,
Parsley, Safflower, Tarragon, Thyme.

33. DRUG TREATMENT FOR ANOREXIA
 Drug treatment for anorexia, such as SSRI’s
or other antidepressants, are not found to be
generally effective in either treatment or in
preventing relapse.
 Even then antidepressants are prescribed to
treat the root cause/ associated anxiety and
depression.

34. DRUGS USED
 FLUOXETINE is effective in treating the
depression, anxiety and substance abuse in
anorexia( its also used for pain relief).
 OLANZAPINE is used as an appetite
stimulant.
MOA- hypothesized to induce weight gain
through modulation of hunger satiety
regulatory peptides- leptin and ghrelin.

35. Olanzapine

36. OTHER DISORDERS
 ORTHOREXIA NERVOSA
 WANNAREXIA
 MUSCLE DYSMORPHIA
NOTE THAT BULIMIA IS COMPLETELY
DITTERENT FROM ANOREXIA.

37. CONCLUSION
ANOREXIA - :
YOU WILL DIE
BEFORE YOU ARE THIN
ENOUGH.

38. REFERENCES
 Essentials of Medical Pharmacology by K D Tripathi.
 Harrison’s principles of internal medicine.
 Merck Manual
 http://www.google.co.in/search?hl=en&q=anorexia+nervosa&meta=
 http://www.sciencedirect.com/http://en.wikipedia.org/wiki/Anorexia_ner
vosa
 http://www.mentalhealth.com/dis/p20-et01.html
 http://images.google.co.in/images?hl=en&q=anorexia+nervosa&gbv=2
 http://www.google.co.in/search?
gbv=2&hl=en&q=appetite+stimulants&meta=
 http://www.google.co.in/search?
gbv=2&hl=en&q=psychotherapy&meta=
 http://en.wikipedia.org/wiki/Obsessive-compulsive_disorder
 http://www.ncbi.nlm.nih.gov/sites/entrez?
db=pubmed&uid=7115930&cmd=showdetailview&indexed=google

39. Thank
you