- Associated with body image disturbance
- Usually seen in adolescent girls
- 3rd most common chronic condition in adolescent girls
- Life long risk
- Body image is predominate measure of self worth
- Mortality 6-20%, highest of any psychiatric disorder
- A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
- B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
- C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
- Fine facial and body hair (lanugo)
- Brittle hair and nails
- Dry, scaly skin
- Loss of subcutaneous fat
- Breast and vaginal atrophy
- Treat medical complications
- Serious electrolyte abnormalities can occur
- Refeeding syndrome risk
- Even 1L of d5 NS could harm patient subsisting on <400kcal daily
- Osteoporosis due to HPA dysfunction
- Risk of fracture with minimal or no trauma
- Must avoid use of bupropion as it may lead to seizures in patients with eating disorders
- Inpatient management for:
- Extremely low weight (<75% of expected body weight) or rapid weight loss
- Hypotension (< 80/50)
- Hypothermia (< 96 degrees F)
- Severe electrolyte imbalances
- Cardiac disturbances
- Bradycardia < 50
- Acute medical disorders
- Severe or intractable purging
- Psychosis or a high risk of suicide
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- John F. Bober, Scott E. Moser: Rakel: Textbook of Family Medicine, 8th ed., Saunders, 2011 (Ch)24: p452