Anorexia nervosa
Criteria for diagnosis of Anorexia Nervosa is as following :
(a) Body weight is maintained at least 15% below that expected (either lost or never achieved), or Quetelet body-mass index’ is 17.5 or less. Prepubertal patients may show failure to make the expected weight gain during the period of growth.
(b) The weight loss is self-induced by avoidance of “fattening foods”. One or more of the following may also be present: self-induced vomiting; self-induced purging; excessive exercise; use of appetite suppressants and/or diuretics.
(c) There is body-image distortion in the form of a specific psychopathology whereby a dread of fatness persists as an intrusive, overvalued idea and the patient imposes a low weight threshold on himself or herself.
(d) A widespread endocrine disorder involving the hypothalamic – pituitary-gonadal axis is manifest in women as amenorrhea and in men as a loss of sexual interest and potency. (An apparent exception is the persistence of vaginal bleed in anorexic women who are receiving replacement hormonal therapy, most commonly taken as a contraceptive pill.) There may also be elevated levels of growth hormone, raised levels of cortisol, changes in the peripheral metabolism of the thyroid hormone, and abnormalities of insulin secretion.
(e) If onset is prepubertal, the sequence of pubertal events is delayed or even arrested (growth ceases; in girls the breasts do not develop and there is a primary amenorrhoea; in boys the genitals remain juvenile). With recovery, puberty is often completed normally, but the menarche is late.
