Anorexia Nervosa
Anorexia Nervosa
General and supportive measures
ICD-10 codes: F50.01/F50.02
DESCRIPTION
This disorder presents with restricted energy intake relative to requirements leading to a low body weight, an intense fear of gaining weight or becoming fat or behaviour that limits weight gain and a disturbance in body weight/shape perception, with poor insight into the seriousness of the low body weight. Children and adolescents may fail to make expected weight gains or maintain normal growth patterns, e.g. increased height without weight gain. The Centre for Disease Control has used Body Mass Index (BMI)-for-age below the 5th percentile as being underweight. Physiological disturbances and cessation of menses should also be considered.
The semi-starvation and purging can result in medical sequelae, even medical emergencies, e.g. arrhythmias.
Co-morbid psychiatric disorders are common, e.g. MDD, OCD.
GENERAL AND SUPPORTIVE MEASURES
- A thorough physical examination.
- Blood investigations including: FBC, U&E, CMP, TSH.
- Cardiac investigation: ECG.
- Suicide risk assessment.
MEDICINE TREATMENT
Supportive measures for medical complications including a dietician referral.
- Refer to a paediatrician for severe medical complications.
- Refer to a psychiatrist for psychiatric management.
- Medication such as fluoxetine and olanzapine should be initiated by a psychiatrist.
- Family based therapy is the gold standard of treatment for eating disorders in adolescents.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 14: Child & Adolescent Psychiatry, 14.8 Feeding And Eating Disorders, 14.8.3 Anorexia Nervosa