Clinical evaluation of anorexia nervosa

A. Dieting behavior. Indications of dieting behavior include preoccupation with body weight or specific body areas, attempts to restrict calories and fatty foods, frequent weighings, mirror gazing, preoccupation with food, meal avoidance, preoccupation with clothes size, and attempts to hide weight loss with bulky clothing.

B. Physical examination should include blood pressure, height, and weight. Emaciation and evidence of slowed metabolic and physiological functions may be apparent. Lanugo, a fine, downy body hair, may be prominent on the arms, torso, and face.

C. Cardiovascular complications are the most likely cause of death in anorexia nervosa. Bradycardia, orthostatic hypotension, and mitral valve prolapse are common.

D. Psychological assessment. The patient may appear indifferent to the weight loss (denial), and mental status examination often reveals a flat affect and poor eye contact. The eyes may have a lackluster appearance due to the effects of starvation. Impairment of concentration, lack of cooperation, limited verbalization, and dysphoric mood are frequent.

E. A general laboratory screen is usually sufficient in the assessment of anorexia nervosa. Among individuals who purge, determination of electrolyte status is the most important concern, particularly serum potassium status. An electrocardiogram is indicated for cardiac symptoms, extremely low body weight, or history of exposure to syrup of ipecac.

Laboratory Abnormalities in Anorexia Nervosa

Anemia

Hypokalemia (vomiting, laxatives,

Leukopenia

diuretics)

Thrombocytopenia

Hypercortisolemia

Reduced erythrocyte sedimenta-

Hypoglycemia

tion rate

Elevated growth hormone levels

Impaired cell-mediated immunity

Reduced estrogen levels

Hypercholesterolemia

Reduced basal levels of luteinizing

Hypocalcemia

and follicle-stimulating hormones

Hypomagnesemia

Elevated liver function tests

Hypophosphatemia

Elevated amylase (vomiting)

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Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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