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PS275 (75)

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Byron Williston

CLINICAL DESCRIPTION  The diagnoses of these two disorders share several clinical feautures the most imp being an intense fear of being overweight  Co-twins of patients diagnoses with A.N for ex are themselves more likely than average to have B.N Anorexia Nervosa  Ms. A had A.N. anorexia refers to loss of appetite and nervosa indicates that this is for emotional reasons  Most patients with A.N actually do not lose their appetite or interest in food. They are preoccupied with food  Ms. A met all the four features required for the diagnosis:  1) the person must refuse to maintain a normal body weight, that is usually taken to mean that the person weights less than 85% of what is considered normal for that persons age and height. Weight loss is typically achieved through dieting although purging (self induced vomiting, heavy use of laxatives or diuretics) and excessive exercise can also be part of the picture  2) the person has an intense fear of gaining weight and the fear is not reduced by weight loss. They can never be thin enough  3) Patients with AN have a distorted sense of their body shape. They maintain that even when emaciated they are overweight or that certain parts of their bodies esp the stomach, butt and thighs are too fat. To check on their body size they typically weight themselves frequently, measure the size of diff parts of the body and gaze critically at their reflections in the mirror. Their self esteem is closely linked to maintaining thinness. The tendency to link self esteem and self evaluation with thinness is known as over evaluation of appearance  4) in females the extreme emaciation causes amenorrhoea the loss of the menstrual period. Of the four diagnostic criteria amenorrhoea seems least imp to determining a diagnosis of anorexia. Moreover amenorrhoea occurs in a significantly minority of women before any significant weight lose and the symptoms can persist after weight gain  eating disorder inventory (EDI). Was developed in Canada and is one of the most widely used measured to assess self reported aspects of eating disorders  patients with AN overestimate their own body size and choose a thing figure as their ideal  DSM-IV-TR distinguishes two types of AN. In the restrictive type, weight loss is achieved by severely limiting food intake; in the binge eating purging type the person also regularly engages in binge eating and purging  The binging purging subtype appears to be more psychopathological; patients exhibit more personality dis, impulsive beh, stealing, alcohol and drug abuse, social withdrawal and suicide attempts than do patients with the restricting type of anorexia  Binging purging patients tend to weight more in childhood, come from heavier families with greater familial obesity and use more extreme weight control methods.  Canadian research suggests that the diff between the two subtypes are becoming less distinct  An increasing proportion of patients were diagnosed with AN, the binging purging subtype, during each period. Over time, participants in both groups appeared to weigh more and were less likely to report
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