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Social Work
SOWK 2025
Jan Lackstrom

DSM Fourth Edition28092011 110400Anorexia NervosaDiagnostic FeaturesBody weight is below a minimally normal level for age and height Criterion AoCriterion A provides a guideline for determining when the individual meets the threshold for being underweightoIt suggests that the individual weigh less than 85 of that weight that is considered normal for that persons age and heightAn alternative and somewhat stricter guideline requires that the individual have a body mass index BMI equal to or below 175 kgm2suggested guidelines for the clinicianIntensely fear gaining weight or becoming fat Criterion Bthis intense fear of becoming fat is usually not alleviated by the weight lossThe experience and significance of body weight and shape are distorted in these individuals Criterion CoWeight loss is viewed as an impressive achievement and a sign of extraordinary selfdiscipline whereas weight gain is perceived as an unacceptable failure of selfcontrolIn postmenarcheal females amenorrhea due to abnormally low levels of estrogen secretion that are due to diminished pituitary secretion of folliclestimulating hormone FSH and luteinizing hormone LH is an indicator of physiological dysfunction in Anorexia Nervosa Criterion DSubtypesoRestricting Typedieting fasting or excessive exercise During the current episode these individuals have not regularly engaged in binge eating or purgingoBingeEatingPurging Typewhen the individual regularly engaged in binge eating or purging or both during the current episode Most individuals with Anorexia Nervosa who binge eat also purge though selfinduced vomiting or the misuse of laxatives diuretics or enemas It appears that most individuals with BingeEatingPurging Type engage in these behaviours at least weekly but sufficient information is not available to justify the specification of a minimum frequencyAssociated Features and DisordersWhen seriously underweight many individuals with Anorexia Nervosa manifest depressive symptoms such as depressed mood social withdrawal irritability insomnia and diminished interest in sexSuch individuals may have symptomatic presentations that meet criteria for Major Depressive DisorderSymptoms of mood disturbance must therefore be reassessed after partial or complete weight restorationObsessivecompulsive features often prominentmost preoccupied with thoughts of foodmay be caused or exacerbated by undernutritionOther features sometimes include concerns about eating in public feelings of ineffectiveness a strong need to control ones environment inflexible thinking limited social spontaneity perfectionism and overly restrained initiative and emotional expressionCompared with individuals with Anorexia Nervosa Restricting Type those with the BingeEatingPurging Type are more likely to have other impulsecontrol problems to abuse alcohol or other drugs to exhibit more mood alternations to be sexually active to have a greater frequency of suicide attempts in their history and to have a personality disturbance that meets criteria for Borderline Personality DisorderComplaints of constipation abdominal pain cold intolerance lethargy and excess energyoThe most obvious finding on physical examination is emaciationoThere may also be significant hypotension hypothermia and dryness of skinoSome individuals develop lanugo a fine downy body hair on their trunksIndividuals who induce vomiting may have dental enamel erosion and some may have scars or calluses on the dorsum of the hand from contact with the teeth when using the hand to induce vomitingSpecific Culture Age and Gender FeaturesAnorexia Nervosa appears to be far more prevalent in industrialized societies in which there is an abundance of food and in which especially for females being considered attractive is linked to being thinImmigrants from cultures in which the disorder is rare who emigrate to cultures in which the disorder is more prevalent may develop Anorexia Nervosa as thinbody ideals are assimilatedCultural factors may also influence the manifestations of the disorderAnorexia Nervosa rarely begins before puberty but there are suggestions that the severity of associated mental disturbances may be greater among prepubertal individuals who develop the illnessMore than 90 of cases of Anorexia Nervosa occur in femalesThe lifetime prevalence of Anorexia Nervosa among females is approximately 05 Prevalence oIndividuals who are subthreshold for the disorder are more commonly encounteredoPrevalence of males is approximately onetenth that among femalesTypically begins in midto late adolescence 1418 years CourseoMay be associated with a stressful life eventoSome individuals with Anorexia Nervosa recover fully after a single episode some exhibit a fluctuating pattern of weight gain followed by relapse and others experience a chronically deteriorating course of the illness over many yearsoWith time particularly within the first 5 years of onset a significant fraction of individuals with the Restricting Type of Anorexia Nervosa develop binge eating indicating a change to the Binge EatingPurging subtypeoHospitalization may be required to restore weight and to address fluid and electrolyte imbalancesoDeath most commonly results from starvation suicide or electrolyte imbalanceThere is an increased risk of Anorexia Nervosa among firstdegree biological relatives of individuals with the disorder Familial PatternoStudies of Anorexia Nervosa in twins have found concordance rates for monozygotic twins to be significantly higher than those for dizygotic twins In general medical conditions serious weight loss may occur but individuals withsuch disorders usually do not have a distorted body image and a desire for further weight loss Differential DiagnosisoThe superior mesenteric artery syndrome characterized by posprandial vomiting secondary to intermittent gastric outlet obstruction should be distinguished from Anorexia Nervosa although this syndrome may sometimes develop in individuals with Anorexia Nervosa because of their emaciationoIn Major Depressive Disorder severe weight loss may occur but most individuals with Major Depressive Disorder do not have a desire for excessive weight loss or excessive fear of gaining weight
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