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Social Work
Course Code
SOWK 2025
Jan Lackstrom
Study Guide

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DSM Fourth Edition 28/09/2011 11:04:00
Anorexia Nervosa
Diagnostic Features:
-Body weight is below a minimally normal level for age and height (Criterion A)
oCriterion A provides a guideline for determining when the individual meets the
threshold for being underweight
oIt suggests that the individual weigh less than 85% of that weight that is
considered normal for that person’s age and height
-An alternative and somewhat stricter guideline requires that the individual have a
body mass index (BMI) equal to or below 17.5 kg/m^2 suggested guidelines for the
-Intensely fear gaining weight or becoming fat (Criterion B) – this intense fear of
becoming fat is usually not alleviated by the weight loss
-The experience and significance of body weight and shape are distorted in these
individuals (Criterion C)
oWeight loss is viewed as an impressive achievement and a sign of
extraordinary self-discipline, whereas weight gain is perceived as an
unacceptable failure of self-control
-In postmenarcheal females, amenorrhea (due to abnormally low levels of estrogen
secretion that are due to diminished pituitary secretion of follicle-stimulating hormone
(FSH) and luteinizing hormone (LH) is an indicator of physiological dysfunction in
Anorexia Nervosa (Criterion D)
oRestricting Type dieting, fasting, or excessive exercise. During the
current episode, these individuals have not regularly engaged in binge eating
or purging
oBinge-Eating/Purging Type when 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 self-induced vomiting
or the misuse of laxatives, diuretics, or enemas. It appears that most
individuals with Binge-Eating/Purging Type engage in these behaviours at
least weekly, but sufficient information is not available to justify the
specification of a minimum frequency
Associated Features and Disorders

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-When seriously underweight, many individuals with Anorexia Nervosa manifest
depressive symptoms such as depressed mood, social withdrawal, irritability, insomnia,
and diminished interest in sex
-Such individuals may have symptomatic presentations that meet criteria for Major
Depressive Disorder
-Symptoms of mood disturbance must therefore be reassessed after partial or
complete weight restoration
-Obsessive-compulsive features often prominent – most preoccupied with thoughts of
food – may be caused or exacerbated by undernutrition
-Other features sometimes include concerns about eating in public, feelings of
ineffectiveness, a strong need to control one’s environment, inflexible thinking, limited
social spontaneity, perfectionism, and overly restrained initiative and emotional
-Compared with individuals with Anorexia Nervosa, Restricting Type, those with the
Binge-Eating/Purging Type are more likely to have other impulse-control 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 Disorder
-Complaints of constipation, abdominal pain, cold intolerance, lethargy, and excess
oThe most obvious finding on physical examination is emaciation
oThere may also be significant hypotension, hypothermia, and dryness of skin
oSome individuals develop lanugo (a fine downy body hair, on their trunks)
-Individuals 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 vomiting
Specific Culture, Age, and Gender Features
-Anorexia 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 thin
-Immigrants from cultures in which the disorder is rare who emigrate to cultures in
which the disorder is more prevalent may develop Anorexia Nervosa as thin-body ideals
are assimilated
-Cultural factors may also influence the manifestations of the disorder

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-Anorexia 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 illness
-More than 90% of cases of Anorexia Nervosa occur in females
-The lifetime prevalence of Anorexia Nervosa among females is approximately 0.5%
oIndividuals who are subthreshold for the disorder are more commonly
oPrevalence of males is approximately one-tenth that among females
-Typically begins in mid-to late adolescence (14-18 years) (Course)
oMay be associated with a stressful life event
oSome 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
oWith 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 Eating/Purging subtype
oHospitalization may be required to restore weight and to address fluid and
electrolyte imbalances
oDeath most commonly results from starvation, suicide, or electrolyte
-There is an increased risk of Anorexia Nervosa among first-degree biological relatives
of individuals with the disorder (Familial Pattern)
oStudies 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 with
such disorders usually do not have a distorted body image and a desire for further
weight loss (Differential Diagnosis)
oThe 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 emaciation
oIn 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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