Diagnosis and investigation - Chang Thai and Jasmine

There are four basic criteria for the diagnosis of anorexia nervosa that are characteristic:

1. The refusal to maintain body weight at or above a minimally normal weight for age and height. Body weight less than 85% of the expected weight is considered minimal.
2. An intense fear of gaining weight or becoming fat, even though the person is underweight.
3. Denial of the seriousness of emaciation and starvation.
4. Self-perception that is grossly distorted and weight loss that is not acknowledged.
5. In women who have already begun their menstrual cycle, at least three consecutive periods are missed (amenorrhea), or menstrual periods occur only after a hormone is administered.

Further Frightening Characteristics:

1. Even if they are clearly emaciated, they continue to insist that they are over-weight.
2. Claim thin but some parts are too fat.
3. Measure or estimate body size frequently.
4. Weight loss = sign of achievement
5. Gaining weight = failure of self-control.

2 types

1) In the binge-eating/purging type, the individual regularly engages in binge eating or purging behaviour which involves self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode of anorexia

--- more extroverted , histrionic , emotionally volatile personalities, impulse control problems, substance abuse.

--- more anxiety, depression & guilt, admitted more frequently to having a strong appetite and tended to be older.

2) In the restricting type accomplish weight loss through dieting or exercising

--- more introverted & deny they suffered hunger and psychological distress, conformity, perfectionism, rigidity.

Types of examination

• Physical exam. This may include measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; checking the skin for dryness or other problems; listening to the heart and lungs; and examining the abdomen.
• Laboratory tests. These may include a complete blood count (CBC), as well as more specialized blood tests to check electrolytes and protein as well as functioning of the liver, kidney and thyroid. A urinalysis also may be done.

--(low potassium levels mean the disorder is more likely to be accompanied by the binge-purge syndrome)dehydration and starvation that occurs with anorexia can reduce fluid and mineral levels

• Psychological evaluation. A doctor or mental health professional can assess thoughts, feelings and eating habits. Psychological self-assessments and questionnaires also are used.
• Other studies. X-rays may be taken to check for broken bones, pneumonia or heart problems. Electrocardiograms may be done to look for heart irregularities. Testing may also be done to determine how much energy your body uses, which can help in planning nutritional requirements.

Questionnaires

SCOFF Questionnaire

Do you make yourself Sick because you feel uncomfortably full?

Do you worry you have lost Control over how much you eat?

Have you recently lost more than One stone's worth of weight (14 pounds) in a 3-month period?

Do you believe yourself to be Fat when others say you are too thin?

Would you say that Food dominates your life?

Answering yes to two of these questions is a strong indicator of an eating disorder.

Links for further referencing

1) http://www.mayoclinic.com/health/anorexia/DS00606/DSECTION=tests-and-diagnosis

2) http://www.medicinenet.com/anorexia_nervosa/page2.htm#toce

3) http://health.nytimes.com/health/guides/disease/anorexia-nervosa/diagnosis.html

4) http://www.primarypsychiatry.com/aspx/article_pf.aspx?articleid=1253.

5) Sue, D. Et al. , Essentials of understanding abnormal behaviour (1997), Houghton Mifflin, USA, pp. 358-362.