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(PSYCHIATRIC TIMES) - A 30-year-old woman was brought to the hospital with syncope, bradycardia, and hypotension. For the past 6 years, she had vomited after eating meals and after occasional episodes of binge eating.

Despite profound weight loss, the patient denied hunger, thinness, and fatigue. She was emaciated and amenorrheic; body fat was undetectable, and the bones protruded through the skin. Drs Demetrios Papaioannides, S. N. Nikas, and E. Athanassiou of Arta, Greece, and Dr N. Akritides of Ioannina, Greece, diagnosed anorexia nervosa; they admitted the patient for nutritional support and further studies.

This chronic disorder is characterized behaviorally by self-induced weight loss; psychologically by distorted body image and other perceptual disturbances; and biologically by physiologic alterations—such as amenorrhea—that result from nutritional depletion. Ninety-five percent of patients with anorexia nervosa are young, affluent white women.1 Estimates of prevalence range from 0.4 to 1.5 per 100,000 population. Rates as high as 1 per 100 adolescent girls from middle- or upper-class white families have been reported.2

The cause of anorexia nervosa is unknown. A psychiatric origin is likely, but its nature is unclear. One view holds that this disorder begins in response to inadequate or destructive interpersonal relationships in goal-oriented and high-achieving families.

A triad of clinical disturbances provides the essential criteria for diagnosing anorexia nervosa in its typical form:

* The patient's weight is markedly below normal. Considerable weight loss results mainly from self-deprivation of foods the patient considers “fattening” (ie, rich in carbohydrates). Weight loss may be accentuated by additional behaviors, such as self-induced vomiting or purging or excessive exercise.
* A specific psychopathology is present: the patient clings tenaciously to the idea that “fatness” is to be avoided at all costs. Her definition of fatness is uncommonly harsh, and she sets a weight threshold that she will not exceed.
* Hypothalamic dysfunction is manifested by partial diabetes insipidus, abnormal thermoregulation, and hypogonadotropic hypogonadism with secondary amenorrhea. Male patients experience a loss of sexual interest and potency. Menses usually return with weight gain.

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