User:Penn1992/Atypical anorexia nervosa

Signs and Symptoms
Many of the physical symptoms of atypical anorexia nervosa are due to the effects of decreased caloric intake which causes the body to significantly suppress the metabolic rate. The body's decreased metabolic rate is a response to stress and causes widespread symptoms that affect many of the organ systems as the body is attempting to adjust to its malnourished state. This causes hypo metabolic symptoms such as chronic fatigue, bradycardia, and amenorrhea. Bradycardia and orthostatic instability are frequent and life-threatening complications that account for the majority of medical hospitalizations in atypical anorexia nervosa.

Physical Symptoms

-       Amenorrhea

-       Rapid, continuous weight loss

-       Bradycardia or tachycardia

-       Chronic fatigue

-       Halitosis

-       Hypotension

-       Insomnia

-       Anemia

While patients have many similar physical symptoms, there are physical symptoms that may be absent or less frequent in atypical anorexia nervosa as compared to typical anorexia nervosa such as lanugo hair (1). These symptoms often are attributed to low body weight which is not seen in atypical anorexia nervosa.

Psychiatric/Cognitive Symptoms

-       Intense fear of gaining weight or becoming fat

-       Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on  self-evaluation

-       Obsessive and compulsive symptoms (2)

-      Anxiety (2)

-      Depression

-     Somatization (2)

-     Social phobia

It is common for patients with atypical anorexia nervosa to have co-morbid psychiatric disorders such as depression, anxiety, and OCD. Depressive and anxious disorders account for the majority of the comorbid disorders seen in association with atypical anorexia nervosa. However, there are limited studies on the prevalence of psychiatric illness in atypical anorexia nervosa.

Diagnosis
The diagnosis of atypical anorexia nervosa is carried out by a licensed health practitioner based on a clinical assessment which includes physical, psychiatric, and behavioral symptoms.

DSM-5 Criteria
The diagnostic criteria used to diagnose psychiatric conditions are found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. The DSM-5 is the most current revision of the manual which was updated in ... to include atypical anorexia nervosa. This update addressed problems pointed out by the psychiatric community that the eating order section of the DSM-4 did not properly address the segment of patients who met many of the criteria of typical anorexia nervosa but did not meet the weight requirement of typical anorexia nervosa. Many of these patients were left without a specific diagnosis while dealing with an eating disorder that did not fit any criteria. Due to this, the DSM-5 included descriptions of disorders that did not meet criteria but created significant impairment in a patient's daily life. These disorders are found in the "Other specified feeding or eating disorders" or OSFED.

According to the DSM-5, in the "Other specified feeding or eating disorders", atypical anorexia nervosa is defined as "all of the criteria for anorexia nervosa are met, except that despite significant weight loss, the individual's weight is within or above the normal range." There is no consensus in the psychiatric community about what constitutes "significant weight loss" and there are calls from the psychiatric community that this be researched and addressed in subsequent DSM publications.

Epidemiology
It is difficult to gauge the true prevalence of atypical anorexia pre-2013 because patients were lumped together under the EDNOS diagnosis. Evidence suggests that atypical anorexia is more prevalent than anorexia nervosa. For example, one prospective study of 196 women found a prevalence of 2.8% for atypical anorexia, compared to only 0.8% for anorexia nervosa by the age of 20. However, individuals experiencing atypical anorexia nervosa are less likely to receive care. In addition, when these individuals do receive care, there is a higher rate of treatment dropout and decreased treatment response. This can be attributed to a number of reasons including less stigma surrounding atypical AN due to patients in the normal or overweight range, as well as, the perception of patients that the severity of their eating disorder is low because of their weight range.