Diagnosis of anorexia nervosa

The diagnosis of anorexia is based on the clinical features of the disease. Denial is the main feature, patients resist examination and treatment. They usually come to the doctor at the insistence of relatives or because of concomitant diseases. Anorexia nervosa, as a rule, manifests itself with noticeable characteristic symptoms and signs, first of all, a loss of 15% or more of body weight in a young girl experiencing a fear of obesity, with amenorrhea, denial of the disease, and otherwise looking well. Fat deposits on the body are practically absent. The basis of diagnosis is the isolation of the key "fear of obesity", which does not decrease even with weight loss. In women, the presence of amenorrhea requires clarification of the diagnosis. In severe cases of severe depression or with symptoms suggestive of another disorder, such as schizophrenia, a differential diagnosis may be required. In rare cases, severe somatic diseases such as regional enteritis or a brain tumor are mistakenly diagnosed as anorexia nervosa. Amphetamine use can cause similar symptoms of anorexia.

Anorexia is most often diagnosed when patients already have a pronounced deficit in body weight. This is explained by careful dissimulation of conscious refusal to eat, inducing artificial vomiting, taking laxatives and diuretics. In this regard, several years pass from the onset of the disease until the correct diagnosis is established. Patients are examined for a long time by therapists, gastroenterologists in search of somatic and endocrine pathology, and even undergo surgical interventions. They are erroneously diagnosed with pituitary cachexia and prescribed replacement therapy. Anorexia is diagnosed based on diagnostic criteria that were proposed by various authors, but it was difficult to represent the entire population of patients with nervous anorexia. The American Psychiatric Association first proposed the "DSM-II", and then the revised criteria of anorexia "DSM-III" of mental illnesses, including nervous anorexia. The latest "DSM-III" include:

• A. A strong fear of gaining weight that does not subside despite weight loss.
• B. Disturbance of body image (“I feel fat” – even in the presence of exhaustion).
• C. Failure to maintain body weight above the minimum normal for one's age and height.
• D. Amenorrhea.

Type I for patients who only restrict food intake. Type II for patients who restrict food intake and purge (induce vomiting, take laxatives, diuretics). "DSM-III" criteria for bulimia:

• A. Recurrent episodes of binge eating (frequent consumption of large amounts of food in limited periods of time, usually less than 2 hours).
• B. At least 3 of the following criteria:
  • consumption of high-calorie, easily digestible foods during bouts of "binge eating";
  • unnoticed eating of large amounts of food during an attack;
  • episodes of binge eating are stopped by abdominal pain, sleep, conscious interruptions, or deliberately induced vomiting;
  • repeated attempts to reduce body weight through severe dietary restrictions, induced vomiting, or the use of diuretics;
  • frequent fluctuations in body weight of more than 4 kg in accordance with overeating or weight loss.
• C. Understanding that such a desire to eat is abnormal, fear of the impossibility of stopping eating voluntarily.
• D. Frequent "binges" should be at least twice a week and last for about 3 months.
• E. If the criteria for anorexia nervosa are also present, then both diagnoses are made.

However, the presented schemes do not fully reflect the characteristics of patients and, first of all, this applies to the severity of somatoendocrine disorders and the characteristics of personality traits.

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Differential diagnosis of anorexia

When excluding somatic pathology, the endocrinologist needs differential diagnostics of anorexia with Simmonds' disease, adrenal insufficiency. Differential diagnostics with neurosis, schizophrenia with anorexic syndrome, depression are also necessary.

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