Diagnosis of anorexia nervosa

Diagnosis of anorexia is based on clinical signs of the disease. Negation is the main symptom, patients resist testing and treatment. They usually get 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, primarily loss of 15% or more of the body weight of a young girl experiencing fear of fullness, with amenorrhea, negation of the disease, and otherwise looking safely. Fat deposits on the body are practically absent. The basis of diagnosis is the allocation of a key "fear of fullness", which does not decrease even with loss of body weight. In women, the presence of amenorrhea requires a more precise diagnosis. In severe cases of severe depression or with symptoms indicative 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. Similar symptoms of anorexia can cause the use of amphetamines.

The diagnosis of anorexia is most often made by the patient when they already have a pronounced body mass deficit. This is due to a thorough dissimulation of a conscious refusal to eat, causing artificial vomiting, laxative and diuretics. In this regard, several years pass from the moment of the onset of the disease to the correct diagnosis. Patients are examined for a long time from therapists, gastroenterologists in search of somatic and endocrine pathology, are even subjected to surgical interventions. They make an erroneous diagnosis of pituitary cachexia and prescribed substitution therapy. Diagnosis of anorexia is based on diagnostic criteria, which were proposed by different authors, but it was difficult to imagine the entire population of patients with anorexia nervosa. The American Psychiatric Association first proposed "DSM-II", and then revised criteria for anorexia "DSM-III" of mental illness, including anorexia nervosa. The latest "DSM-III" includes:

• A. Strong fear of getting fat, which does not decrease, despite the reduction in body weight.
• B. Impaired perception of my body ("I feel thick" - even if there is depletion).
• C. Refusal to keep body weight above the minimum, normal for its age and growth.
• D. Amenorrhea.

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

• A. Recurring episodes of binge eating (frequent consumption of large amounts of food at limited intervals, usually less than 2 hours).
• B. At least 3 criteria from the following:
  • consumption of high-calorie, easily assimilated food during bouts of "gluttony";
  • unnoticeable eating of a large amount of food during an attack;
  • episodes of overeating stop pain in the abdomen, sleep, conscious disturbances or specially caused vomiting;
  • repeated attempts to reduce body weight due to strict restriction of diets, especially caused by vomiting or 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 is abnormal, the fear of being unable to stop is voluntary.
• D. Frequent "gluttony" should be at least twice a week and last about 3 months.
• E. If the criteria for anorexia nervosa are also present, then both diagnoses are made.

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

[1], [2], [3], [4], [5], [6]

Differential diagnosis of anorexia

With the elimination of somatic pathology, the endocrinologist needs differential diagnosis of anorexia with Simmonds disease, adrenal insufficiency. Differential diagnostics with neurosis, schizophrenia with anorectic syndrome, and depression are also needed.

[7], [8], [9], [10], [11], [12]