Anorexia nervosa

Although anorexia nervosa has been described since ancient times, it has only been under systematic scientific investigation over the past century. Although there are some differences between the most commonly used diagnostic criteria (ie, theDiagnostic and Statistical Manual of Mental Disorders-IV-TR and theInternational Classification of Diseases-10), which may account for differences in the reported epidemiologic rates, even a relatively low prevalence rate has important public mental health implications because of the high morbidity and mortality associated with this disorder. The etiology, course, treatment, and prognosis of this disorder fits into the bio-psycho-social model of mental illness with a strong, but as yet unclear, genetic predisposition influenced by psychologic factors and social support systems. Current good clinical practice recommendations include a multidisciplinary approach integrating pharmacotherapy, psychotherapy, and medical stabilization until future genetic and functional imaging studies reach a level of sophistication where they can guide accurate diagnosis and management.     

Anorexia nervosa. Fluid-electrolyte and acid-base manifestations

Psychiatric nurses need to know about the biologic, psychologic, and social implications of anorexia nervosa; however, the current nursing literature presents little information regarding the physiologic aspects of the syndrome. The pathophysiologic basis for the clinical manifestations of acid-base and fluid-electrolyte disturbances associated with anorexia nervosa are examined, and, when appropriate, the implications for nursing assessment are discussed.     

Anorexia nervosa and visual impairment

Following a review of the scarce literature, the author presents two cases of anorexia nervosa in visually handicapped or blind adolescents. Though visual experience might be considered as an essential factor in body perception and cultural valuation of thinness, the cases illustrate that visual impairment may accentuate a series of psychosocial problems contributing to the development of anorexia nervosa. Finally, it is emphasized that severe starvation itself may lead to ocular and visual impairment.     

Anorexia nervosa in Glasgow

A case note review of referrals to psychiatrists in Glasgow for 1979-1983 yielded 122 patients. Demographic and clinical data are described and compared to findings in earlier British series. Social class distribution for the Glasgow patients was no different from that of the local general population. This finding contrasted with the upper social class bias found in earlier studies and possible reasons for this difference are discussed.