Pneumomediastinum in an adolescent female with anorexia nervosa

This case report describes an unusual complication of anorexia nervosa. Hyperventilation-induced pneumomediastinum is a little understood, clinically relevant finding associated with many medical conditions, including anorexia nervosa.     

Anorexia nervosa associated with right frontal brain lesion

OBJECTIVE: A causal association of brain lesion to the physiopathology of anorexia nervosa will be discussed. METHOD: The authors report the case of a female patient who developed anorexia nervosa. A cavernoma, located on the frontal side of the right sylvian, was discovered by chance after a seizure. RESULTS: Surgical treatment of the lesion resulted in complete remission of the eating disorder at two years follow-up. CONCLUSION: Evidence for organic brain contribution to anorexia nervosa is strong and can be illustrated by this case report of anorexia nervosa associated with cerebral tumour.     

Pineal germinoma presenting as anorexia nervosa: Case report and review of the literature

OBJECTIVE: Tumors of the hypothalamic-pineal region may present with a wide variety of symptoms, including disturbed eating. We present a case where such a tumor was misdiagnosed as anorexia nervosa. METHOD: We describe a case of pineal germinoma invading the hypothalamus, which was initially diagnosed as anorexia nervosa. RESULTS: Clinical features included weight loss, vomiting, pyrexia, hypernatraemia, and visual disturbance and the typical psychopathology of anorexia nervosa was absent. CONCLUSION: Organic disorder should always be considered before making a diagnosis of anorexia nervosa, particularly if the presentation is atypical.     

Age of onset in eating disorders

This paper presents age of onset data for anorexia nervosa and bulimia nervosa, derived from a sample of 323 patients referred to a tertiary referral center. Patients had anorexia nervosa (n = 39), bulimia nervosa (n = 173), or bulimia nervosa with a history of anorexia nervosa (n = 173). While the pattern of onset of anorexia nervosa and bulimia nervosa is similar up to age 25, there is a significant excess of new cases of anorexia nervosa beyond this point. Significantly, age of onset was constant for both anorexia nervosa and bulimia regardless of whether they occurred in isolation (anorexia or bulimia alone) or in concert in the same individual (bulimia with a history of anorexia nervosa).     

Anorexia nervosa with bipolar disorder: A case report

Whether eating disorders cause or are the result of affective disorders is an unsettled question. The association between manic syndromes and eating disorders has been reported rarely. We describe a patient in whom anorexia nervosa developed shortly after the onset of rapid cycling manic—depressive disorder, and whose eating disorder and manic—depressive symptoms twice resolved simultaneously with lithium treatment. This case demonstrates that anorexia nervosa can occur in the context of manic—depressive disorder. This patient first developed depressive, then anorexic, and finally manic symptoms, rapidly alternating with depression. It is uncertain whether this patient's anorexia nervosa had a biological or a psychological basis. Response to lithium carbonate argues for the mobilization of an anorexic diathesis during a mood disorder. Appearance of the anorexia nervosa after initial depression could be seen also as an unsuccessful way to defend against major mood problems.     

On the emergence of bulimia nervosa as a syndrome a historical view

A review of the anorexia nervosa literature suggests that bulimia as a symptom has been known throughout the past century, but that bulimia as a syndrome is of recent origin, around 1940, when it occurred in connection with anorexia nervosa. Comments indicating concern over body shape are infrequent in case reports before the forties, but afterwards become the rule. It is hypothesized that changes in the cultural and economic conditions, such as the rising prosperity after the Depression Years, promoted an increased concern over body weight and recruited not only more, but also women of a psychologically different composition from the traditional anorexia nervosa patient, into dieting. This situation exposed more females to the risk of developing anorexia nervosa and those with a particular vulnerability, for example a tendency for affective instability, to the risk of developing bulimia nervosa. Similar dynamics might have promoted the unfolding of the bulimia nervosa syndrome in the late fifties and sixties.     

Anorexia nervosa and schizophrenia in a male Chinese

A case of a young male Chinese recent migrant with anorexia nervosa and schizophrenia is presented. The relevant diagnostic issues relating to anorexia nervosa among Chinese males and the nature of the relationship between anorexia nervosa and schizophrenia are discussed. © 1995 by John Wiley & Sons, Inc.     

Superior mesenteric artery syndrome presenting as an anorexia nervosa-like illness

Anorexia nervosa is often overdiagnosed in adolescent females with anorexia and extreme weight loss. In some cases, an anorexia nervosa-like illness is due to a treatable organic disorder. We describe a 16-year-old female with anorexia, vomiting, extreme weight loss, and amenorrhea who was referred as an anorexia nervosa case and was subsequently found to have superior mesenteric artery syndrome that was causing a duodenal obstruction. Conservative treatment with oral hypercaloric liquid feeding resulted in optimal weight gain and complete recovery. This syndrome should be considered in adolescents with an anorexia nervosa-like illness associated with vomiting and postprandial epigastric discomfort.     

Suicide and attempted suicide in eating disorders, obesity and weight-image concern

Suicide in anorexia nervosa and bulimia nervosa is a major cause of death. Meta-analyses have shown that individuals suffering from anorexia nervosa and bulimia nervosa commit suicide more often than their counterparts in the general population; also a few studies have suggested that suicide is the major cause of death among patients with anorexia nervosa, refuting the assumption that inanition generally threatens the life of these patients. Data concerning suicide in bulimia nervosa, on the other hand, are still scarce but suicide attempts are easily found among cohorts of patients with bulimia nervosa, which constitutes a risk factor for completed suicide. Suicidality in obesity and individuals with disturbed weight status has been reported. Both in the case of bulimia nervosa and obesity more long-term follow-up studies need to be completed before the risk of suicide for such disorders may be compared with that for anorexia nervosa.     

Bulimia and anorexia nervosa alternating with the seasons: A case report

A case of seasonal bulimia nervosa developing in a 26 year old woman with preexisting anorexia nervosa is described. The relationship between seasonal affective disorder, anorexia, and bulimia is discussed.     

Use of total parenteral nutrition in the refeeding of selected patients with severe anorexia nervosa

OBJECTIVE: At present there is no consensus on how to refeed patients with severe anorexia nervosa. In these case reports, we describe two patients beset with gastrointestinal comorbidities which impaired their ability to refeed with a staged oral feeding program. The use of total parenteral nutrition (TPN) facilitated their recovery. METHOD: We present two cases of severe anorexia nervosa, complicated by comorbid gastrointestinal disorders, which precluded them from successful refeeding using oral food calories. The treatment with TPN consisted of using a surgically placed, indwelling tunneled catheter to deliver progressively increased amounts of intravenous calories. This facilitated successful weight restoration. CONCLUSION: Although most patients with anorexia nervosa should be refed with a dietary program which is based on progressive increases in oral calories, TPN should be judiciously considered for patients with severe anorexia nervosa who also have medical comorbidities which preclude the usage of this standard approach.     

On the uses of history in psychiatry: diagnostic implications for anorexia nervosa

OBJECTIVE: The current study demonstrates that recent attempts to equate anorexia nervosa with any form of voluntary self-starvation are not justified. METHOD: Three arguments are critically reconsidered: That weight phobia was not part of early case reports on anorexia nervosa, that weight phobia should be eliminated from the diagnosis of anorexia nervosa, and that there is a continuity of forms of extreme fasting since the late Middle Ages. RESULTS: A critical approach to the history of eating disorders by interpreting historical sources makes the emergence of anorexia with weight phobia in the middle of the 19th century probable. The criteria for establishing psychiatric diagnoses and the differences between historical types of extreme fasting also support the historical novelty of anorexia nervosa. DISCUSSION: The etiologic implications of the historical specificity of anorexia nervosa are limited. Research should be directed to better understand self-starvation without weight phobia.     

Anorexia nervosa in a prelingually deaf young woman: A case report

This paper reports a case of anorexia nervosa in a 17-year-old girl who had been deaf since before the development of speech. The case-perhaps the first of its kind to be reported in the literature-raises interesting issues on interpretation. Attention is focused on the possibility that the two diseases might not be simply coexistant, the deaf-mutism possibly having predisposed the subject to the onset of anorexia nervosa.     

Chronicity in anorexia nervosa: Pregnancy and birth complications as risk factors

The chronic form of anorexia nervosa (AN) affects about one-quarter of patients and has serious somatic and psychological consequences. This paper presents evidence in support of the hypothesis that pregnancy and birth complications (PBCs) associated with neuropathology may be risk factors for chronic anorexia nervosa. There is increasing evidence that PBCs are risk factors for other psychiatric and somatic disorders. Recent findings of possible premorbid neuropathology in patients with anorexia nervosa suggest that PBCs may be risk factors for chronicity in anorexia nervosa. Topics discussed include the origins of constitutional vulnerability to anorexia nervosa, correlates of PBCs and of chronic anorexia nervosa, the relationship of PBCs to neurological and neurochemical abnormalities, chronicity of anorexia nervosa in relation to PBCs and to neurological and neurochemical abnormalities, and the research implications of the hypothesis that PBCs and associated neuropathology are risk factors for chronicity in anorexia nervosa.     

Gastric inhibitory polypeptide (GIP) in anorexia nervosa

Simultaneous glucose, insulin, and gastric inhibitory polypeptide (GIP) responses to meal stimulation were measured in five anorexia nervosa patients, eight bulimia patients with a past history of anorexia nervosa, and twenty-two healthy subjects. Although basal levels of GIP were similar, anorexia nervosa patients had an early and significantly higher (p <.05) mean peak GIP response than controls or bulimics with past anorexia nervosa. Mean peak insulin levels in anorexia nervosa patients did not differ significantly from those of control or bulimia/past anorexia nervosa patients, although anorexia nervosa patients had a nonsignificantly prolonged elevation of serum insulin. Glucose responses were not significantly different among the various groups. The exaggerated CIP response to meal stimulation with no significant difference in insulin levels suggests that the usual association between insulin and GIP is altered in anorexia nervosa. This is apparently a state-dependent abnormality since GIP responses in bulimia patients with a history of anorexia nervosa do not differ from healthy subjects. Altered GIP responses may contribute to the gastric hypomotility and acid secretion changes previously reported in low-weight anorexia nervosa patients.     

"Anorexia saved my life": coincidental anorexia nervosa and cerebral meningioma.

OBJECTIVE: We report on a 13-year-old girl with coincidental occult intracranial tumor and early-onset anorexia nervosa. METHOD: The cerebral meningioma was discovered fortuitously as the result of a research project using SPECT imaging to locate a neurobiological substrate in patients with anorexia nervosa. Without SPECT, the meningioma would have remained undiagnosed until it had become symptomatic. The two conditions appear to have been completely unrelated. RESULTS AND DISCUSSION: The case highlights two important points. First, intracranial pathology should also be considered however certain is the diagnosis of early-onset anorexia nervosa. Second, neuroimaging plays an important part in diagnosing early-onset anorexia nervosa, both from a clinical and a research prospective.     

Weight restoration in a patient with anorexia nervosa on dialysis

OBJECTIVE: We report a case of weight restoration in a patient with anorexia nervosa, end-stage renal disease (ESRD) requiring dialysis, and cardiac insufficiency. METHOD: The technical challenges and ethical issues involved in her clinical management are reviewed. Renal insufficiency is a common complication of more severe anorexia nervosa. RESULTS: Progression to renal failure, when it occurs, is most typically a terminal event. There are currently no published guidelines for monitoring the weight gain of patients undergoing dialysis. CONCLUSION: We present a case of a patient who progressed from renal insufficiency to renal failure while in treatment for anorexia nervosa, and who was ultimately successfully weight restored while on renal dialysis.     

Friderada: A case of miraculous fasting

The case of Friderada, reported by a monk in the 9th century, is presented. She first developed hysterical, then bulimic, and finally anorectic-like symptoms. She is compared with other historical cases considered as resembling anorexia nervosa. After a detailed diagnostic discussion of the case, it is concluded that (a) she presents the medieval case which most closely resembles modem anorexia nervosa, and (b) that primary anorexia has only gradually been differentiated from similar syndromes and become an ethnic disturbance reflecting typical conflicts of girls in modern western society during the last 100 years.