Preparation for Child Psych PRITE and Boards
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===Differential diagnosis===
 
===Differential diagnosis===
History and physical exam are essential for ruling out medical causes of anorexia (poor appetite) and weight loss. Some examples include: chronic infection, thyroid disease, Addison’s disease, IBD, connective tissue disorders, cystic fibrosis, peptic ulcer disease, disease of the esophagus, celiac disease, disease of the small intestine, diarrhea, diabetes, and occult malignancies.(1)
+
History and physical exam are essential for ruling out medical causes of anorexia (poor appetite) and weight loss. Some examples include: chronic infection, hyperthyroidism, Addison’s disease, IBD, connective tissue disorders, cystic fibrosis, peptic ulcer disease, disease of the esophagus or small intestine, celiac disease, diarrhea, diabetes, and occult malignancies.(1)
 +
 
 +
===Co-morbidities===
 +
Common co-morbid conditions include depression, social anxiety, separation anxiety, [OCD|obsessive-compulsive disorder], GAD, and substance abuse, and avoidant, dependent,
 +
obsessive-compulsive, or passive-aggressive personality disorders
 +
are also often diagnosed
  
  
 
==References==
 
==References==
 
1. Lock, J. et.al. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Eating Disorders. J Am Acad Child Adolesc Psychiatry 2015;54(5):412–425
 
1. Lock, J. et.al. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Eating Disorders. J Am Acad Child Adolesc Psychiatry 2015;54(5):412–425
 +
 
2. Arcelus J, et. al. Mortality rates in patients with anorexia nervosa and other eating disorders. Arch Gen Psychiatry. 2011; 68:724-731
 
2. Arcelus J, et. al. Mortality rates in patients with anorexia nervosa and other eating disorders. Arch Gen Psychiatry. 2011; 68:724-731
  
 
[[Category: Eating Disorders]]
 
[[Category: Eating Disorders]]
 
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Revision as of 20:55, 4 September 2015

Introduction

Anorexia nervosa (AN) was first described in 1689 by Richard Morton, who called it nervous consumption. In 1870's Sir William Gull in England coined the terms anorexia nervosa while Charles Lasegue in France described anorexia hysterique

Epidemiology

  • Prevalence among US female adolescents is 0.5% and 1-2% among adult females.
  • F:M ratio is 10:1.
  • Mortality in patients with AN is 5-7%; Death is most often secondary to medical complications of starvation (50%) or suicide (50%).(2)

Diagnosis

Essential features of DSM-5 diagnosis are:

  • (A)Persistent restriction of energy intake
    • This generally means BMI<17 for adults (however, those with BMI>17 may have mild AN)
    • In children, BMI below the 10th percentile is consistent with AN diagnosis (1)
  • (B) Fear of become fat or persistent behaviors that prevent weight gain
  • (C) Disturbance of body image

The DSM-IV requirement for amenorrhea was removed in DSM-5

Differential diagnosis

History and physical exam are essential for ruling out medical causes of anorexia (poor appetite) and weight loss. Some examples include: chronic infection, hyperthyroidism, Addison’s disease, IBD, connective tissue disorders, cystic fibrosis, peptic ulcer disease, disease of the esophagus or small intestine, celiac disease, diarrhea, diabetes, and occult malignancies.(1)

Co-morbidities

Common co-morbid conditions include depression, social anxiety, separation anxiety, [OCD|obsessive-compulsive disorder], GAD, and substance abuse, and avoidant, dependent, obsessive-compulsive, or passive-aggressive personality disorders are also often diagnosed


References

1. Lock, J. et.al. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Eating Disorders. J Am Acad Child Adolesc Psychiatry 2015;54(5):412–425

2. Arcelus J, et. al. Mortality rates in patients with anorexia nervosa and other eating disorders. Arch Gen Psychiatry. 2011; 68:724-731