Talk:Anorexia nervosa

Statistical Inaccuracy

"Globally anorexia is estimated to affect two million people as of 2013." That seems very low, but okay... "It is estimated to occur in 0.9% to 4.3% of women and 0.2% to 0.3% of men in Western countries at some point in their life." Those numbers do not add up. Even assuming on the low end that it affects 1% of all people, that's about 70 million people worldwide, not 2 million. I checked the reference for these statements and could not find any mention of anorexia whatsoever. — Preceding unsigned comment added by 2601:204:C103:6036:BC73:88F7:91D0:CDC7 (talk) 23:06, 17 March 2016 (UTC)

Anorexia vs Bulimia

This text is wrong:

Seemingly minor changes in a people's overall behavior or attitude can change a diagnosis from anorexia: binge-eating type to bulimia nervosa. A main factor differentiating binge-purge anorexia from bulimia is the gap in physical weight. Someone with bulimia nervosa is ordinarily at a healthy weight, or slightly overweight. Someone with binge-purge anorexia is commonly underweight.[75] People with the binge-purging subtype of AN may be significantly underweight and typically do not binge-eat large amounts of food, yet they purge the small amount of food they eat.[75] In contrast, those with bulimia nervosa tend to be at normal weight or overweight and binge large amounts of food.[75] It is not unusual for a person with an eating disorder to "move through" various diagnoses as their behavior and beliefs change over time.[32]

This makes it look like doctors look at a patient's weight, and call them anorexic if they're underweight, or bulimia if they're normal or slightly overweight.

Doctors don't do this. They use the DSM 5, which says that - if you have bulimia in the context of anorexia, it is still anorexia. The one for anorexia says:

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Coding note: The ICD-9-CM code for anorexia nervosa is 307.1, which is assigned regardless of the subtype. The ICD-10-CM code depends on the subtype (see below).

Specify whether: (F50.01) Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

(F50.02) Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Specify if: In partial remission: After full criteria for anorexia nervosa were previously met, Criterion A (low body weight) has not been met for a sustained period, but either Criterion B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) or Criterion C (disturbances in self-perception of weight and shape) is still met.

In full remission: After full criteria for anorexia nervosa were previously met, none of the criteria have been met for a sustained period of time.

Specify current severity: The minimum level of severity is based, for adults, on current body mass index (BMI) (see below) or, for children and adolescents, on BMI percentile. The ranges below are derived from World Health Organization categories for thinness in adults; for children and adolescents, corresponding BMI percentiles should be used. The level of severity may be increased to reflect clinical symptoms, the degree of functional disability, and the need for supervision.

Mild: BMI ≥ 17 kg/m2

Moderate: BMI 16–16.99 kg/m2

Severe: BMI 15–15.99 kg/m2

Extreme: BMI < 15 kg/m2

The one for bulimia says:

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.

2) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Specify if: In partial remission: After full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time.

In full remission: After full criteria for bulimia nervosa were previously met, none of the criteria have been met for a sustained period of time.

Specify current severity: The minimum level of severity is based on the frequency of inappropriate compensatory behaviors (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.

Mild: An average of 1–3 episodes of inappropriate compensatory behaviors per week.

Moderate: An average of 4–7 episodes of inappropriate compensatory behaviors per week.

Severe: An average of 8–13 episodes of inappropriate compensatory behaviors per week.

Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.

I'm going to notify the resident medical genius at Wikipedia, James Heilman to add his 2 cents to this too 182.255.99.214 (talk) 12:45, 27 January 2016 (UTC)

User name is "Doc James". To get my attention you need to @Doc James:. Let me look. 15:00, 27 January 2016 (UTC)

Yes agree we should base it on the DSM 5. You want to update it to that? Better source than the abnormal psych textbook. Doc James (talk · contribs · email) 15:03, 27 January 2016 (UTC)

Low weight requirement for AN

Let's start with removing the low weight requirement. DSM 5 has removed that 182.255.99.214 (talk) 12:52, 17 February 2016 (UTC)

This is the DSM 4 requirement: A. A refusal to maintain body weight at or above a minimally normal weight for age and height (e.g. weight loss leading to a maintenance of body weight less than 85% of that expected, or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).

Compare this with DSM 5: A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

This is DSM 4: B. Intense fear of gaining weight or becoming fat, even though underweight.

Compare this with DSM 5: B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

This is DSM 4: C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Compare this with DSM 5: C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

This is DSM 4: D. In postmenarcheal females, amenorrhea, i.e. the absence of at least three or more consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g. oestrogen, administration).

Compare this with DSM 5: (removed)

This is DSM 4: Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behaviour (i.e. self-induced vomiting or the misuse of laxatives, diuretics or enemas)

Compare this with DSM 5: (F50.01) Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

This is DSM 4: Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behaviour (i.e. self induced vomiting or the misuse of laxatives, diuretics or enemas).

Compare this with DSM 5: (F50.02) Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). 182.255.99.214 (talk) 06:23, 18 February 2016 (UTC)

I've emphasized where the low weight requirement has been modified. It is also highlighted here: "In addition, the first criterion for Anorexia, which is currently that the "patient must be 85% or less than their recommended body weight," is removed. The DSM-5 now addresses weight by requiring ""restriction of energy intake . . . leading to significantly low body weight."". "For example, many insurance companies have long relied upon the DSM-IV criterion that "the patient must be 85% or less than their recommended body weight" as a way to restrict or terminate treatment for Anorexia for anyone above that percentage or who reached that percentage while in treatment. Without this criterion, insurance companies can no longer rely upon percentage of body weight as a barrier to treatment". (http://www.kantorlaw.net/Blog/2012/December/The-DSM-5-Makes-Important-Changes-to-the-Diagnos.aspx) "In anorexia nervosa, the removal of the amenorrhoea criteria and clarification of the low body weight criterion are also significant in nutritional management" (http://www.nedc.com.au/e-bulletin-number-thirteen) 182.255.99.214 (talk) 06:28, 18 February 2016 (UTC)

LGBT tag

Why does the article on Anorexia talk page, have a category tag classifying it as an "LGBT" article? Is this plain homophobic bullying? There is nothing even about this relationship in the anorexia article itself 182.255.99.214 (talk) 12:54, 27 January 2016 (UTC)

I think it is more common in this community. Doc James (talk · contribs · email) 13:24, 27 January 2016 (UTC)

Diff for the addition is here. The editor, now retired, was highly unlikely to be engaging in homophobic bullying. Try to assume good faith. William Avery (talk) 13:40, 27 January 2016 (UTC)

Risk factors

The risk factors for anorexia should be classified according to "predisposed", "precipitated", and "perpetuated", like this: http://autoprac.com/anorexia-nervosa Ana4eva (talk) 13:01, 17 February 2016 (UTC)

Not sure. We should use easier language than those. Doc James (talk · contribs · email) 13:26, 17 February 2016 (UTC)

Autism comorbidity

I think it's important to separate autism and anorexia being somehow linked, as supposed to just having similar symptoms (http://www.eatingdisorderhope.com/treatment-for-eating-disorders/types-of-treatments/autism-and-anorexia-examining-the-correlation). "It is clear that autism spectrum disorders (ASD) and anorexia nervosa (AN) have some similarities. Both groups demonstrate a lower capacity for empathy, difficulty set shifting and rigid attitudes. These traits often come across to most of us as “uptight” or “tightly wound” and “cold” or “impersonal”."

"When they are underweight, people with anorexia get even more like people with autism," says Treasure. "They can't interpret other people's emotions, they can't regulate their own emotions, and they get overwhelmed when they are frightened or angry." "The theory is that hunger focuses the brain so sharply on the task of getting food that, as with other stressors, it shuts down higher cognitive functions, like reading other people's emotions"(http://content.time.com/time/health/article/0,8599,1904999,00.html)

It's also important to differentiate anorexia from autism, because having autistic traits, doesn't even mean it's on the spectrum. They're different things Ana4eva (talk) 06:37, 18 February 2016 (UTC)

Please read WP:MEDRS regarding what type of sources we generally use. The popular press is not suitable for medical content. Best Doc James (talk · contribs · email) 10:34, 18 February 2016 (UTC)

Redundency

It is estimated to occur in 0.9% to 4.3% of women and 0.2% to 0.3% of men in Western countries at some point in their life. About 0.4% of young females are affected in a given year and it is estimated to occur ten times less commonly in males. Is it necessary to give the "ten times less commonly in males" point when we gave a more a specific estimate that essentially says the same thing in the previous sentence? I understand that in the body we should give all the estimates given in all the reliable sources we have consulted, but the lead is supposed to summarize, so one or the other should be sufficient. Hijiri 88 (聖やや) 06:17, 29 February 2016 (UTC)

Yes, because percentages don't make it as clear as saying 10x less prevalent in males 182.255.99.214 (talk) 11:06, 7 April 2016 (UTC)

"Orthorexia nervosa"

Should this non-scientific link be removed? It isn't even recognized as a mental illness under DSM 5, and is some sort of self diagnosis that is being made. I think it probably is better classified under EDNOS 182.255.99.214 (talk) 11:07, 7 April 2016 (UTC)

Unable to get refs to work

"The Royal College of Psychiatrists has developed a checklist which is intended to be used be used in concert with the MARSIPAN guidance.

Psychotropic medication

Medicating the very sick patient with AN is often difficult. The patient may be very agitated, and treatment with a small oral dose of a benzodiazepine or a neuroleptic can be beneficial. For more extreme agitation, for example, when a very emaciated patient is fighting the insertion of a nasogastric tube, the use of parenteral medication can be very dangerous, because in such a patient a small intramuscular dose of a benzodiazepine can cause fatal hypotension or apnoea. The advice given in MARSIPAN is to manage such a patient in a medical Intensive Care setting, so that cardiovascular and respiratory support can be given if required."

Doc James (talk · contribs · email) 18:49, 10 April 2016 (UTC)

Sorry, what do you mean @User:Doc James? Yes, benzo and antipsychotics (sometimes people call them neuroleptics) are sometime used so that we can help put NG tubes in etc. Is your point because it can cause hypotension or apnea, to send them into ICU so they can get cardio or resp support? It's correct, but that's not already on here? It should be, at least under an acute care area for Tx 182.255.99.214 (talk) 14:44, 11 April 2016 (UTC)

Which ref supports this content? WP:MEDHOW provides some advice on ref formatting. Doc James (talk · contribs · email) 14:58, 11 April 2016 (UTC)

Thank you Doc James. I have put the link in under reference 101 and it works on my machine.

I have been trying to understand your objection to the advice about benzos and neuroleptics. Yes, you are right, the problem is that the use of these drugs, especially parenterally, in a patient with a BMI of 9 and a BP of 80/30 can be very tricky, and considering ICU care is a reasonable option. This came not from a publication but from a discussion that is reported in the MARSIPAN guidelines. Perhaps I didn't understand your point well enough. Please clarify.

Paul2322 (talk) 15:41, 11 April 2016 (UTC)