MENTAL ANOREXIA It is always very difficult, even illusory, to define any psychiatriccondition in a few words. With this reservation, we can consideranorexia nervosa as a refusal to eat linked to a disturbance in theperception of body image. Epidemiology Impact -It has increased in recent decades, particularly among subjects considered to be at risk (ballet dancers, models). The annual incidence is approximately 14.6/100,000 in girls,1.8/100,000 in boys. Prevalence -It is around 1% in women. Age at diagnosis -Anorexia nervosa mainly affects women between the ages of 12 and 24, with two frequency peaks around 13-14 years and 16-17 years. It is rare after 40 years. Sex ratio -It is very disadvantageous to women (10 to 1). Ethnic factors -White women are much more affected than Asian or black women. Socio-economic factors -The disease is more common in middle or high socioeconomic classes. The prevalence of anorexia nervosa is also approximately 10 times greater amonggirls aged 16 to 18 attending a private school than among those of the same age attending apublic school. Etiology The exact etiology of anorexia nervosa is unknown (individual or familypsychopathology? Biological mechanism linked to serotonin, catecholamines orneuropeptides?), but some findings are of indisputable importance: - anorexia nervosa is very rare in situations of genuine food shortage; - numerous studies demonstrate the impact of the cult of thinness on young girls:research carried out among 1,800 18-year-old girls with normal weight and heightrevealed that 80% of them want to lose weight, 23% follow diet, 15% have bulimicepisodes, 8.2% vomit from time to time and 2.4% take “diet pills”. - genetic factors are involved (higher concordance in homozygous twinsthan in heterozygotes), but not identified.
Diagnostic The diagnosis of anorexia nervosa is classically based on the triad of weightloss-anorexia-amenorrhea, to which is added a certain number of specific psychological attitudes. Weight loss -It can be very significant, up to 50% of normal weight depending on age. The appearance is very evocative: melting of superficial and deep fat reserves (effacement of femaleforms: breasts, hips, buttocks), muscle wasting, dry and dull hair (even alopecia), ridged and brittlenails, hypertrichosis with appearance of lanugo, circulatory disorders (low blood pressure,bradycardia, cold and clammy extremities), constipation, enlarged salivary glands making a roundface which contrasts with the thinness of the rest of the body. The diagnosis of anorexia nervosatypically requires that the weight be less than or equal to 85% of the weight considered normal. Anorexia -It is established under the pretext of a diet and is associated with a whole ritual regarding food: collection of recipes, sorting of foods according to personal criteria, endlesschewing, merycism, potomania (the latter two being considered as gravity factors). Amenorrhea -It is constant (either primary if the girl had never been menstruated before, or secondary otherwise), usually coincides with the start of food restriction and readily persists forsome time after weight rebalancing. The amenorrhea of anorexia nervosa is said to be spontaneous(i.e. it disappears after administration of estrogens) and must, according to some, be observed overat least 3 successive cycles. Sexuality -She is completely disinvested, both physiologically and in her dimension of desire (the anorexic does not masturbate). On the other hand, seductive behaviors are not rare (controldimension), as well as a tendency towards voyeurism/exhibitionism. Intellect -Intellectual overinvestment is classic, but the results are better for learning than for creativity. Restrictive type or with hyperphagic attacks? -Anorexia nervosa and bulimia are two distinct pathologies, but they nevertheless have some common characteristics. It is thereforeappropriate to specify the type of anorexia: - restrictive type: during the period of anorexia nervosa, the subject has not, on aregular basis, experienced hyperphagic attacks nor resorted to induced vomiting orthe abuse of purgatives (laxatives, diuretics or enemas); - type with hyperphagic attacks: during the period of anorexia nervosa, the subject has regularlyexperienced hyperphagic attacks and/or resorted to induced vomiting or the abuse ofpurgatives (laxatives, diuretics or enemas).