Posted: March 23rd, 2023
Numerous medical conditions affect different groups depending on changes in their bodies. Anorexia nervosa is one such condition whose typical onset is early or middle adolescence. During this stage, individuals experience fast physical and psychological growth and development. To understand the condition effectively, practitioners should learn its physiological and pathophysiological factors and its differential diagnosis to inform treatment.
The patient’s diagnosis is anorexia nervosa, which is an eating disorder. A patient with the condition has an abnormally low body weight, resulting from a strong desire to control weight and shape. The distorted perception of weight and intense fear of gaining weight leads them to adopt destructive eating behaviors. They use extreme attempts to avoid gaining weight that interferes with their lives (Bordo, 2020). For instance, they limit the amount of food they eat to prevent additional weight or try to lose it. The affected person could control the consumption of calories by using laxatives, enemas, diuretics, or engage in forced vomiting. The patient could also exercise excessively to achieve the same objective. The person continues to fear adding weight regardless of the weight they lose (Rania et al., 2021). The condition is not necessarily about food but an unhealthy means of coping with emotional challenges. Hence, a person with the disorder might equate thinness with self-worth.
Possible Differential Diagnoses
Practitioners can misdiagnose numerous medical and psychological conditions like anorexia nervosa. Diseases that lead to food refusal and weight loss can be easily confused with anorexia. Various conditions, such as hysteria disorders, depression, organic illness, schizophrenia, and hysteria disorders, can cause aversion to food and loss of appetite. However, the conditions do not include obsession with weight loss and drive for thinness, common in anorexia (Nadelson et al., 2017). In some cases, the conditions are comorbid with anorexia since it is uncommon to misdiagnose the condition. Ulcerative colitis and Crohn’s disease are rare but common comorbid with anorexia.
Another reason for common misdiagnosis is because anorexia is a psychological disorder. Achalasia is one of the common differential diagnoses in the cases of anorexia. The condition affects the esophagus, specifically peristalsis. The condition has been claimed in some cases where there is a sub-clinical appearance of anorexia and if complete diagnostic criteria of anorexia lack. However, in such cases, the patient does not try to control their weight like in anorexia. Acute pandysautonomia is another common differential diagnosis of anorexia nervosa. However, unlike anorexia, the condition is a collection of diseases and syndromes that affect the autonomic nervous system (ANS)’s autonomic neurons (Nadelson et al., 2017). The condition causes infections that affect the body and differs from anorexia, which is a psychological condition. Another disease that could be common among patients with anorexia is Lyme disease (or “great imitator”) (Rania et al., 2021). The superior mesenteric artery syndrome could also compress a section of the duodenum against the aorta, leading to anorexia-like complications. However, the condition can be ruled out through tests to determine the compression and the effect. Conditions affecting the digestive system, such as gall bladder disease, colonic tuberculosis, and insulinomas are (pancreatic tumors), can also be confused for anorexia until the correct diagnosis is made (Bordo, 2020). The knowledge of differential diagnosis helps to make the proper diagnosis for the right treatment.
Research related to the physiological principles of anorexia focus on psychological factors that cause the risk or maintain the condition. The psychological processes cause biases in thinking and perception that create feelings of fatness and unattractiveness. The condition is also maintained by cognitive biases affecting how the patient evaluates or thinks about food, eating, and body (Gorwood et al., 2016). One revealing finding is that individuals with the condition tend to overestimate their body size and shape. They tend to view themselves as being fat, even when they are skinny. The problem is not related to perception but how the person evaluates the perceptual information. Individuals with anorexia have altered brain structures and functions due to a deficit in neurotransmitters dopamine and serotonin. Neurotransmitters dopamine controls eating behavior and the reward system, while serotonin controls impulses and neuroticism. The corticolimbic system’s differential activation (affecting appetite) also affects the condition (Bordo, 2020). Anorexia patients also lack an overconfidence bias that makes others feel confident about their physical attractiveness. Those with anorexia appear to judge their attractiveness, suggesting a potential lack of the self-image-boosting bias.
Furthermore, research has revealed some personality traits that place patients at the risk of eating disorders, such as high obsessionality (intrusive thoughts about eating, food, and weight), perfectionism, and restraint. Other findings have revealed that some people with the disease have poor cognitive flexibility, affecting their capacity to alter past thinking patterns (Bordo, 2020). Overall, the findings reveal that the condition has a psychological basis, and their treatment patterns should target the system for effective recovery.
Pathophysiology helps create a deeper understanding of a disease, including the cortical or subcortical pathology of the condition. The concept covers correct disease manifestation, mechanism, and treatments (Huether and McCance, 2018). Providing a clear understanding of anorexia is a critical process in creating effective interventions. Ongoing research on anorexia nervosa suggests that there is no specific cause of the condition. Instead, the disease is an interplay of psychological, biological, and social factors. The condition is associated with endocrine abnormalities, including low gonadal hormones, increased secretion of cortisol, and mildly low levels of thyroxine (T4) and triiodothyronine (T3). Individuals with the condition experience obsessive-compulsive personality traits that cause them to develop and maintain negative eating behaviors. While the condition affects the brain and the endocrine system, severe undernourishment cases can negatively affect almost all major organs and systems in the body (Gorwood et al., 2016). Although research about biological causes of the condition is ongoing, some studies reveal potential genetic associations with anorexia nervosa.
Genetic causes of diseases are associated with changes in genes or genetic makeup that controls bodily functions. For example, they suggest a genetic tendency towards perfectionism, sensitivity, and perseverance (Beery & Workman, 2011). These are genetic factors associated with developing and maintaining the restraint to consume food or eliminate excessive calories. Potential social or environmental factors are associated with contemporary Western culture that emphasizes thinness. Being thin is associated with being attractive, causing people, especially young girls, to desire the “perfect” body shape (Bordo, 2020). Thus, effective treatment should focus on the three interrelated factors to fully understand the condition and successfully design interventions.
Anorexia nervosa is a common condition among women during early and middle adolescence when individuals experience rapid growth and development. The condition emanates from biological factors and psychological and environmental conditions that cause or maintain the condition. Medical experts should understand the interplay of the factors to create effective interventions and support recovery for the affected individual.
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