CPG for Eating Disorders

c) Body image distortion that consists of a specific psychopathology characterised by a dreadof fatness and flaccidity of body areas that persists as an intrusive, overvalued idea, leadingthe patient to impose a low weight threshold on himself or herself.d) A widespread endocrine disorder that affects the hypothalamic-pituitary-gonadal axismanifesting in women as amenorrhoea and in men as loss of sexual drive and potency (Anapparent exception is the persistence of vaginal bleeds in anorexic women who arereceiving replacement hormonal therapy, most commonly taken as a birth control pill).There may also be elevated levels of growth hormone and cortisol, changes in theperipheral metabolism of the thyroid hormone, and insulin secretion abnormalities.e) If onset occurs before puberty, the sequence of pubertal events is delayed or even stunted(growth ceases; in girls the breasts do not develop and there is a primary amenorrhoea; inboys the genitals remain juvenile). If recovery takes place, puberty is often completednormally, but the menarche is late.Excludes:Anorexia, loss of appetite (R63.0).Psychogenic anorexia (F50.8).Atypical Anorexia Nervosa (F50.1)This term must be used in cases where one or more key features of AN (F50.0), such asamenorrhoea or significant weight loss, are missing, but that otherwise present a rathercharacteristic clinical picture. These types of patients are more frequent in consultative andliaison psychiatry and in primary care. Patients who present all key symptoms of AN in a milddegree an also be included in this group. This term must not be used for eating disorders thatresemble AN but that are actually a result of a known physical ethiology.Diagnostic Criteria for Bulimia Nervosa (F50.2)Syndrome characterised by repeated episodes of binge-eating and excessive preoccupation withthe control of body weight, leading the patient to use extreme measures to mitigate the weightgain caused by ingested food. This term should be limited to the forms of the disorder that arerelated to AN by virtue of sharing the same psychopathology.The age and sex distribution is similar to that of AN, but the age of presentation tends to beslightly later. The disorder may be considered a sequel to persistent AN (although the reversesequence may also occur). At first glance, a previously anorexic patient may appear to improveas a result of weight gain and menstruation may even return in the case of a female, but aharmful pattern of behaviour characterised by overeating and self-induced vomiting thenbecomes established. Repeated self-induced vomiting is likely to give rise to disturbances ofelectrolyte balance, physical complications (litany, epileptic seizures, cardiac arrhythmias,muscular weakness), and greater loss of weight.Diagnostic Guidelines:All the disturbances listed below must be present, thus constituting strict diagnostic guidelines.229CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS