Mental Health Nursing
high school girl, who has fears of being obese, visited the primary healthcare centre with her mother.
The mother reports that her daughter refuses to eat with the family, and often pretends being asleep. Which of the following disorders best describe the girl?
Explanation
Core Concept: Anorexia Nervosa is an eating disorder characterized by an intense fear of gaining weight, a distorted body image, and severe restriction of food intake. Avoiding family meals and hiding eating behaviors (such as pretending to sleep to avoid eating) are classic signs of food restriction and secrecy associated with this disorder.
Clinical Presentation:
- Intense fear of obesity and distorted body image.
- Severe food restriction, avoidance of social eating, and secretive behaviors.
- Physical signs: amenorrhea, lanugo (fine body hair), bradycardia, hypotension, and severe weight loss.
Diagnosis:
- First-line diagnostic plan: Comprehensive psychiatric interview and physical examination assessing BMI, vital signs, and nutritional status.
- Most accurate (gold standard) test: Diagnosis based on DSM-5 criteria (restriction of energy intake, intense fear of gaining weight, disturbed body image) alongside ECG and electrolyte panels to check for cardiac and metabolic complications.
Management:
- Acute management: Nutritional rehabilitation and medical stabilization (correcting electrolyte imbalances, monitoring closely for refeeding syndrome).
- Gold standard long-term management: Multidisciplinary approach including cognitive-behavioral therapy (CBT), family-based therapy (Maudsley approach for adolescents), and ongoing nutritional counseling.