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Panminerva Medica 2002 December;44(4):301-11

lingua: Inglese

Anorexia nervosa. A review

Tamburrino M. B., McGinnis R. A.

Department of Psychiatry Medical College of Ohio, OH, USA


Anorexia ner­vo­sa is an ill­ness char­ac­ter­ized by sig­nif­i­cant ­weight ­loss, ame­nor­rhea, dis­tort­ed ­body ­image and a relent­less pur­suit of thin­ness. The dis­or­der ­affects pri­mar­i­ly ­young wom­en ­between the ­ages of 13 and 20, and is ­more com­mon­ly ­seen in west­ern­ized coun­tries. Although the inci­dence is rel­a­tive­ly ­rare, affect­ing approx­i­mate­ly 0.5 to 1.0% of young­er wom­en in the United States, med­i­cal com­pli­ca­tions can be ­severe, and ­long-­term mor­tal­ity ­rates may ­approach 20%. Recent stud­ies indi­cate ­that sub­clin­i­cal eat­ing dis­or­ders ­occur in at ­least 5% of wom­en and up to 1/3 of ­females ­among spe­cial pop­u­la­tions ­such as ath­letes and insu­lin-depen­dent dia­bet­ics. The eti­ol­o­gy of eat­ing dis­or­ders is not ­known, but ­there are psy­cho­so­cial and bio­log­i­cal influ­enc­es. Malnutrition asso­ciat­ed ­with ano­rex­ia ner­vo­sa can ­affect near­ly eve­ry ­organ ­system in the ­body, ­with car­diac com­pli­ca­tions respon­sible for 50% of the ­deaths in ano­rex­ia ner­vo­sa. More ­recent ­brain stud­ies sug­gest ­that ­grey mat­ter vol­ume def­i­cits may per­sist ­after refeed­ing. Subclinical ano­rex­ia ner­vo­sa in ath­letes is asso­ciat­ed ­with pre­ma­ture frac­tures and ­long-­term oste­o­pe­nia. Early com­pli­ca­tions, ­such as reti­nop­a­thy, are increas­ing­ly ­seen in ­female dia­bet­ics who ­have dis­or­dered eat­ing pat­terns. Well-­designed empir­i­cal ­trials of treat­ment ­with psy­cho­ther­a­py and psy­cho­phar­ma­col­o­gy are ­very lim­it­ed. There is ­some evi­dence ­that fam­i­ly ther­a­py may be ­more effec­tive ­than indi­vid­u­al ther­a­py in young­er ano­rec­tics who ­have ­been ill ­less ­than 3 ­years. The ­most prom­is­ing find­ing in med­i­ca­tion treat­ment sug­gests ­that flu­ox­e­tine may ­help pre­vent ­relapse in the ­weight ­restored ano­rec­tic.

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