Anne D. Walling
(Australia–Australian Family Physician, April 2000, p. 328.) In adolescent patients, anorexia nervosa often begins with moderate dieting, but then they become driven to be in control of their diet because they feel they have little control in other areas of their life. The disease progresses to a preoccupation with food and a distorted body image. Adolescents with anorexia nervosa commonly come from higher socioeconomic backgrounds and tend to be high-achieving perfectionists. It has been suggested that patients with anorexia nervosa may fear adult life, especially sexuality, and may have controlling and enmeshed families. Several significant medical conditions are associated with anorexia nervosa, including the side effects of long-term starvation, and the high prevalence of depression among these patients can lead to a serious risk of suicide. Diagnosis of anorexia nervosa may be difficult because of the secretive and evasive behavior that is associated with the condition. Management of anorexia nervosa often requires a multidisciplinary approach, involving nutritionists and psychologic support. Up to one half of all patients with anorexia nervosa manage to regain and sustain weight. Conversely, the mortality rate may be as high as 20 percent. The remaining 30 to 40 percent of patients will have continuing weight problems, maladaptive behaviors and associated medical problems.
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