Anxiety Disorders and Stress Q 14
The school nurse assesses for anorexia nervosa in an adolescent girl. Which of the following findings are characteristic of this disorder? Select all that apply.
A. Bradycardia
B. Hypotension
C. Chronic pain in one or more sites
D. Fear of having a serious illness
E. Irregular or absent menses
F. Refusal to maintain a minimally normal weight
Correct Answer: A, B, E, F
These are all characteristics of anorexia nervosa. Anorexia nervosa is an eating disorder defined by restriction of energy intake relative to requirements, leading to a significantly low body weight. Patients will have an intense fear of gaining weight and distorted body image with the inability to recognize the seriousness of their significantly low body weight.
Option A: Cardiac complications are arguably one of the most severe medical issues stemming from anorexia. Bradycardia (heart rate less than 60 beats per minute) and hypotension (blood pressure less than 90/50) are among the most common physical findings in anorexia, with bradycardia seen in up to 95 percent of patients.
Option B: Bradycardia (pulse <60) and hypotension are among the most common physical findings in patients with anorexia nervosa, with bradycardia seen in up to 95% of patients. Anorexia nervosa should be considered in the differential for unexplained bradycardia in the outpatient setting. Low blood pressure and heart rate universally increase to normal levels after refeeding and restoration of normal weight.
Option C: Chronic pain in one or more sites is common for somatoform pain disorder. The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) category of Somatic Symptom Disorders and Other Related Disorders represents a group of disorders characterized by thoughts, feelings, or behaviors related to somatic symptoms. This category represents psychiatric conditions because the somatic symptoms are excessive for any medical disorder that may be present.
Option D: Fear of having a serious illness is common in hypochondriasis. Illness anxiety disorder (IAD) is a recent term for what used to be diagnosed as hypochondriasis, or hypochondria. People diagnosed with IAD strongly believe they have a serious or life-threatening illness despite having no, or only mild, symptoms. Yet IAD patients’ concerns are to them very real. Even if they go to doctors and no illnesses are found, they are generally not reassured and their obsessive worry continues.
Option E: Of patients with anorexia nervosa, 20–25 percent may experience amenorrhea before the onset of significant weight loss, and 50–75 percent will experience amenorrhea during the course of dieting and its weight loss. In some patients with anorexia nervosa, amenorrhea occurs only after more marked weight loss. Overall, the development of amenorrhea is most strongly correlated to loss of body weight.
Option F: Many exercise compulsively for extended periods of time. Patients with anorexia nervosa develop multiple complications related to prolonged starvation and purging behaviors.