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My curls aren’t as defined anymore this is what they don’t tell you about anorexia

— Eris (hospital arc) (@st4revd) November 19, 2022

In the last post, we saw how:

• A very important feature of AN is the fear of gaining weight
• Part of the limitations of this study was the fact that they used EAT-26 to assess the subjects
• When considering admission there are some features that should be paid close attention to such as temperature, heart rate and blood pressure.

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Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for four consecutive months. This month will be dedicated to Eating Disorders. In the first month, we discussed Depression, and in the subsequent month, anxiety. We just finished with Schizophrenia.

In this post, we are looking at Twitter posts. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.

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Pathology and Lab Findings

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Patients with An usually have abnormally high white blood cell count in patients who have started having visible signs of weight loss. There will be reduced potassium levels in patients with the binge and purge variant of AN. This is because of the loss of Hydrogen ions from hydrochloride acid that keeps the balance in potassium levels.

At the extreme of starvation, there is reduced glucose concentration in addition to serum salivary amylase as the patient continues to vomit.

There are ECG changes that can be identified as the patient has sinus bradycardia and there is evidence of reduced blood pressure seen in the ST segment and T wave changes.

Blood levels of cholesterol are also abnormal in girls with AN. These features go back to normal when the patient can maintain healthy nutritional habits.

Other endocrine abnormalities that happen are amenorrhoea, reduced thyroid function, and increased corticotrophin-releasing hormone.

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Differential Diagnosis

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The biggest problem with patients who have anorexia nervosa is the fact that they do not accept that they have a problem, they weirdly eat food, and they also do not want to get treatment.

It is often very hard to see the continuous thoughts and it is hard for the patient to see the cause of the weight loss.

It is very important to exclude medical problems as a cause of the emaciated look. Some medical problems that can have similar weight findings are cancer and brain tumours. There can be weight loss and abnormal eating with vomiting is different mental health conditions.

In depression and AN, the patient is sad mood, cries frequently, has problems with sleeping and has continuous thoughts that can progress to those of suicide.

The patients with depression however do not eat because of a loss of appetite and not because of an abnormal eating habit. The patient with AN says they do not feel hungry.

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Hair changes in Eating Disorders (Reaction post)

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People illustrations by Storyset

According to Wimpole clinic, They explained that anorexia is a mental health disorder that features restricted eating. In this disorder, there is quick weight loss and the with this extremely low weight comes health challenges among the unhealthy features seen in anorexia are the hair changes, including hair loss.

The tweet talks about hair changes in anorexia nervosa so we will be looking into that.

The reason patients with anorexia lose hair is because of the diet they follow this is because of the problem of having restricted eating. The body reallocates the limited resources (energy) to parts of the body essential for survival like the brain, and heart and sends little to the hair, skin and nail beds. Because of the limited nutrients that arrive at these structures, they begin to fall off.

Also in extreme emotional states the hair falls out, this is called “telogen effluvium” and this is possibly the case in AN. Gradually adding to the existing problem.

One of the first features people with hair loss due to anorexia nervosa experience will be hairline recession another could be thinning of the hair. Because the patient is not getting enough vitamins the hair will lose its characteristic strength. The hairs of the eyelashes also start to fall the cuticles also start losing their value and the gums become thinner also.

Patients with this disorder also feel unconfident in themselves and do not like being looked at and appear to be punishing themselves for being fat. They continue t punish themselves even for the hair loss they experience.

Hair loss is particularly evident in children and adolescents suffering from eating disorders. It might present with hair thinning and hair patches in addition to the normal features seen in eating disorders. Patients with this disorder will usually be in denial of the fact that they are dealing with this disorder.

Some cases have an abnormal increase in hair growth because of the hormonal interplay seen in anorexia.

The hair that is grown in anorexia is typically those seen in premature babies called “lanugo hair”. This hair is not typically seen in adults. The reason why this hair pattern and texture is grown is because of the need to conserve heat in the body of a patient with anorexia.

Bulimia can also present with some hair changes, particularly those of hair loss. In Bulimia, if there is excessive eating in a short time then why use laxatives? In Bulimia, there is also hair loss because of the emotional shock in these patients.

Getting back the hair in AN is not difficult, the main issue is for the patient to gain control of their eating habits. The problem is that eating disorders are very difficult to get past. With psychotherapy, it is possible to make hair loss a thing o the past for the patient and this is what should be paid attention to. Proper psychotherapy.

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Treatment

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The evaluation for AN patients starts with psychiatric evaluation and physical assessment. The assessment in psychiatry starts with the assessment using the Diagnostic and Statistical Manual 5th edition. The features include the patient not being able to keep their weight within the normal of the specific weight and age. The patient will be very afraid of building weight through any means. The patient will have a dissociation from reality in his body image and they do not accept the body weight features. In women, there might be 3 months of amenorrhoea.

There are 2 types of AN, the restricting type and the binge and purge type. In the first time, the patient eats low-caloric diets and does not compensate with vomiting and in the second type, the patent binge eats and purges to compensate for the food eaten. The vomiting is usually self-induced or the purge will be caused by laxative use. The patient may use diuretics to ensure weight loss.

For extra assurance in your diagnosis the patient may present with abnormal diet activity in addition to thoughts about cloth size fixation and eating low-caloric food. They also tend to fall into a particular demographic, female, caucasian in the middle upper socioeconomic class. There will be features physical features of weight loss such as slow heart rate, reduced blood pressure sold intolerance and amenorrhoea and lanugo hair.

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Questions

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• What did you learn about Eating Diorders?

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Conclusion

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• There are several changes in patients that have AN also the are many conditions that look like AN
• Among the hair changes that are seen in AN are those of hair loss and in some cases, they may grow abnormal hair called Lanugo hair.
• A patient being evaluated for AN has to be evaluated both psychologically and physically.

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References

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• Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry
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• Wimpole Clinic