Comorbidity, differential diagnosis and prognosis for Anorexia Nervosa

Comorbidity

Other disorders, especially mental disorders, could occur together with AN. For instance 65 percent of AN cases are associated with a co-occurring depression, 34 percent of the cases with social phobia and 26 percent of the cases with obsessive-compulsive disorder (Sadock, Kaplan & Sadok, 2007, p. 727). Other comorbid conditions include mood disorders (dysthymia and bipolar mania) and substance abuse or dependence (Swanson, et al., 2011, p. 719).

Differential Diagnosis

Factors such as patients’ denial of symptoms make it challenging to distinguish AN from other disorders that have similar manifestations (Sadock, Kaplan & Sadok, 2007, p. 732). For instance, diseases such as cancer may result into weight loss similar to that experienced in AN. Accordingly, in suspected cases of AN, clinicians must first rule out possible medical illnesses that could result into weight loss before confirming the diagnosis of AN (Sadock, Kaplan & Sadok, 2007, p. 732). In addition to weight loss, features of AN such as vomiting and peculiar eating behaviors are associated with depression (Sadock, Kaplan & Sadok, 2007, p. 732). However, whereas in depression patients lose their appetite, in AN patients have a normal appetite with decreased appetite occurring only in advanced stages (Sadock, Kaplan & Sadok, 2007, p. 732). Additionally, unlike in depression, the hyperactivity noted in patients with AN occurs in a planned and ritualistic fashion; for instance, such individuals are obsessed with determining the caloric content of any food that they consume (Sadock, Kaplan & Sadok, 2007, p. 732). The fear that patients with AN have of gaining weight is also not observed in individuals with depression (Sadock, Kaplan & Sadok, 2007, p. 732).

Another disorder manifesting itself as AN does is somatization disorder. However, unlike AN, patients with somatization disorder do not exhibit an excessive fear of weight gain and their amenorrhea course rarely exceeds a period of 3 months (Sadock, Kaplan & Sadok, 2007, p. 732). Nevertheless, rare cases may qualify for a diagnosis that confirms the presence of both conditions. Schizophrenic patients may also exhibit features similar to those exhibited by patients with AN such as bizarre eating habits (Sadock, Kaplan & Sadok, 2007, p. 732). However, schizophrenics are neither obsessed with caloric content of their food nor preoccupied with the fear of gaining weight (Sadock, Kaplan & Sadok, 2007, p. 732). AN is also associated with bulimia nervosa but different in that patients with bulimia nervosa maintain their weight within normal range despite engaging in behaviors (e.g. purging) similar to those exhibited by patients with AN (Sadock, Kaplan & Sadok, 2007, p. 732).

Course and Prognosis

The course of AN is wide-ranging; in some cases recovery may occur immediately without treatment, in others recovery results from application of various treatments, while in others weight gains are followed by relapses (Sadock, Kaplan & Sadok, 2007, p. 732). Recovery rates noted in studies range from 25-85% (Guarda, 2008, p. 114; Sim et al., 2010, p. 746). In severe cases, mortality could arise from complications associated with starvation (Sadock, Kaplan & Sadok, 2007, p. 732). Generally, the prognosis of AN is unfavorable with mortality rates estimated to range between 5 to 18% (Sadock, Kaplan & Sadok, 2007, p. 732). Go to part 6 here

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