bubble_chart Overview

The term "neurogenic anorexia" (anorexia nervosa) was first coined in 1874, also known as neurogenic loss of appetite, characterized by long-term unexplained anorexia and significant weight loss. The onset age is mostly over 10 years old, with female adolescents being more commonly affected. If left untreated, it can lead to severe malnutrition and extreme exhaustion, affecting the physical and mental health as well as the development of adolescents.

bubble_chart Etiology

The disease cause and pathogenesis of the disease are not yet fully understood. It is a common condition abroad, where the majority of patients consciously restrict their diet due to fear of obesity affecting their physical appearance. Most scholars believe it to be a psychoendocrine disorder, where excessive dietary restriction due to specific psychological abnormalities leads to severe malnutrition, weight loss, and dysfunction of the hypothalamic-pituitary-gonadal axis. According to research in China's medical community, most domestic cases of anorexia nervosa develop gradually due to chronic mental stress or excessive academic or work pressure, predominantly affecting adolescent females, indicating the instability of personality during this period and susceptibility to external stimuli.

In patients with anorexia nervosa, the hypothalamic function of releasing luteinizing hormone-releasing hormone (LHRH) is reduced or lost, possibly due to metabolic disturbances of norepinephrine and dopamine in the central nervous system. The psychological abnormalities in patients may result from increased dopaminergic activity in the central nervous system, and the endocrine changes are likely caused by severe malnutrition rather than primary hypothalamic dysfunction.

bubble_chart Clinical Manifestations

The most prominent symptom of this disease is anorexia, with daily food intake reduced by more than two-thirds compared to before the illness. Patients become emaciated, and their weight drops by over 20% of their original body weight. In addition to anorexia, symptoms such as nausea, vomiting, and persistent constipation may also be observed. Due to prolonged insufficient food intake, patients may develop malnutrition and hypometabolic symptoms, such as cold body, chills, bradycardia, hypotension, and rough skin. Girls who have already menstruated may experience secondary amenorrhea. Most cases can still manage general indoor activities and attend school, but they are prone to fatigue and weakness. A few cases exhibit mental depression and apathy. Despite extreme emaciation, they still show no desire to eat and avoid seeking medical treatment.

bubble_chart Diagnosis

Currently, foreign scholars still adhere to the six diagnostic criteria proposed by Feighner in 1972, suggesting that the onset age is approximately between 10 and 30 years. Based on the characteristics of anorexia nervosa cases in China, the diagnostic criteria for juvenile anorexia nervosa should include: ① Age over 10 years. ② Onset often triggered by psychological stress or excessive academic/work pressure. ③ Weight loss exceeding 20% or a reduction of more than 15% below the standard weight for height in the same age group. ④ Accompanied by severe illness or mental disorders leading to anorexia and emaciation. ⑤ Exclusion of anorexia caused by organic diseases or mental disorders. ⑥ A minority of patients, driven by a desire to maintain a slim figure and fear of gaining weight, consciously restrict their diet and prefer to endure hunger.

Cases of anorexia nervosa should be hospitalized for further examination, including a detailed medical history, to rule out secondary anorexia caused by organic sexually transmitted diseases. Essential tests include liver, kidney, and gastrointestinal examinations, as well as sella turcica tomography and/or cranial CT scans (paying attention to pituitary cachexia). Hospitalized cases should also undergo endocrine gland function tests, such as pituitary-thyroid function, adrenal cortex function, and growth hormone secretion tests.

bubble_chart Treatment Measures

Neurogenic anorexia should be treated with a comprehensive approach. ① Psychotherapy: Doctors and nurses should actively care for and empathize with the patient, explaining the treatability and risks of the condition. Efforts should be made to address the obvious triggers of the disease to gain the patient's trust and cooperation. ② Dietary therapy: Encourage the patient to eat small, frequent meals and actively consume nutrient-rich foods and vitamins. Patients not only experience significant weight loss but also suffer from poor overall nutritional status. For those with difficulty eating, intravenous or gastric tube feeding of nutritional solutions should be used to correct malnutrition. During the first week of hospitalization, attention should be paid to cardiovascular system changes and electrolyte imbalances in the child. ③ Drug therapy: Antidepressants such as Amitriptyline can be used initially to improve the patient's mood and appetite, with improvement typically seen within 6–12 days. If side effects occur, antihistamines and anti-serotonin drugs like cyproheptadine can be used as appetite stimulants. Taking the medication for 2–3 weeks can alleviate the child's symptoms and signs, but regular monitoring of blood cortisol levels is necessary due to the drug's side effect of lowering cortisol. Beijing Children's Hospital has treated four cases of juvenile neurogenic anorexia primarily with Chinese medicinals, achieving favorable results. The average age of the patients was 13, with unexplained anorexia lasting over three months and weight loss exceeding 20% or 15% below the standard weight for their age. The average hospitalization period was 1.8 months, with one dose of Chinese medicinals administered daily. By the end of treatment, the average weight gain was 5.3 kg. Appetite gradually recovered, food intake increased, clinical symptoms disappeared, and weight was fully restored. The principle of Chinese medicinals treatment was to strengthen the spleen, nourish the stomach, soothe the liver, and resolve stagnation. The main prescription included Jianqu, scorched Atractylodes, grass cardamom, Villous Amomum Fruit, Solomonseal Rhizome, Arnebia, etc.

bubble_chart Prognosis

Currently, domestic treatments often include psychotherapy, diet, Chinese medicinals, sedatives, physical therapy, and magnetic therapy. Although the treatment process is slow and challenging, it was previously believed that the prognosis of this disease was favorable. Long-term follow-up studies have found that most patients' anorexia symptoms gradually disappear, with weight recovery, and cases leading to severe psychiatric manifestations are rare. However, a recent report on 42 severe hospitalized cases abroad showed that 32 cases improved, 5 showed no change, and 3 died (7%). Other reports indicate a mortality rate ranging from 2% to 20%. The primary causes of death are severe metabolic imbalances and physical exhaustion, leading to uncontrollable infections. This has reinforced the understanding that this disease is far from benign, warranting vigilance and attention.

bubble_chart Prevention

Chronic mental stimulation and excessive academic stress are the main factors contributing to the onset of this condition in adolescents, with only a minority (13%) intentionally dieting to maintain a slim figure. Therefore, alleviating chronic stress and excessive academic burdens are key measures for preventing or reducing the incidence of the disease. 1. **Emotional Prevention**: This condition is more common among adolescent females, indicating emotional instability during this period, making them susceptible to external stimuli. Factors such as family discord, conflicts between parents, severe illness or death of relatives, or unexpected academic setbacks can trigger the condition. Thus, maintaining optimism and a broad-minded attitude is crucial. 2. **Balancing Work and Rest**: Properly managing study and daily life, combining mental work with appropriate physical exercise and labor, and arranging recreational activities and rest can prevent hypothalamic dysfunction caused by excessive fatigue. 3. **Education on Healthy Body Image**: A small number of cases exhibit stubborn biases and pathological psychology toward eating and obesity, leading to extreme fear of weight gain and restrictive eating to maintain so-called "beauty." Therefore, education on correct and healthy concepts of beauty is essential.