11. ANOREXIA NERVOSA IN ASSOCIATION WITH MEDICAL DISORDERS

Crohn’s disease has been reported coexisting with anorexia nervosa [72,73, 74]. Hershman and Hershman [72] reported a 27-year-old anorectic female with diarrhea and increasing lower abdominal pain who developed a palpable cecal mass with inflamed appendix. At surgery a diagnosis of Crohn’s disease was made. Diagnostic confusion can arise between patients with Crohn’s disease, atypical anorexia and anorexia nervosa because of the similar symptoms of nausea, anorexia and abdominal pain. In addition these two disorders can coexist.

Blinder et al. [40] noted that a 34-year-old patient following right temporal lobectomy for post-traumatic intractable motor seizures developed anorexia nervosa. Central nervous system disorders have been reported in anorexia nervosa. A 25-year-old female presenting with complaints of poor memory, nausea, ataxia, diplopia and dysarthria was later diagnosed to have Wernicke’s encephalopathy. The anorexia, producing a thiamine deficiency, may have caused this disorder. However, thiamine levels were not performed because she presented six months after resuming a normal diet. Anorexia patients developing mental status changes with ataxia and nystagmus should be screened for Wernicke’s encephalopathy [75]. A 19-year-old female who presented with both acute, severe depression and anorexia nervosa syndrome subsequently developed petechial skin hemorrhages, suddenly collapsed and died. At postmortem disseminated herpes simplex infection with massive intra-cerebral hemorrhage was note. The sudden onset of depression was due to the herpes simplex infection. The patient’s malnutrition contributed to a lowered immunological defense and other susceptibility to herpes simplex [76]. Symptoms of anorexia nervosa have been reported in the initial stage of multiple sclerosis [77].

Anorexia Nervosa in Genetic Disorders

Anorexia nervosa has been reported in genetic disease such as Turner’s Syndrome [59] and Gaucher’s disease [78]. There are thirteen case reports of patients with the coexistence of anorexia nervosa with Turner’s Syndrome, a disorder manifesting a 45-chromosome XO genotype, webbed neck, and gonad hypodevelopment. Endocrine treatment with estrogen at pubertal age may induce sufficient body and weight changes in the Turner Syndrome patient to provoke attempts at dieting or restrictive eating.

Anorexia Nervosa with Autophonia

An interesting report associates anorexia nervosa with autophonia, the perception of one’s own voice and breathing. Rapid weight loss seen in a variety of wasting disorders including anorexia nervosa has been associated with autophonia. The therapist should not confuse a patient’s complaint of hearing her own voice with transitory psychotic phenomena occasionally seen in anorexic patients [79].