|Year : 2015 | Volume
| Issue : 1 | Page : 39-41
Anorexia nervosa in the male with co-morbid adjustment disorder and body dysmorphic disorder
AK Koushik, PV Bhaskar Reddy, N Senthil
Department of General Medicine, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
|Date of Web Publication||16-Mar-2015|
Dr. A K Koushik
7/23, Karunanidhi 3rd Street, Kotturpuram, Chennai - 600 085, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Anorexia nervosa is a rare psychological disorder. Epidemiological studies have shown a female to male ratio of 10:1, suggesting, it is predominately seen among females. Anorexia nervosa and related eating disorders are rare in non-Western countries. The association of anorexia nervosa with body dysmorphic disorder and Adjustment disorder indicate a more severe form of illness. This case is rare because here in we present a male anorexic with adjustment disorder and body dysmorphic disorder. To the best of our knowledge, there is no case report in the literature describing a male anorexic patient with co-morbid adjustment disorder and body dysmorphic disorder.
Keywords: Adjustment disorder, anorexia nervosa, body dysmorphic disorder, male
|How to cite this article:|
Koushik A K, Bhaskar Reddy P V, Senthil N. Anorexia nervosa in the male with co-morbid adjustment disorder and body dysmorphic disorder. J NTR Univ Health Sci 2015;4:39-41
|How to cite this URL:|
Koushik A K, Bhaskar Reddy P V, Senthil N. Anorexia nervosa in the male with co-morbid adjustment disorder and body dysmorphic disorder. J NTR Univ Health Sci [serial online] 2015 [cited 2020 Jan 18];4:39-41. Available from: http://www.jdrntruhs.org/text.asp?2015/4/1/39/153320
| Introduction|| |
Anorexia nervosa is a rare psychological disorder. Epidemiological studies have shown a female to male ratio of 10:1, suggesting it is predominately seen among females.  Anorexia nervosa and related eating disorders are rare in non-Western countries.  It is a life-threatening psychological illness characterized by self-starvation and excess weight loss. The association of anorexia nervosa with body dysmorphic disorder and adjustment disorder indicate a more severe form of illness.  Among women the lifetime prevalence of Anorexia nervosa is approximately 1%, it is much less in males.  Diagnosis of anorexia nervosa is based on history of weight loss accomplished by restrictive dieting and excessive exercise accompanied by a marked reluctance to gain weight. In Diagnostic and Statistical Manual-IV and International Classification of Diseases-10 classification systems (WHO, 1992 and American psychiatric association, 1994) core feature are intense fear of gaining weight.  Anorexia nervosa can be associated with other psychiatric disorder but with multiple disorders is rare.
| Case Report|| |
A 20-year-old male was referred for hematemesis and vomiting. He initially complained of vomiting for 1 week (3-4 episodes per day after every meal, not induced) and 1 episode of hematemesis (<50 ml) 3 days back. He gave a history of induced vomiting after food for the past 1 year in an attempt to reduce weight. He also gave history of weight loss around 50 kg in 1 year, self-imposed calorie restriction since 1 year (3 chapatti and few raw vegetables per day), excessive exercise (3 h of walking per day), increased fear of weight gain, repeated mirror and weight checking, social phobia, prefers wearing baggy clothes to hide his figure and decreased sleep. He skips college and finds it difficult to concentrate in studies. There was no history of binge eating, followed by vomiting, fever, chest pain, diarrhea, headache. There were no co-morbidities, or addictive habits.
On examination vitals were normal, systemic examination was normal. Speech was relevant and coherent. Psychomotor activities were normal. Mood was euthymic. Insight intact. He frequently thinks about his weight and his abstract thinking was within normal limits [Figure 1] and [Figure 2]. All routine blood investigations, urine examination, FT3, T4, thyroid stimulating hormone, electrocardiogram, serum amylase, serum lipase, HIV 1 and 2, chest X-ray and upper gastrointestinal endoscopy were normal. Anorexia nervosa was diagnosed. Psychiatric opinion was obtained, and patient was also diagnosed with adjustment disorder and body dysmorphic disorder.
|Figure 2: Three months before hospitalization, patient weight: 90 kg. Patient was not willing for photo during hospitalization but at admission patient weighed 70 kg|
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A treatment plan was designed by the attending physician, psychiatrist and dietitian. It included behavior therapy, family therapy and a watch on the patient's dietary intake. Patient was discharged and was on regular out-patient follow-up. After 6 months patient gradually improved, having normal meals, and his body weight increased.
| Discussion|| |
Anorexia nervosa is a severe life-threatening disorder in which the individual refuses to maintain a minimal normal body weight, is intensely afraid of gaining weight, and exhibits a significant distortion in the perception of the shape or size of his body, as well as dissatisfaction with his body shape and size.
One of the most prevalent myths regarding eating disorders is that it's only seen in women, in fact, it is also diagnosed in men. The symptoms of anorexia nervosa in males are similar to females although the criteria of amenorrhea will not apply.  The rate of Anorexia nervosa in men seems to be increasing along with increased messages in media about the ideal male figure and advertisements regarding weight reduction in men. Men are under increasing pressure to conform to an ideal physique.  Anorexia nervosa with body dysmorphic disorder is more ill, the rate of attempting suicide is significantly greater. 
Recent literature continues to reflect that multi-organ systems are frequently affected by Anorexia nervosa. Early treatment is vital, as once the disorder becomes more entrenched, its damage becomes less reversible, hence eating disorders should be diagnosed early. Screening for such disorders should be done by primary care physicians. 
Physicians play an integral role in educating and assisting the individual who may be struggling. Many people with Anorexia nervosa respond to outpatient therapy support groups, nutritional counseling and psychiatric medications under careful supervision was also proven helpful. In-patient care is required if associated with severe psychological or behavioral problems. The exact treatment needs of each individual will vary.
| References|| |
Cinemre B, Kulaksizoglu B. Case report: Comorbid anorexia nervosa and schizophrenia in a male patient. Turk Psikiyatri Derg 2007;18:87-91.
Makino M, Tsuboi K, Dennerstein L. Prevalence of eating disorders: A comparison of Western and non-Western countries. MedGenMed 2004;6:49.
Grant JE, Phillips KA. Is anorexia nervosa a subtype of body dysmorphic disorder? Probably not, but read on. Harv Rev Psychiatry 2004;12:123-6.
Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007;61:348-58.
National Institute for Health and Clinical Excellence: Guidance. Leicester (UK): British Psychological Society (UK); 2004. Source National Collaborating Centre for Mental Health (UK). Editors Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders.
Hoffman ER, Zerwas SC, Bulik CM. Reproductive issues in anorexia nervosa. Expert Rev Obstet Gynecol 2011;6:403-14.
Morris AM, Katzman DK. The impact of the media on eating disorders in children and adolescents. Paediatr Child Health 2003;8:287-9.
Mitchell JE, Crow S. Medical complications of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry 2006;19:438-43.
[Figure 1], [Figure 2]