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CC BY 4.0 · Avicenna J Med 2023; 13(01): 003-014
DOI: 10.1055/s-0042-1758859
Review Article

A Clinical Overview of Anorexia Nervosa and Overcoming Treatment Resistance

Hassan Nagy 
1   Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
,
Tanya Paul 
1   Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
,
Esha Jain 
1   Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
,
Hanyou Loh 
1   Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
,
Syeda Hafsa Kazmi 
1   Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
,
Rishbha Dua 
1   Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
,
Ricardo Rodriguez 
1   Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
,
Syed Ali Abbas Naqvi 
1   Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
,
Metu Chiamaka U. 
1   Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
,
Erjola Bidika 
1   Division of Research & Academic Affairs, Larkin Health System, South, Miami, Florida, United States
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Abstract

Anorexia nervosa (AN) is a type of eating disorder that has been increasing in incidence and has been encountered more commonly by physicians in their daily practice. Both environmental and genetic risk factors paired along with a more susceptible neurobiology are at play in the emerging resistance to treatment in AN. Preoccupations with intense fear of weight gain, dietary restrictions, excessive exercise, and how the individual is perceived by society mixed with underlying psychopathology all further add to the issue. Many patients who fall into this cycle of obsessive and restrictive patterns refuse to get treatment. As clinicians, it is essential we recognize the early signs of both eating disorders during the initial primary care appointments.

To review the literature on the etiology of AN, possible misdiagnosis leading to inappropriate management of this condition, and understand the treatment-resistant AN and its management. Additionally, it will explore possible reasons that contribute to the resistance to treatment, the underlying psychopathology of anorexics, its genetic predisposition, psychiatric comorbidities, identification of the early signs and symptoms, and timely prevention.

Early recognition by a physician includes a thorough history and physical examination, pertinent laboratory, and electrolyte studies, and identifying comorbid psychiatric conditions. The treatment of AN is intricate and requires a holistic approach. Treatment includes multiple modalities such as nutritional rehabilitation and psychosocial and pharmacological therapies. An interdisciplinary team of medical professionals for managing chronic AN is recommended.

Keywords

anorexia nervosa - treatment-resistant anorexia - eating disorders - psychiatric disorders - managing chronic anorexia - psychosocial treatments of anorexia - deep brain stimulation in anorexics


Publication History

Article published online:
21 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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