Special Issues for Adolescents with HIV: Anorexia Nervosa and Bulimia As a patient population, adolescents are at high risk for bulimia and anorexia nervosa. Primary care practitioners must be aware of these disorders and appropriately screen for them

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Special Issues for Adolescents with HIVAnorexia
Nervosa and BulimiaAs a patient population,
adolescents are at high risk for bulimia and
anorexia nervosa. Primary care practitioners
must be aware of these disorders and
appropriately screen for them in their patients.
It should be noted that eating disorders are not
more prevalent in adolescents with HIV than the
general adolescent population. The clinician
must differentiate an eating disorder from
HIV-associated anorexia or other infectious
causes of weight loss.

• Diagnostic Criteria for Anorexia Nervosa
• Refusal to maintain body weight over a minimum
  normal weight for age and height (i.e., weight
  loss leading to body weight 15 below that
  expected or failure to make expected weight gain
  during a period of growth).
• Intense fear of gaining weight or becoming fat
  even though underweight.
• Disturbance in the way in which one's body
  weight, size or shape is experienced, undue
  influence of body shape and weight on
  self-evaluation, and/or denial of the seriousness
  of low body weight.
• In females, absence of at least three consecutive
  menstrual cycles when otherwise expected to occur
  (primary or secondary amenorrhoea).

• Diagnostic Criteria for Bulimia
• Recurrent episodes of binge eating characterized
  by
• Eating in a discrete period of time (i.e., a 2
  hour period) an amount of food that is definitely
  larger than most people would eat during a
  similar period of time in similar circumstances.
• A sense of lack of control over eating during the
  episode (i.e., a feeling that one cannot stop
  eating or control what or how much one is
  eating).
• Recurrent inappropriate compensatory behavior in
  order to prevent weight gain such as self
  induced vomiting, use of laxatives, diuretics or
  other medications, fasting or excessive exercise.
• A minimum average of two binge eating and
  inappropriate compensatory behaviors per week for
  at least three months.
• Self evaluation is unduly influenced by body
  shape and weight.
• The disturbance does not occur exclusively during
  episodes of anorexia nervosa.

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Clinical Resource Guide
Prevalence
Signs
Symptoms
Treatment
Condition

• Long process, requiring team
• approach (family, primary care
• provider, nutrition specialist,
• and mental health professional)
• Hospitalization required if the
• blood pressure is low or
• electrolytes out of normal range
• Weight gain should be initial
• focus, but psychological
• issues must be addressed at
• the same time
• Psychotropic medications if
• depressed or obsessive-
• compulsive behavior present
• Education about the disorder

• Depression may be
• present (see
• complementary
• depression tool)
• Frequent
• inappropriate
• references to being
• overweight or fat
• Requesting
• prescriptions for
• diuretics, laxatives,
• or weight loss pills
• Generalized lethargy
• due to malnutrition or
• electrolyte
• disturbances

• Weight 15 or
• greater below expected
• weight
• Inappropriate use of
• laxatives, enemas, or
• diuretics to loose
• weight
• Skeletal muscle
• atrophy and
• loss of fatty tissue
• Low blood pressure
• Dental cavities
• secondary to induced
• vomiting

3 of adolescent and adult women and 1 of men
have either bulimia, anorexia nervosa, or a binge
eating disorder (Harvard Eating Disorders
Center). An adolescent woman with anorexia is
twelve times more likely to die as compared to
adolescents her own age without anorexia (Harvard
Eating Disorders Center). Mortality for anorexia
nervosa may be as high as 15. Approximately
90-95 of those with anorexia nervosa are female
and approximately 80 of those with bulimia are
female (National Eating Disorders Association).
Adolescent Anorexia Nervosa Bulimia
Signs objective indication(s) of a
medical fact or quality that can be detected by
a clinician. Symptoms subjective
experiences that a patient might report to a
clinician.
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References

• Diagnostic Criteria for Anorexia Nervosa,
  www.edauk.com/media/media_sub_diagnostic.htm
• Diagnostic Criteria for Bulimia,
  www.edauk.com/media/media_sub_diagnostic.htm
• 3. Associated Features or Symptoms,
  www.medicineonline.com
• Harvard Eating Disorders Center,
  http//www.hedc.org
• National Eating Disorders Association,
  http//www.edap.org

Credits
This tool was developed by the Mental Health
subset (Chair Linda Frank, PhD, MSN, ACRN, PA/MA
AETC) of the AIDS Education and Training Centers
(AETC) National Resource Center, Adolescent
HIV/AIDS Workgroup (Chair Marion Donohoe, RN,
MSN, CPNP, St. Jude Childrens Research Hospital,
ANAC and Ronald Wilcox, MD,FAAP, Delta Region
AETC). Collaborating members include Elizabeth
Cabrera, MEd (TX/OK AETC), Verita Ingram, MBA
(TX/OK AETC), Elise Johnson, MSW (Bickerstaff
Pediatric Family Center), Jennifer Scanlon, FNP
(The Children's Hospital, Denver), and Ronald
Wilcox. The workgroup efforts were coordinated
by the AETC National Resource Center (Managing
Editor Megan Vanneman, MPH).