A Complex Case of Anorexia Nervosa Associated with Pediatric Acute-Onset Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS)

Abstract

Anorexia nervosa is a severe eating disorder that affects 0.3–0.9% of women and 0.1–0.3% of men. It has a lifetime mortality rate of 5–20%, which is the highest mortality rate of any mental illness and is twelve times higher than death rates for all causes of death for females 15–24 years of age. The DSM-V classification of anorexia nervosa includes the following: (1) persistent restriction of energy intake leading to significantly lower body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health), (2) either an intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain (even though body weight is low), and (3) disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight (Diagnostic and statistical manual of mental disorders: DSM-5, Washington, D.C: American Psychiatric Association 2013 [8]). Anorexia nervosa is commonly associated with various other comorbid psychiatric conditions including depression in 65% of cases, social phobia in 35% cases, and obsessive-compulsive disorder in 25% cases. Multiple etiological factors are implicated in the cause of anorexia nervosa including biological, social, and psychological factors.

In atypical cases where the symptoms of anorexia nervosa are preceded by the onset of streptococcal infection particularly in youths, a diagnosis of PANDAS; Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections may be worth considering.

PANS is a newer term used to describe the larger class of acute-onset neuropsychiatric syndromes. PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome and includes all cases of abrupt onset psychiatric symptoms, not just those associated with streptococcal infections, e.g., mycoplasma, influenza A, Lyme disease, chickenpox, and other noninfectious causes.

PANDAS/PANS are not DSM diagnoses. The following chapter consists of a case study of such a condition preceding the onset of anorexia nervosa as well as a general description of the disorder.