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Article 24: Salinophagia in anorexia nervosa, a case study, The British Journal of Psychiatry

(C) 1998 The Royal College of Psychiatrists

Volume 173(10), October 1998, pp 352-353

Outline

REFERENCES

EDITED BY LOUISE HOWARD

Sir: We report a case of pathological salt ingestion as a feature of anorexia
nervosa. The patient is a single woman in her thirties with a 15-year history of
anorexia nervosa (World Health Organization, 1992), [3] of sufficient severity
to necessitate in-patient treatment on a specialist unit. While engaged in our
standardised treatment programme, combining weight gain with psychotherapy, she
admitted to intermittent pathological ingestion of Table saltover the preceding
two years in the form of up to 20 packets (approximately 80 g) of salt per day,
which she would consume with bread or potatoes. Her impulses towards salt
ingestion existed in negative reciprocity with her body mass index, and came to
light as her weight reached the mean matched population weight. Despite this
history her electrolyte levels were normal, with adequate renal compensation of
hypernatraemia.

The phenomenology of her behaviour appeared to be a form of deliberate
self-harm, ego-syntonic but self-punative in nature. In particular, her salt
ingestion lacked salient features of an obsessive-compulsive disorder or pica.
Notably, another patient on the unit appeared to adopt similar behaviour in
imitation, which reflects the tendency for some symptoms of anorexia nervosa to
run in trends.

We addressed her salt ingestion as a form of learned maladaptive behaviour,
combining both cognitive-behavioural and psychodynamic techniques, and the
patient remains in treatment.

Compulsive eating of unusual substances has been described in a variety of
psychiatric disorders, including schizophrenia, learning disability (Jawed et
al, 1993) [1] and anorexia nervosa (McLoughlin & Hassanyeh, 1990) [2]. The
latter description linked pagophagia (the compulsive eating of ice) with iron
and zinc deficiency. However, our patient's behaviour was not compulsive in
nature and, to our knowledge, is the first published description of pathological
salt ingestion, or 'salinophagia', as a symptom of anorexia nervosa. Although
rare, we feel it should be added to the list of maladaptive behaviours
associated with anorexia nervosa and bulimia nervosa. In addition, physicians
should consider salinophagia among their differential diagnoses when faced with
unexplained compensated or uncompensated hypernatraemia.

J. F. Morgan, J. H. Lacey Division of General Psychiatry, Department of Mental
Health Sciences, St George's Hospital Medical School, London SW17 0RE
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