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Anorexia
Nervosa
Anorexia
Nervosa is an illness that mainly affects adolescent girls although
in recent years there has been a rise in the number of boys
being diagnosed with the disorder. The most common features
are loss of weight and a change in behavior in which the weight
loss may become severe and life threatening. Personality changes
will be those of increasing seriousness and introversion and
an increasing tendency to become obsessional. She/He will usually
begin to lose contact with her friends, regress and appear to
lose confidence. She/He may become less assertive, less argumentative
and more dependant The disorder, which usually begins in young
people around the time of puberty, involves extreme weight loss;
at least 15 percent below the individual's normal body weight.
Typical symptoms are:
The patient will not maintain a minimum body weight (for example,
85% of expected weight for height and age).
Despite being underweight, the patient intensely fears becoming
fat.
Self-perception of the body is abnormal, shown by at least 1
of:
Unduly
emphasizes weight or shape in self-evaluation.
Denies seriousness of low weight.
Has a distorted perception of own body shape or weight.
Due to weight loss, a female patient has missed at least 3 consecutive
periods (or periods occur only when she is given hormones).
Potential
Medical Complications:
Dry skin,
Hypothermia, Bradycardia, Hypertension, Dependent Edema, Anemia,
Lanugo, Infertility, Osteoporosis, Cardiac Failure, and Death
(most commonly results from starvation, suicide, or electrolyte
imbalances).
Associated
Features:
Depressed
Mood
Somatic
or Sexual Dysfunction
Guilt or Obsession
Anxious or Fearful or Dependent
Personality
Differential
Diagnosis:
Some disorders display similar or sometimes even the same symptom.
The clinician, therefore, in his diagnostic attempt has to differentiate
against the following disorders which one needs to be ruled
out to establish a precise diagnosis.
General
Medical Conditions
Superior Mesenteric Artery Syndrome
Major Depressive Disorder
Schizophrenia
Social Phobia
Obsessive-Compulsive
Disorder
Body Dysmorphic Disorder
Bulimia Nervosa
Cause:
The self
esteem of individuals with eating disorders is directly related
to their body shape, weight, and management of food. Eating
disorders often lead to diminished concentration and attention
leaving one less able to focus on academic course work. Preoccupation
with food and body image result in feelings of anxiety which
may also interfere with daily functioning. In severe cases medical
problems may arise such as hypertension, dental enamel erosion,
malnutrition, impaired renal functioning, electrolyte imbalance,
and cardiovascular problems which require immediate medical
attention and possible hospitalization.
Treatment:
Counseling
and Psychotherapy [ See
Therapy Section ]:
Psychotherapeutic
interventions may include individual or group therapy modalities.
The focus of psychotherapy is often on improving self-esteem,
but may be supplemented with nutrition education, discussions
of eating habits, exploration of the role that food and eating
play in one's life and underlying family and interpersonal dynamics.
There are a number of treatment options available according
to the symptoms shown:
Inpatient:
Indications for hospitalization may include any of the following:
Patient's
weight less than or equal to 70% of ideal body weight.
Persistent suicidal ideation.
Need for withdrawal from laxatives, diet pills, or diuretics.
Failure of outpatient treatment.
Outpatient:
The combination
of medical, psychological, and educational treatments can be
effective on an outpatient basis. Occasionally, a person with
anorexia nervosa whose weight is dangerously low, or a person
with bulimia who is out of control may require temporary hospitalization.
It is important to seek professional treatment as quickly as
possible. Treat the medical complications of starvation.
Nutritional
counseling to establish a balanced diet, an expected rate
of weight gain (up to 2 lbs. per week), and a final goal weight.
Use behavioral techniques to reward weight gain.
Individual
and group cognitive therapy to alter anorexic attitudes, enhance
autonomy, and improve self-esteem.
Family
therapy may also be useful.
Treat
any associated mood disorder.
Treatment
options are best discussed with the general practitioner who
will be able to advise if specialist help is needed. Another
source of unbiased advice is the Eating Disorders Association.
Some regions have good N.H.S.
facilities but many do not or have long waiting lists. Some
private clinics also have well developed eating disorder units,
but quality varies and costs are often high making medical insurance
necessary for many. Sometimes the N.H.S.
will pay for private treatment where there are no suitable N.H.S.
facilities and these options can be explored by the clinic with
the assistance of the local doctor.
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ChatterBox
UK - Anorexia
Anorexia
Nervosa
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