Anorexia Nervosa, Control Issues, Signs and Symptoms - Term Paper Example

Running head: ANOREXIA NERVOSA Anorexia Nervosa: Signs, Symptoms, Causes and Treatment First Middle initial and of University Course Name April 7, 2011 Anorexia nervosa is a complex multifaceted psychiatric disorder that focuses on food, with an underlying motive to look perfect by strictly regulating food intake and controlling weight. Therefore, to this extent it is also an eating disorder. Today, anorexia nervosa has become the most common reason for eating disorder related hospitalization in America. It accounted for 37% of hospitalizations in 2005 to 2006, which is an increase of 17% over those reported for 1999 to 2000 (Harvard Medical School, 2009). Anorexia nervosa often begins between the ages of 15 and 18 years. A large nationally representative U.S. study conducted on this group of people revealed that there were no new cases registered after the respondents reached their mid-20s (Harvard Medical School, 2009). This finding reveals that adult patients who seek treatment for anorexia nervosa have usually struggled with this disorder much earlier in their life. Anorexia is a very common disorder and nearly three quarters of those affected by this disorder are females. This can be attributed to environmental factors, such as magazines, web and other media sources that promote and idolize thin models thereby leading unsuspecting readers to be obsessed by the desire to be thin. There are two types of anorexia: Restricting type of anorexia: Weight loss is attained by following extreme diet regimen, fasting and too much exercising. Purging type of anorexia: Weight loss is attained by vomiting or using laxatives and diuretics. Signs and Symptoms There are some tell tale signs and symptoms to identify Anorexia nervosa: Physical signs of anorexia: Physical signs of anorexia include excessive weight loss without any medical cause, dry skin, thinning of hair, poor or no menstrual periods in women, feeling cold or presence of swelling in extremities of limbs, downy hair covering the body, low blood pressure, fatigue and/or abnormal heart rhythms. Psychological and behavioral signs: Psychological and behavioral signs of anorexia include feeling fat despite being underweight, refusing to eat, not able to remember things, refusing to accept low body weight as a problem, depression and obsessive-compulsive behaviors like frequently checking weight, following extreme exercise regimen and/or pretending or lying about eating. Causes of Anorexia Although the exact cause of anorexia is still unknown, medical experts believe that several factors work together in a complex fashion to lead to this eating disorder. These factors may include: Severe trauma or emotional stress such as death of a loved one or sexual abuse Abnormalities in brain chemistry, wherein serotonin, a chemical found in the brain associated with depression may be involved Cultural environment that values being “thin” A tendency towards perfectionism that stems from the fear of being humiliated or ridiculed Family history of anorexia since about one-fifth of anorexic patients have a relative with an eating disorder. Key Indicators to Identify Anorexia Nervosa There are some key indicators to identify Anorexia Nervosa: Weight loss or lack of expected gain: Significant loss of weight without any medical reason is one of the main indicators to identify Anorexia Nervosa. A loss of 5 to 10 pounds in a healthy individual is a matter of concern and should be followed-up (Dubansky, 2010). The annual health checkup is a good time to track adequate weight gain in children and identify significant weight loss in adults. Anorexia during the initial phase can go unnoticed even by physicians because a lot of attention is given to obesity and related issues. Sudden change in eating habits: Behaviors that interfere with normal eating habits like skipping meals or making excuses not to eat, eating only a few foods and avoiding entire food groups like meat or carbohydrate, refusing to eat in public and/or preparing elaborate meals for others but not eating, need to be monitored and addressed since these are signs of anorexia. Mealtime rituals like cutting food into tiny pieces and chewing food endlessly are also examples of eating habits that need to be addressed. Over exercising or unnecessary activity: Over exercising may be difficult to detect in children who are already engaged in sports. However, monitoring the individual closely can determine if their exercising regimen is turning into a compulsive behavior. Giving a specific example, Dubansky (2010) states that if you catch your daughter doing 100 sit-ups or push-ups in her room on days she has swim practice or dance class, she may be tipping towards an exercise obsession which may be due to anorexic behavior (Dubansky, 2010). Distorted body image: Comments like “I’m so fat” are common among teens and adolescent girls but when it becomes an obsession such that most of the time is spent making disapproving comments about oneself, then there is cause for worry. If the person spends a lot of time in front of the mirror, tries to cover up the so called “thin” look by wearing oversized clothes etc then these are indicators that he/she needs help. Anxiety: According to the American Journal of Psychiatry, two out of three adults with eating disorders struggled with anxiety when they were children (Dubansky, 2010). Anxiety may be most obvious in situations involving food but can occur in other areas as well. Myoedema or muscle mounding: Routine physical examinations of anorexics typically reveal a phenomenon called myoedema or muscle mounding (Morgan et.al., 2008). In this test a voluntary muscle is seen to develop a localized swelling that lasts for a short time as a result of tactile percussion with a patellar hammer. Authors in the study suggest using myoedema in the management of anorexia nervosa by challenging patients who deny having any illness. Perfectionism: A recent study has also revealed that patients with high level of perfectionism may be at risk for long duration of illness when compared to patients with low level of perfectionism who have comparatively shorter illness duration (Nilsson et. al., 2008). Clinical Interventions Used to Treat Anorexia The treatment of anorexia nervosa requires a multidisciplinary approach that involves nutritional support, psychological counseling and behavioral modification. The severity of the disorder typically determines if the treatment should take place in a residential, partial hospitalization unit, intensive inpatient or outpatient basis. However, the importance of family involvement is very important in treating this disorder especially when dealing with children and adolescents. Typically, when an adult patient loses 15% or more of her ideal body weight, inpatient treatment or a highly structured outpatient program is recommended. For children and adolescents who are at risk of suffering from irreversible developmental damage due to malnourishment, inpatient treatment is recommended even before they reach the 15% weight-loss criteria. According to Harvard Medical School (2009), some of the clinical interventions used to address anorexia nervosa include: Nutritional therapy: Patients who are severely malnourished because of starvation are likely to be obsessive, negative and manipulative. Psychotherapy at this phase would be practically ineffective. Therefore, the first step would be to provide support and encourage weight gain through a meticulously planned nutrition therapy. Clinicians typically use positive reinforcement techniques like linking privileges to target weights and praising weight gain to achieve this goal. The patient is closely monitored to ensure that food is eaten and the body weight also checked regularly. Gradually the calorie intake is increased while restricting excessive exercise to promote weight gain and proper nutrition. In inpatient care, a weight gain of 2 to 3 pounds a week is reasonable while in out-patient care, ½ to 1 pound a week is the norm. Use of antidepressant and antipsychotic medications: Although patients with anorexia nervosa are often prescribed medications, there is little evidence that they are useful for promoting weight gain or addressing psychological distress during the initial phase of treatment. However, the APA practice guidelines strongly support the use of antidepressants like serotonin reuptake inhibitors (SSRIs) with psychotherapy to address issues like depression, anxiety or obsessive thinking in some patients once they have gained weight. Antipsychotic drugs are used to accelerate weight gain and reduce obsessions and mealtime anxieties and have been found to help some patients with anorexia nervosa. However, thorough research in this area is lacking. Psychotherapy: Once the patient gains sufficient weight, psychotherapy treatments can used to help the patients to realize the distorted thinking about themselves and find better ways to deal with their emotions while avoiding relapse. Studies however have confirmed that nearly 50% of the patients who gain weight successfully in in-patient programs relapse within a year of being discharged (Pike, 1998). Over the years, psychotherapy for anorexia nervosa has changed from a behavioral model to cognitive model. It was found that the weight restoration achieved through behavioral therapy in inpatient setting was often temporary. This could be attributed to the fact that early contingency management programs were mechanistic and subjected the patients to harsh deprivation that served as a method of punishment (Blue, 1979). More recently cognitive behavioral therapy (CBT) has been used extensively to treat anorexic patients. CBT has been found to help patients identify and change their distorted thinking about food. In the past fifteen years, professionals have explored a variety of behavioral therapy approaches like Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and Eastern mindfulness/meditation to treat anorexia nervosa (Kotler et.al., 2003). Anorexia Nervosa: An Issue of Control Although most physicians believe that anorexia is caused due to psychological, genetic or environmental issues, studies have confirmed that self-control-related variables can powerfully predict outcomes in anorexia (Birgegard et. al., 2009). People, especially women are constantly pressurized by demands at work and home over which they have no control. Those with poor sense of self tend to focus on food intake and weight which are areas that a person can control in his/her life. This could be the reason why many anorexics admit that they began the downward journey towards anorexia when they perceived that they had lost control of their lives. Classic examples of an adolescent girl obsessive about her looks or a pubescent girl who wants to diet away the signs of puberty reveal that anorexics come to enjoy the feeling of control that dieting gives (Brown, 1990). They enjoy this control so much that they obsessively continue their dieting and exercising even when they are bone-thin. In her book ‘The Golden Cage’, Hilde Bruch states that, “for a woman who always withholds her opinions and suppresses her needs, controlling food and her body may feel like the only way to really express herself. Anorexia then becomes pat of a struggle to define herself and establish a sense of autonomy, self-definition and direction”. However, this desire to control their lives by ritualistic constructions gives anorexics only an illusion of control and leads them to a life that is desperately out of control. People who come for therapy are surrounded by negative attitudes about themselves and feel as if they have lost control over every aspect of their life. In these cases, the primary goal of therapy is to assist the patients in developing a positive self-image about themselves and increase the sense of control in their lives not based on body size or food intake. A sense of trust must be established between the therapist and patient so that the patient would feel safe enough to expose the perceived bad and disgusting things about themselves. Dangers of Continued Weight Loss and Starvation Due to Anorexia Some studies suggest that the mortality rate of anorexia nervosa related complications are as high as ten percent within the first ten years after diagnosis. Majority of these deaths have been found to be because of starvation or suicide. According to Rome and Ammerman (2003), there are serious complications that can develop as a result of continued weight loss and starvation: Heart problems: Anorexics can develop irregular heartbeat known as sinus bradycardia. Unlike a normal heart rate of 70 beats/minute, anorexics have a resting heart rate of less than 50 beats/minute. If sinus bradycardia is suspected, the patient should avoid both caffeine and exercise because they can result in heart arrhythmias which can be fatal. Dehydration and electrolyte imbalance: Imbalances in blood salts like sodium can cause cardiac arrhythmias and death. Gastrointestinal complications: Since gastrointestinal movement slows with continued starvation, it takes longer for the digestive system to empty. Constipation is therefore a common complication of anorexia. Some anorexics develop abnormal muscle activity in the esophagus. With continued anorexia, other gastrointestinal complications like feeling bloated or early fullness results. This quickens the process of weight loss and starvation. Self-induced vomiting and abuse of laxatives: Anorexics often resort to self-induced vomiting, enemas and/or laxatives to achieve weight loss. Abusing laxatives damage the stomach nerves and aggravates constipation resulting in death. Ipecac syrup is commonly used to induce vomiting in poison victims. When anorexics abuse this syrup regularly, it can lead to damage of the heart and muscles. It can also cause irregular heartbeats, stomach cramps, fatigue and breathing trouble. Amenorrhea: In women, continued anorexic condition can lead to cessation of the menstrual cycle. Missing her periods for a few months can cause osteopenia, which can later develop into osteoporosis. This increases the risk of stress fractures or bone abnormalities. Infertility and birth complications: Continued anorexia can lead to infertility. If women do become pregnant, there is an increased risk of miscarriages and cesarean sections. Again, babies born to women who are anorexic tend to have low birth weight and a higher risk of being born prematurely. Hyponatremia: Anorexics often drink a lot of water which can lead to water intoxication or Hyponatremia. This is a condition wherein excessive water is ingested quickly without enough electrolytes like sodium and potassium which can lead to cerebral swelling, seizures, coma and death. Other dangers: Other dangers of excessive weight loss and starvation include depression, enlarged parotid salivary glands, hypoglycemia, hypothermia and kidney stones. Conclusion In conclusion, anorexia nervosa is a life-threatening disorder that can take a person from harmless dieting to an obsession which can even lead to death. The best way to address this issue is to create awareness and avoid this disorder from creeping into one’s life. The most effective way to prevent anorexia is to develop healthy eating habits and a strong body image from an early age. Also cultural standards that value “thin” or “perfect” bodies should not be accepted. To this extent parents have tremendous responsibility to be educated themselves and their children about the life-threatening nature of this disease and raise their children in a healthy and supportive environment. For people who have already developed anorexia, the support of friends and family is very important to help them come out of anorexia and avoid relapse. Social gatherings should be fun filled and relaxing but careful and frequent monitoring of weight and other physical signs are important. With the support of friends and family and a trusting relationship between the patient and therapist, anorexics can come out of their condition and face life boldly. References Birgegard, A., Bjorck, C., Norring, C., Sohlberg, S., Clinton, D., 2009. Anorexic Self-Control and Bulimic Self-Hate: Differential Outcome Prediction from Initial Self-Image. International Journal of Eating Disorders 42:6 522–530. Blue, R. (1979). Use of punishment in treatment of anorexia nervosa. Psychological Reports, 44,743–746. Brown, C., 1990. The Control Paradox: Understanding and Working with Anorexia and Bulimia. National Eating Disorder Information Centre. Retrieved from http://www.nedic.ca/knowthefacts/documents/TheControlParadox.pdf. Bruch, H., 2001. The Golden Cage. Harvard University Press. Cambridge, Massachusetts. Dubansky, H., 2010. 5 Eating-Disorder Signs in Your Child. U.S. News. Retrieved from http://health.usnews.com/health-news/diet-fitness/diet/articles/2010/09/16/5-eating-disorder-signs-in-your-child Harvard Medical School, 2009. Treating anorexia nervosa. Harvard Mental Health Letter. 26 (2):1 Kotler, L. A., Boudreau, G. S., & Devlin, M. J. (2003). Emerging psychotherapies for eating disorders. Journal of Psychiatric Practice, 9, 431–441. Morgan, G.H., Barry, R., Morgan, M.H., 2008. Myoedema in Anorexia Nervosa: A Useful Clinical Sign. European Eating Disorders Review. 16, 352–354. Nilsson, K., Sundbom, E., Hagglof, B., 2008. A Longitudinal Study of Perfectionism in Adolescent Onset Anorexia Nervosa-Restricting Type. European Eating Disorders Review. 16, 386–394. Pike, K. M. (1998). Long-term course of anorexia nervosa: Response, relapse, remission, and recovery. Clinical Psychology Review, 18, 447–475. Rome, E.S. & Ammerman, S. (2003, December). Medical complications of eating disorders: An update. Journal of Adolescent Health 33(6), 418-426. Read More