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331). Anorexia nervosa involves restricting oneself of food intake and nutrients while anorexia bulimia involves repeated acts of bingeing and purging. Thus, people with the disorder are characterized with either loss of desire to eat or purging behaviors in intent to reduce weight. In the United States, the incidence and prevalence of Americans afflicted with anorexia have risen steadily to 1.2 million individuals and majority of this statistic are adolescents and women (Mehler and Krantz, 2003, p. 331). Anorexia is also common among cancer patients in U.S. with 50% of cancer patients who developed anorexia upon diagnosis and 60%-65% when in the later stage of the disease (Adams et al. 2009, p. 96).
The increasing incidence of anorexia for the past decades has been attributed to physiologic, gastrointestinal, metabolic, nutritional, neuronal, endocrine, and societal factors such as emphasis on promoting dieting behaviors and thinness. To study further anorexia, this paper will discuss the different signs and symptoms of anorexia during a mental status examination, the evidence-based therapeutic interventions, and the potential risks to self and others of unmanaged anorexia. Signs and Symptoms during Mental Status Examination During mental status examination, the consumer with anorexia may present to the emergency department in lethargic state.
According to Gurenlian (2002), the dehydration and malnutrition brought by severe dieting may result to headaches, lethargy, and syncope (p. 221). In addition, prolonged protein and electrolyte depletion in the body will lead to weakness, dizziness, and paresthesia. A consumer with anorexia demonstrates behaviors that are profoundly narrow, rigid, and disconnected from reality (Merwin at al. 2011, p. 63). Emotions are suppressed to reduce distress in weight and body image and speech is centered rigidly on verbal guidelines about eating and exercises; thus, becomes preoccupied with weight and body image.
Due to emotional suppression, anorexic consumers also have poor self-image and greater rate of suicide attempts (Keifer et al. 2010, p. 304). Thought contents include delusion of seeing oneself as fat, suicidal ideations, and obsessions (Harris, Eberly and Cumella, 2004, p. 24-25). Nutritional and emotional suppression not only account for the delusional thoughts and decreased mental state but also in being less responsive to feedback when learning a task and difficulty in concentrating and making decisions.
Evidence-based Therapeutic Interventions Adams et al. (2009) conducted a review of evidence-based interventions to treat and manage anorexia and found out a limited number of empirically-based interventions recommended for management of the disorder (p. 100). Interventions that were reviewed for evidence in the study include dietary interventions and counseling, intake of oral supplements, and use of pharmacologic agents. Based upon the evidences, only two pharmacological interventions are recommended for treatment of anorexia: these include use of corticosteroids and progestin.
Systematic reviews confirmed that corticosteroids stimulate appetite and promote weight gain while progestin not only treat hormone-dependent tumors but has additional effect of increasing body weight and appetite (Adams et al. 2009, p. 98). Dietary interventions and counseling were also found to be effective in reducing incidence of anorexia through improvement in nutritional intake and
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