Female Adolescent with Anorexia and Its Effect on the Family - Term Paper Example

FEMALE ADOLESCENT WITH ANOREXIA AND IT’S EFFECT ON THE FAMILY ACKNOWLEDGEMENTS: I would like to thank ………………for his / her continued assistance and patience in the production of this report. I would also like to thank my parents, family and friends for their support and encouragement. LIST OF CONTENTS: ABSTRACT……………………………………………………………………….5 INTRODUCTION ……………………………………………………………… .6 BACKGROUND………………………………………………………………….8 PURPOSE…………………………………………………………………………9 DEFINITION OF TERMS………………………………………………………..9 RESULTS………………………………………………………………………...10 CONCLUSION …………………………………………………………………..12 RECOMMENDATIONS…………………………………………………………13 REFERENCE LIST……………………………………………………………….15 LIST OF ILLUSTRATIONS Thin girl with anorexia nervosa eating a small meal………………………………..11 ABSTRACT A family is a close-knit unit in itself and any problem if one member faces, other members would also feel its impact. Besides many other causes, anorexia once touched the life of one member would create upheaval in the whole family. A patient would keep aloof and not only be secretive about it but also starve that would create more health problems for him and a matter of greatest worry for the parents. There are several reasons for anorexia and the biggest reason is a social problem and psychological effect. It has become the most common disease after obesity and 2 to 3 per cent of Australian adolescents are suffering from this disease. Its main treatment is the emotional and psychological support from the family members and support groups. Medications can reduce the gravity of the problem but it is only the family whose support is really helpful for the patients. Along with that patient needs proper diet and nutritious food. Only in severe cases that patient needs to be hospitalized. INTRODUCTION Anorexia Nervosa is a disorder in body functioning. It effects’ adolescent females who gets’ easily carried away by the media image of slim body as a sign of beauty. They intend to control the body weight through the means of voluntary starvation like purging, vomiting, excessive exercise, or other weight control measures such as diet pills or diuretic drugs. (Wikipedia, 2008) However, 10 per cent of the people diagnosed with anorexia approximately are males. It brings the patient into a very complex situation including neurobiological, psychological, interpersonal and sociological impacts. The psychological factors include: Too much of self-evaluation regarding the body’s shape and weight, obsessive thoughts on food and weight, keenness to attain perfect body, poor insight and obsessive-compulsive disorder. Interpersonal factors include family problems, social and sexual abuse, difficulties arising out of the expressing emotions and feelings or exposure to physical or sexual abuse. The first sign of anorexia is weight loss that continues to take place despite reaching his or her required weight. In most of the cases, people eat too little or when they eat they flush out so the body gets deficient in nutrients and stop functioning properly. Starvation could make the heart, brain or other organs at risk as metabolism in the body begins to get slow, heart rate decreases and also affects the thyroid function and blood pressure. They can also suffer from problems like constipation, hair loss and fragile nails. Besides, they can have deficiency of iron; suffer from dizziness and foggy thinking etc. They also can have other very serious complications. Family members are the first ones to get affected with anorexia. They have following characteristics involved in relation to each other: Enmeshment, over-protectiveness, rigidity, lack of conflict resolution and involvement of a vulnerable symptomatic child. There is a feeling of emotional and physical bond with each other and they both feel each other’s movement. Generally parents are over protective and this nature creates a hindrance in the path of their growth. Sequences and the behaviors in the family are fixed and reflect in the same way even though whatever circumstances the outside forces exert. The basic problem with the family is the unending arguments and conflicts that bring out number of tensions and disagreements. These conflicts and tensions give birth to symptomatic child. It is also suggested that some families carry a specific tendency to pathology in the area of eating and weight per se. For e.g. If we see a family history of the patient, we will find problem is carried from ancestors and is being carried forward. Studies conducted have found that one quarter of the anorexia patient had at least one relative who had at least one time suffered from anorexia nervosa. Others could be families showing their unusual interest in weight, food or shape. It had also been found by many researchers that patients with eating disorder generally don’t eat in front of their children or don’t behave in the positive way towards their children. It is also the problem of un-conducive environment and circumstances. (Gilbert, 2005) For the treatment of the patients, nursing actions are highly recommended from assessment stage to intervention stage. Observations of anorexia patients include close watch over weight loss receiving biotherapy: loss of weight of more than 2 per cent total body weight, more than 5 per cent per month and more than 6 per cent every three months and more than 10 per cent six months is considered to be severe condition. According to the research groups, The Common Toxicity Criteria is a scale used to measure the severity of nutritional and metabolic toxicity. (Reiger, 2000, p. 593) The physical examination by nurses involves review of body systems to identify signs of nutritional problems to check the contents of protein, fat and extra-cellular mass. Physical examination includes checking of medical history of patients including history of pain, depression, nausea and vomiting, constipation, and food intolerance. Assessment should also be made on the symptoms such as stomatitis, dry-mouth and changes in taste and smell. For the management of anorexia, identifying about the impact of poor nutrition on health should be included as a part of nursing assessment. (Reiger, 2000, p. 595) Nurses should take enteral route for nutrient intake process to maintain normal gut flora, transit and histology along with that liquid and protein supplements should be given orally. If you are recommending the use of commercial supplements then it is important that specific patients needs are being met like their ability to tolerate lactose. (Reiger, 2000, p. 595) It is recommended that supplements should be given between meals. BACKGROUND Anorexia Nervosa was first described in 1684 but it was only in 1870 that the disease became identifiable and diagnosed as it was Sir William Gull in the 19th century who first coined the term and since then we began to further understand the serious complications the problem anorexia can lead us into. It is understood as the nervous loss of appetite but the various symptoms and mood swings elude us to get a better understanding of the causes of anorexia. Richard Morton was the first one to make the first medical discovery of anorexia in 1968. (Halse, Honey & Boughtwood, 2007) The discovery of this new disease had not only shown us the method of treatment but it also had a profound effect on the changes in society and how we can make our mission idealized. The culture and the several problems in social structure is a reason why anorexia is spreading so fast. Even the psychologists had knowledge about the disease much before its official discovery yet it was not until the beginning of the 1970 that media of America began to write about the disease. PURPOSE What anorexia is and how anorexia affects the whole family is the main topic of my concern of the report. I also wanted to show that anorexia is curable but because of the length and scope of the report I cannot go in depth regarding its treatment. DEFINITION OF TERMS: Osteopenia: Osteopenia is a condition when the mass of the bone becomes thinner. It is not very serious condition but it can be serious when it leads to Osteoporosis. (Hirsch, 2008) Osteoporosis: It is a fragile bone disease caused due to the condition of the loss of bone mass and is caused due to the deficiency of calcium, vitamin D, magnesium and other vitamins and minerals. (Hirsch, 2008) Hypothalamic-pituitary-gonadal axis: “The hypothalamic-pituitary-gonadal axis (also HPTA) is a way of referring to the combined effects of the hypothalamus, pituitary gland, and gonads as if these individual endocrine glands were a single entity. Because these glands often behave in cooperation, physiologists and endocrinologists find it convenient and descriptive to speak of them as a single system.” (Nationmaster.com, Online) Anxiety: Anxiety is a state of agitation and tension, troubled state of mind, and uneasiness. (Barlow, 2004) Obsessive-compulsive symptoms: It is a kind of extreme nervousness, and can continue through out person’s life. The individual gets “trapped in a pattern of repetitive thoughts and behaviors which are senseless and distressing but extremely difficult to overcome.” (Psychology Today, 2002) Schizophrenia: “It is a chronic and severe mental disorder that is characterized by the disintegration of the process of thinking, emotional responsiveness and of a contact with reality”. (Gur & Johnson, 2006, p. 4) RESULTS: Research and studies found that anorexia is the next most common disease after obesity and asthma and 2 to 3 per cent of Australian adolescents are suffering from this disease. The average time duration of anorexia is five years. In the National Youth Survey by Mission, it was revealed that the image of body had been top priority among Victorian girls aged between 15 to 19 and now between 70 to 76 per cent high school girls wished considered thin body as an ideal figure and among the adolescent boys, one among the third would like to have a thinner body weight and they get succumbed to bulimia and binge eating, both culprits in anorexia. (Report of the Media Code of Conduct on Body Image Working Group, Melbourne 2007, 2008). The statistics reveal that one in every 100 Australians suffers from anorexia. But research by Dr Jenny O’Dea of the University of Sydney depicted far worse picture that one in five teenagers vomit their food or starve themselves to reduce their weight and slowly symptoms of anorexia would begin to appear. (Katelin, 2008) The studies on the family and twin studies have reflected that genetic factors are the main cause of development of eating disorder and it includes clinic depression. And evidence reflects the fact that eating regulation and changes in personality and emotions are also the most important factors. One of the studies conducted found that changes in the norepinephrine transporter gene promoter have been found linked to restrictive anorexia nervosa. Several rodent models related to anorexia have been developed exposing animals to several stresses or they also made use of gene knockout mice to test hypotheses about the effects of certain genes. These models came out with the result that the hypothalamic-pituitary –adrenal- axis is also the most important factor for the development of anorexia nervosa. (Wikipedia, 2008) Patients get severe health related problems like their nails would begin to tear out and patient feels hair loss. Some patients can also have constipation problems. The fat content in the body is reduced causing the normal body to become all time low increasing the chances of cold. During starvation, muscle tissues also begin to deplete, as they are not getting enough nutrients. Person can also become anemic owing to deficiency of iron. Oxygen rate is also reduced and person may feel dizziness, light headedness, foggy thinking and constant fainting. In severe cases, anorexia can also cause kidney failure and even heart and brain damage. Patient should be hospitalized much before this situation is reached. Besides, patients can also have complications leading to osteopenia and osteoporosis that can increase the risk of fracture all through the life. Patients also display changes in the hypothalamic-pituitary-gonadal axis, causing disorder in menstrual cycles. (Sadock, Kaplan & Sadock, 2007). Thin girl with anorexia nervosa eating a small meal (Source: Anorexia illustrations and clipart. Online) If one child is affected then the whole family is affected and there is a sense of gloominess and insecurity. Family is scared of loosing their child; is concerned over starvation effects of anorexia; discovery of the disorder leads to disbelief in the disclosure of the secret life of daughter; is always anxious about child’s welfare. Over-protectiveness and enmeshment are the causes of anorexia as well as the effects of it. Need is always felt to give over protection to the child which is in itself is very difficult. Parents may be affected in one-way or the other and on the whole, would feel confused, helpless, anxious, and even angry. Their anxiousness is clearly seen when their child starts getting secretive about eating habits and often seen complaining on the deceptions they thought their child had given them while sick which could be tremendous shock to them. CONCLUSION: In many cases, the problem gets unnoticed whereas in various others, the problem leads to serious consequences. In the report it is highlighted that psychological factors like eating less and reduction in weight loss is main reason of turning anorexia nervosa into problem. Norepinephrine transporter gene promoter has also been found linked to restrictive anorexia nervosa. The anorexia patients are observed by keeping a watch on their continuous weight loss. Nurses are recommended to take a review on their body systems identifying signs of nutritional problems to check the contents of protein, fat and extra-cellular mass. They should be physically examined which includes checking of medical history of patients including history of pain, depression, nausea and vomiting, constipation, and food intolerance. Assessment should also be made on the symptoms such as stomatitis, dry-mouth and changes in taste and smell. Several rodent models have also shown that hypothalamic-pituitary –adrenal- axis is also the most important factor to develop the anorexia nervosa. Medications can reduce the gravity of the problem but family members can build the support base and family structure in the way their whole disease would subside. Proper diet and nutritious food may also go along with the other treatments to give final look. But if the problem gets serious and symptoms of various other problems and disease begins to show, patient should be hospitalized. RECOMMENDATIONS: Nurses have to play greater role in the treatment of patient. It is recommended that they should adopt more friendly and emotional help to parents. Besides taking care of the patient’s food habits they have, nurses should make efforts to keep the family dysfunctions to the minimum, in other words to keep the family problems to the minimum and create the most conducive and friendly environment and make the patient at ease. Once cured, nurses should teach patient and its family for the use of Mcknight Risk Factor Survey to further prevent the disease. (Byod, 2007, p. 526) Treatment of the patient is based on severity of the case. If the problem is serious patient requires hospitalization. All the medical, nutritional, and psychiatric care is required for the patients to recover. The most important part in the whole treatment is the regular monitoring of weight and it is recommended that nurse should weigh the patient and record is kept of the weight for diet specialist. And if the problem is not of grave nature, it is family who could provide the best treatment. (Byod, 2007, p. 526) Recent studies on the clinical reviews suggest that the most effective treatment is psychotherapy that can help in the increase of weight, help in the start of menstrual cycles among female patients, and change the behavior of patients including their psychological and social functioning. Family therapy is also found to be very fruitful for the treatment of adolescents with anorexia particularly the method adopted by Maudsley Hospital. (Le Grange, 2005) Supplement of 14mg/day of zinc is also recommended for patients on routine basis leading to their weight increase. (Walsh et al., 2006) REFERENCE LIST Anorexia illustrations and clipart. Retrieved on August 20, 2008 from W.W. W: http://www.fotosearch.com/illustration/anorexia.html Barlow, D.H. (2004). Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic. New York: Guilford Press. Boyd, M. A. (2007). Psychiatric Nursing: Contemporary Practice. Philadelphia: Lippincott Williams & Wilkins. Gilbert, S. (2005) Counselling for Eating Disorders. London & California: SAGE. Gur, R.E. & Johnson, A.B. (2006). If Your Adolescent Has Schizophrenia: An Essential Resource for Parents. Oxford University Press US. Halse, C., Honey, A. & Boughtwood, D. (2007). Inside Anorexia: The Experiences of Girls and Their Families. New York: Jessica Kingsley Publishing. Hirsch, J.A. 2008. Osteopenia and Osteoporosis: Is There a Difference? Retrieved on August 20, 2008 from W.W.W: http://www.spineuniverse.com/displayarticle.php/article3148.html Katelin. (2008). Mirror, mirror on the wall… Retrieved on August 15, 2008 from W.W.W: http://www.actnow.com.au/Opinion/Mirror_mirror_on_the_wall.aspx Le Grange D. (2005) The Maudsley family-based treatment for adolescent anorexia nervosa. World Psychiatry, 4 (3), 142-6. Linda Gehlin, L. 2008. The History Of Anorexia Nervosa and other Eating Disorders. Retrieved on August 15, 2008 from W.W.W: http://www.web4health.info/en/answers/ed-anorexia-history.htm NationMaster.com. Anabolic steroid. Retrieved on August 20, 2008 from W.W.W: http://www.nationmaster.com/encyclopedia/Anabolic-steroid Perlmutter, R. (2004). A Family Approach to Psychiatric Disorders. Arlington, VA: American Psychiatric Pub, Inc. Psychology Today. 2002. Obsessive Compulsive Disorder. Retrieved on August 20, 2008 from W.W.W: http://www.medicinenet.com/obsessive_compulsive_disorder_ocd/article.htm Reiger, P. T. (2000) Biotherapy: A Comprehensive Overview. Sudbury, MA: Jones & Bartlett Publishers. Report of the Media Code of Conduct on Body Image Working Group, Melbourne 2007. (2008). DATA AND GENERAL INFORMATION ON YOUNG. Retrieved on August 15, 2008 from W.W.W: http://www.youth.vic.gov.au/Web21/ofy/rwpgslib.nsf/GraphicFiles/Key+Facts+about+Body+Image/$file/Key+Facts+about+Body+Image+pdf.pdf Sadock, B. J., Kaplan, H. I. & Sadock, V. S. (2007) Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. Philadelphia: Lippincott Williams & Wilkins. Walsh BT, Kaplan AS, Attia E, Olmsted M, Parides M, Carter JC, Pike KM, Devlin MJ, Woodside B, Roberto CA, Rockert W. (2006) Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. JAMA, 295(22), 2605-12 Wikipedia. (2008). Anorexia Nervosa. Retrieved on September 3, 2008 from W.W.W: http://en.wikipedia.org/wiki/Anorexia_nervosa Read More