Anorexia Nervosa: Causes and Treatment - Essay Example

Anorexia Nervosa Teacher               Anorexia Nervosa Based on information from the National Institute of Mental Health, anorexia nervosa is an eating disorder that affects 0.9% of all American women and 0.3% of the men, usually beginning at the age of 19 (Eating Disorders, 2014). Although it affects women more than men and despite the fact that it is not as prevalent as other mental disorders, it remains as one of the worst diseases that can affect the quality of life of an individual and of those around him. Moreover, data from the NIMH reveals that only 33.8% of American patients with anorexia are receiving treatment (Eating Disorders, 2014).Thus, it is best to look more into the symptoms, causes and treatment methods for this particular disorder. Research on these aspects of anorexia nervosa yields new insights regarding the disease, making it deadlier than what it seems yet the new methods to treat it make it less of a concern. Symptoms Actually, based on the DSM-IV Diagnostic Criteria for Anorexia Nervosa, patients suffering from this particular eating disorder usually refuse to maintain body weight above normal and usually go for minimal. Patients with anorexia also suffer from an intense fear of gaining weight and turning into a fat person despite the fact that he or she is even underweight. Moreover, there is also constant mental disturbance while the body is gaining weight or as the body assumes a different shape. In women, there is also amenorrhea or the absence of a minimum of three menstrual cycles (Katzman & Golden, n.d.). These are the very things that actually characterize someone with anorexia based on the standards set by the American Psychiatric Association. Nevertheless, there are common, general symptoms of someone suffering from anorexia. First of all, anorexia patients are into constant dieting or being overly conscious of one’s diet. Second, not only does the affected patient use dieting as a way to lose weight – he or she also wants to be thin at all costs. In fact, this is even sometimes reinforced by compliments from family and friends on the patient’s progressive success in losing weight. A third characteristic is the perception of a distorted body image. Something that happens together with this is the denial of the feelings of hunger while forcing oneself to focus on weight loss. Thus, the body becomes emaciated (Katzman & Golden, n.d.). A fourth symptom of anorexia nervosa is all about having unusual eating habits and behaviors. There is however a general tendency to go for low-fat and low-calorie foods and even overeat these. There is also a tendency to avoid foods that are perceived as unhealthy. However, there are some who would still choose to cook these foods and serve them to others, without actually eating these. Adolescent anorexics may also secretly throw food away, eat food at the same time everyday, or eat food of the same color. These unusual eating behaviors often manifest in a few special cases of anorexia (Katzman & Golden, n.d.). A fifth characteristic is increased physical activity especially those that the patient thinks would contribute to further weight loss. Sixthly, there are also patients who purge or vomit their food, restrict themselves from eating, or even perform excessive exercises as well as indulge in alternative medicines sometimes to the point of over dosage. A seventh characteristic is the tendency to check the weighing scale frequently, even several times in one day. Usually in this situation, the current weight of the patient seems to determine how he or she is supposed to feel (Katzman & Golden, n.d.). An eighth symptom of anorexia nervosa may be wearing baggy clothes in order to conceal their weight loss. Ninthly, many anorexics my actually develop poor self-esteem, which manifests in feelings of helplessness and insecurity especially when dealing with others. Thus, in order to alleviate the negative feelings, the teenager actually reinforces his or her dieting habits (Katzman & Golden, n.d.). This clearly shows that constant dieting does not actually remove the negative feelings although the patient believes that he is going through the right direction. A tenth characteristic of anorexia nervosa patients is isolation, and this stems from low self-esteem. Young patients tend to withdraw from friends and family as well as social situations. Another reason is actually the avoidance of food, which is usually associated with social situations. These negative attitudes usually lead the patient further to two other symptoms – inflexibility and irritability. An anorexic would naturally remain inflexible not only in her dieting and health habits but also in her moral sense of right and wrong. In fact, he is not apt to accept individual differences in this aspect. At the same time, she becomes irritable as these are the body’s physiological reactions to starvation and to drastic changes in diet (Katzman & Golden, n.d.). Aside from the general characteristics mentioned, there are also physical signs and symptoms which are actually characteristic of someone who is suffering from anorexia nervosa. First is weight loss that is unexpected, significant or unusual. This weight loss is always brought about by the wasting of muscle mass and subcutaneous tissue, and is evidenced by sagging skin or the prominence of bones. Second, there is amenorrhea, which is a criterion mentioned in the DSM-IV specifically for females who have undergone menarche. Thirdly, there is pubertal delay in the sufferer. This may actually also lead to long-term effects on sexual maturation when one becomes an adult. Fourthly, sufferers of anorexia experience a lack of growth or a rather poor growth (Katzman & Golden, n.d.). Other minor changes but which may appear in someone with anorexia nervosa include the development of lanugo hair, which is a special type of fine hair often seen on the face, back and stomach; hair loss, dry and hyperkeratotic skin, hypothermia up to 35°C, bradycardia, recurrent fractures, hypotension, acrocyanosis, systolic murmur and edema. Other symptoms include fainting, cold intolerance or constant complaints about feeling cold, abdominal bloating or discomfort, fatigue and cramps, poor concentration, and constipation (Katzman & Golden et al., n.d.). Moreover, there are also laboratory characteristics for someone with anorexia nervosa. Hematological findings include leucopenia, thrombocytopenia, decreased serum and decreased sedimentation rate of erythrocytes. Chemistry findings include increased blood urea nitrogen, hypophosphatemia, increased cholesterol and serum carotene level, and decreased levels of vitamin A, copper, zinc, magnesium and calcium. Moreover, other changes include decreased growth hormone, low sex hormone levels, decreasedechocardiogram, decreased glomerular filtration rate and low bone mineral density (Katzman & Golden et al., n.d.). Anorexia nervosa may actually have seriously debilitating consequences. According to Russell et al. (2009), patients suffering from anorexia usually suffer greatly when it comes to cognitive-related tasks which remain the same even if one takes into account the IQ and years of education of the patient. This means that no matter how intelligent the person is, if he becomes affected with anorexia, he would never be able to redeem himself with his intelligence or level of education. Thus, this characteristic of the disease makes it actually worse than what it seems. Another serious symptom or complication of anorexia nervosa is the development of suicidal thoughts. In fact, according to Papadopoulus et al. (2009), increased rates for suicide are evident in those suffering from anorexia although the correlation is unclear. Nevertheless, this information brings one to the realization that suicide is indeed one of the feared effects of anorexia, thus there is a great reason to opt for immediate treatment. Still, another symptom or rather a complication of anorexia is the crossover to bulimia nervosa. This crossover actually usually happens to the binge/type of anorexia sufferers (Peat et al., 2010). This is definitely another reason why the disorder should be treated right away. Anything that is ignored may always lead to such complications. Another complication of anorexia nervosa is a problem with the bone marrow and bone density mass. According to Bredella et al. (2009), patients with anorexia are suffering from an increase in bone marrow fat and a corresponding decrease in bone density mass. This is actually a paradoxical event when compared to the actual decrease of overall body fat. However, this may be a prelude to bone cancer or to any other fat-related or bone-related medical problems in the sufferer of anorexia nervosa. Causes Certain risk factors are strongly associated with anorexia nervosa. These include age (usually adolescents), gender (usually female), picky eating habits in childhood, digestive and other eating-related problems in childhood, concerns about weight and negative body image, a past history of anorexia, a perfectionist personality that is characterized by anxiety and low self-esteem, early puberty among girls, chronic illness such as diabetes mellitus, incidence of physical and sexual abuse, occurrence of psychiatric disorders among first-degree relatives, and participation in activities and sports that emphasize body weight (Katzman & Golden, n.d.). Overall, anorexia nervosa is a product of several factors – biological, sociocultural and psychological – that combine to produce the disease. The predispositions to the disease include a family line of people with eating disorders, the cultivation of a personality that exemplifies perfectionism, and the activity of serotonin, which is a neurotransmitter that functions to modulate appetite. Add to this the societal emphasis on thinness and the pressures that create all sorts of concerns regarding weight and appearance (Katzman & Golden, n.d.). Moreover, recent research has shown interesting theories on the other possible causes of anorexia nervosa. Harrison et al. (2009) stated that “women with [anorexia] have difficulties recognizing emotions on a complex emotion recognition task” (p. 354). Although the researchers believe that this is more of an effect of anorexia on the brain, there have been considerable evidence that the brain loses its capacity to recognize emotions prior to the onset of the disorder and the appearance of other symptoms. Anorexia nervosa may also be caused by significant sociocultural factors. In fact, according to Tozzi et al. (2009), individuals with anorexia believe that family environment, dieting and stress contribute to their disorders. This means that although this cannot be quantified in detail, the opinion of the patients themselves really matters as to what could have possibly triggered the disorder. This information also somehow sheds light on the possible ways by which the external environment can actually trigger a disease or promote an unhealthy mental make-up. The disease may also be brought about by a lack of cooperation with treatment, particularly psychotherapy. According to Wentz et al. (2009), what can predict the onset of anorexia nervosa in adolescents includes factors like not attending psychotherapy sessions, and this occurs in 1 out of 5 patients. However, what could have possibly caused such an absence from the session is the lack of money for training these people. In fact, one in four anorexia patients have no money at all, and are therefore not expected to continue or even start therapy (Wentz et al., 2009). Treatments Standard treatment for anorexia nervosa firstly begins with a diagnosis that should be conducted by an interdisciplinary team of medical professionals who are skilled when it comes to eating disorders. As soon as possible, diagnosis must be performed on someone suspected of having it. Secondly, as soon as it is confirmed, there should be medical and nutritional intervention for the purpose of weight restoration and the reversal of symptoms. A noticeable improvement in the symptoms of starvation serves as the signal for the beginning of psychological treatment. Thirdly, the psychological intervention that follows consists of a prescribed psychotherapy session with components like family psychoeducation, family therapy and family-based therapy. Fourthly, pharmacological treatment should follow. According to Kaye et al. in 2001, this must actually be mainly psychotropic medications especially with the use of Fluoxetine (as cited in Katzman & Golden, n.d.). Nevertheless, according to Attia et al. in 1998, there have also been claims that Fluoxetine does not appear effective (as cited in Katzman & Golden, n.d.). Nonetheless, drugs of choice remain to be “fluoxetine, sertraline, paroxetine, fluuvoxamine, and citalopram” (Katzman & Golden, n.d., p. 483). Finally, the treatment process must end with the medical professionals giving valuable advice to the parents and caretakers of the patient. Key points recommended for interpersonal care and intervention include being patient, avoiding blames, avoiding comments, promoting a positive body image through modified eating practices and activities, more meals with the family, avoiding food as a topic for discussion, and cooperation with the health team in charge of the patient (Katzman & Golden, n.d.). Nevertheless, recent research has somehow slightly modified and added more insight to the existing standard treatments for anorexia. In fact, according to Tozzi et al. (2003), treatment consists of the factors known to significantly contribute to recovery from anorexia, such as “supportive familial relationships, therapy and maturation” (p. 150). Although supportive relationships within the family and psychotherapy somehow conform to the standard methods of treatment for anorexia, maturation is something else. According to Tozzi et al. (2003), some patients believed that part of their recovery was thay “they [simply] matured out of the disorder” perhaps out of pregnancy or desire to start a family (p. 151). This means that somehow if the right psychotherapy was given together with adequate support, then there is a good chance that the patient will eventually outgrow his anorexia. Anorexia may also be treated through family therapy. According to Treasure and Russell (2011), the Maudsley (London) model of family therapy proved to be effective in treating adolescents with a short duration of anorexia. Moreover, even five years later, the outcome was much better for those treated using this model. The Maudsley (London) model of family therapy, which was endorsed by the National Institute for Health and Clinical Excellence, consists of family therapy for patients with a shorter duration of the eating disorder. All trials and actual case studied yielded in a marked improvement in treatment and full remission rates (Treasure & Russell, 2011). Three more psychotherapies are being recommended by experts. These are interpersonal therapy (IPT), cognitive behavior therapy (CBT), and specialist supportive clinical management (SSCM). Based on the conclusion of the authors, IPT and CBT can actually provide better psychotherapy strategies when it comes to dealing with wider life stressors while SSCM may be used if the patient wants to raise certain issues as well as the immediate and quick restoration of weight (Carter et al., 2011). Thus, in the course of treatment of anorexia, it is best that an expert on eating disorders be consulted regarding the appropriate mode of treatment since much can be achieved if only the exact method is used. Another recommended form of therapy for this particular eating disorder is focused on weight restoration or refeeding. According to Fisher et al., (2010), what can best include this is systems therapy, which is a form of structural therapy and something that includes Milan and post-Milan family therapy. The purpose of this therapy is to elicit changes in family dynamics and to encourage family members to contemplate and reflect on the fitness of their behavior within the context of the family dynamic. Milan and post-Milan family therapy is all about acknowledging the effect of the illness on every member of the family and to revert the focus on how to induce change by making changes in the eating disorder symptoms. The Milan family therapy does not consider the family as a causative agent for anorexia but rather assumes that the family is a factor that can restore the anorexia patient to his or her normal mental and physiological state. However, what is recommended by some experts remains to be the multidimensional approach. According to Beumont et al. (2005), when it comes to the multidimensional approach to treating anorexia nervosa, the first thing that should be addressed should be the medical manifestations of the illness in order that physical harm may be averted. Aside from this, there must be weight restoration, psychotherapy, family therapy and diet advice, depending on whichever works for the particular patient. Conclusion Based on the research done, the symptoms of anorexia nervosa are indeed worse than what was originally known. Some of these include the crossover to bulimia nervosa and the tendency to affect bone mass and bone marrow content. The causes of the disease have also become more multidimensional, with possibilities extending to external factors and the possible factor of financial difficulty. The treatment methods have also become more varied, as now family therapy is being emphasized as well as making the appropriate choice for the type of psychotherapy to be used. With all these new insights, one is tasked to be more aware of one’s health and of the various things that bring about the disease and to watch out against these. References Beumont, P., Beumont, R., Hay, P., Beumont, D., Birmingham, L., Derham, H., Jordan, A., Kohn, M., McDermott, B., Marks, P., Mitchell, J., Paxton, S., Surgenor, L., Thornton, C., Wakefield, A. & Weigall, S. (2005). Australian and New Zealand Clinical Practice Guidelines for the Treatment of Anorexia Nervosa. The Journal of Lifelong Learning in Psychiatry, 3(4), 618-628. Retrieved from Psychiatry Online: http://journals.psychiatryonline.org/data/Journals/FOCUS/2626/618.pdf Bredella, M. A., Fazeli, P. K., Miller, K. K., Misra, M., Torriani, M., Thomas, B. J., Ghomi, R. H., Rosen, C. J. & Klibanski, A. (2009). Increased Bone Marrow Fat in Anorexia Nervosa. The Journal of Clinical Endocrinology and Metabolism, 94(6), 2129-2136. Retrieved from the National Institutes of Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690416/ Carter, F. A., Jordan, J., McIntosh, V. V. W., Luty, S. E., McKenzie, J. M., Frampton, C. M. A., Bulik, C. M. & Joyce, P. R. (2011). The Long-Term Efficacy of Three Psychotherapies for Anorexia Nervosa: A Randomized, Controlled Trial. International Journal of Eating Disorders, 44, 647-654. Retrieved from The Red Leaf Practice: http://www.theredleafpractice.com/uploads/7/3/9/2/7392147/long-term_efficacy_of_3_psychotherapies.pdf Eating Disorders Among Adults – Anorexia Nervosa. (2014). Retrieved from the National Institute of Mental Health: http://www.nimh.nih.gov/statistics/1eat_adult_anx.shtml Fisher, C. A., Hetrick, S. E. & Rushford, N. (2010). Family Therapy for Anorexia Nervosa. The Cochrane Collaboration, 6, 1-113. Harrison, A., Sullivan, S., Tchanturia, K. & Treasure, J. (2009). Emotion Recognition and Regulation in Anorexia Nervosa. Clinical Psychology and Psychotherapy, 16, 348-356. Katzman, D. K. & Golden, N. H. (n.d.). Anorexia Nervosa and Bulimia Nervosa. Retrieved from Stanford University: http://peds.stanford.edu/Rotations/adolescent_medicine/documents/EDArticle.pdf Papadopoulos, F. C., Ekbom, A., Brandt, L. & Ekselius, L. (2009). Excess mortality, causes of death and prognostic factors in anorexia nervosa. The British Journal of Psychiatry, 194, 10-17. Retrieved from St. Vincents: http://www.stvincents.ie/dynamic/File/femi%20article.pdf Peat, C., Mitchell, J. E., Hoek, H. & Wonderlich, S. (2010). Validity and Utility of Subtyping Anorexia Nervosa. International Journal of Eating Disorders, 42(7), 590-594. Retrieved from the National Institutes of Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844095/ Russell, T. A., Schmidt, U., Doherty, L., Young, V. & Tchanturia, K. (2009). Aspects of social cognition in anorexia nervosa: Affective and cognitive theory of mind. Psychiatry Research, 168, 181-185. Tozzi, F., Sullivan, P. F., Fear, J. L., McKenzie, J. & Bulik, C. M. (2003). Causes and Recovery in Anorexia Nervosa: The Patient’s Perspective. International Journal of Eating Disorders, 33, 143-154. Retrieved from Brown.Uk.Com: http://brown.uk.com/eatingdisorders/tozzi.pdf Treasure, J. & Russell, G. (2011). The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. The British Journal of Psychiatry, 199, 5-7. Retrieved from the British Journal of Psychiatry: http://bjp.rcpsych.org/content/199/1/5.long Wentz, E., Gilberg, I. C., Anckarsater, H., Gilberg, C. & Rastam, M. (2009). Adolescent-onset anorexia nervosa: 18-year outcome. The British Journal of Psychiatry, 194, 168-174. Retrieved from the British Journal of Psychiatry: http://bjp.rcpsych.org/content/194/2/168.long Read More