Features of Anorexia Nervosa - Coursework Example

Anorexia Nervosa First Middle initial and of Prof. First and of lecturer March 26, Anorexia Nervosa Anorexia nervosa is a multifaceted psychiatric disorder which centers on regulating food intake and controlling weight in order to look perfect. Hence it is also an eating disorder. Anorexia nervosa is currently the most common reason for eating disorder related hospitalization in America and accounted for 37% of hospitalizations in 2005 to 2006 (Harvard Medical School, 2009). This is a 17% increase from anorexia related hospitalizations in1999 to 2000 (Harvard Medical School, 2009). Studies have revealed that anorexia often begins between the ages of 15 and 18 years and typically does not occur after an individual reaches their mid 20s (Harvard Medical School, 2009). This finding reveals that adults who seek treatment for the disease have usually struggled with this disorder much earlier in their life. Again, nearly three quarters of those affected by this disorder are females. There are two types of anorexia: 1. Restricting type of anorexia: Individuals follow extreme diet regimen, fasting and too much exercising to attain weight loss. 2. Purging type of anorexia: Individuals resort to vomiting or using laxatives and diuretics to attain weight loss. Signs and Symptoms Some of the common physical and behavioral signs of this disorder are stated below: Physical signs. The physical signs and symptoms include excessive weight loss without any medical cause, dry skin, thinning of hair, feeling cold or presence of swelling in extremities of limbs, low blood pressure, fatigue and/or abnormal heart rhythms. Psychological and behavioral signs. The psychological and behavioral signs and symptoms 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 The exact cause of anorexia is still unknown. However, medical experts believe that there are several factors that may work together and lead to this eating disorder. These factors include: Severe trauma or emotional stress that is associated with loosing a loved one or being sexually abused Serotonin, a chemical found in the brain has been found to cause abnormalities in brain chemistry Cultural environment that encourages people to be “thin” Fear of being humiliated or ridiculed leading the individual towards perfectionism Family history of anorexia Key Indicators to Identify Anorexia Nervosa Following are some of the key indicators to identify Anorexia Nervosa: 1. Weight loss: Significant loss of weight without any associated medical reason is one of the primary indicators of Anorexia Nervosa. The disease may go unnoticed even by physicians during the initial phase because a lot of attention is given to obesity and related issues. However, if a healthy individual looses 5 to 10 pounds, then it is a matter of concern and should be followed-up (Dubansky, 2010). 2. Sudden change in eating habits: If an individual skips meals, eats only a few foods and avoids entire food groups like meat or carbohydrate or chews food endlessly, their behavior needs to be monitored and addressed as these are signs of anorexia. 3. Over exercising: If the exercising regimen of an individual is turning into a compulsive behavior, it is an indicator of Anorexia Nervosa. It may be difficult to detect over exercising in individuals who are already engaged in sports. However, on close observation, if you catch your daughter doing 100 sit-ups or push-ups in her room on days she has swimming practice or dance class, she may be inclined towards an exercise obsession due to anorexic behavior (Dubansky, 2010). 4. Distorted body image: If an individual spends considerable amount of time in front of the mirror, tries to cover up the so called “thin” look by wearing oversized clothes or frequently makes disapproving comments like “I’m so fat”, then they may be tipping towards anorexic behaviors. 5. Anxiety: Two out of three adults struggling with eating disorders have been found to have anxiety issues when they were children (Dubansky, 2010). Although anxiety may be most obvious in situations involving food, it can occur in other areas also. 6. Myoedema or muscle mounding: Anorexics usually exhibit a phenomenon called myoedema or muscle mounding during routine physical examinations (Morgan, Barry & Morgan, 2008). Clinical Interventions Used to Treat Anorexia Anorexia nervosa is typically treated using a multidisciplinary approach that integrates nutritional support, psychological counseling and behavioral modification. The individual may be treated in a residential, partial hospitalization unit, intensive inpatient or outpatient basis depending on the severity of the disorder. However, family involvement has been found to be extremely important in treating this disorder especially when children and adolescents are dealing with this disorder. Inpatient treatment is typically recommended when an adult patient loses 15% or more of their ideal body weight (Harvard Medical School, 2009). Children and adolescents who are at risk of suffering from irreversible developmental damage due to malnourishment are also recommended inpatient treatment even if they have not reached the 15% weight-loss criteria (Harvard Medical School, 2009). According to Harvard Medical School (2009), following are some of the clinical interventions that are typically used to address anorexia nervosa: Nutrition therapy: Individuals who are severely malnourished because of starvation are first provided support and encouraged to gain weight through a carefully planned nutrition therapy. To achieve this goal clinicians resort to positive reinforcement techniques like linking privileges to target weights and praising weight gain. The patient is monitored closely to make sure that they eat the food given to them and their body weight is also checked regularly. The clinicians increase the patient’s calorie intake gradually and restrict excessive exercise to promote weight gain. Medication options: Although there is little evidence that medications promote weight gain during the initial phase of treatment, the APA practice guidelines strongly recommend the use of antidepressants to treat depression, anxiety or obsessive thinking in some patients after they have gained weight. Antipsychotic drugs are also used to promote weight gain and reduce obsessions and mealtime anxieties. Psychotherapy: Psychotherapy treatments are used to change the distorted thinking of patients about themselves and prevent relapse. Psychotherapy for anorexia nervosa has changed from a behavioral model to cognitive model as it was found that the weight gain achieved through behavioral therapy often lasted for a short time. On the other hand, cognitive behavioral therapy (CBT) has been found to help patients identify and change their distorted thinking about food and has a lasting impact. Anorexia Nervosa: An Issue of Control Although psychological, genetic and environmental issues have been found to cause anorexia, recent studies have confirmed that self control related factors can powerfully predict outcomes in anorexia (Birgegard, Bjorck, Norring, Sohlberg & Clinton, 2009). Women have frequently been found to feel pressurized by the demands at work and at home over which they have no control. Therefore those with poor self esteem resort to food intake and managing weight, which seem to be under their control. This is probably the reason why many anorexics agree that they resorted to their anorexic behaviors when they perceived that they had lost control of their lives. As Bruch (2001) states, “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 behavior only gives the anorexics an illusion of control and directs them to a life that is greatly out of control. Dangers of Continued Weight Loss and Starvation Due to Anorexia Numerous studies have revealed that the mortality rate of anorexia nervosa related complications are as high as 10% within the first ten years and most of the deaths occur due to starvation or suicide. According to Rome and Ammerman (2003), continued weight loss and starvation can lead to serious complications like: Heart Problems: Anorexics can develop irregular heartbeat where they have a resting heart rate of less than 50 beats/minute unlike a normal heart rate of 70 beats/minute. Such patients should avoid caffeine and exercise since it can cause heart arrhythmias which can be fatal. Dehydration and electrolyte imbalance: Anorexics can develop imbalances in blood salts like sodium can cause cardiac arrhythmias and death. Gastrointestinal complications: Since anorexics starve themselves, it slows down the gastrointestinal movements causing the digestive system to take longer to empty. Therefore anorexics frequently feel constipated. Other gastrointestinal complications include abnormal muscle activity in the esophagus and feeling bloated. This hastens the process of weight loss and starvation. Self-induced vomiting and abuse of laxatives: Anorexics frequently resort to self-induced vomiting, enemas and/or laxatives to achieve weight loss. This can damage the stomach nerves and aggravate constipation resulting in death. It can also lead to irregular heartbeats, stomach cramps, fatigue and breathing trouble. Water intoxication: Anorexics drink a significant amount of water which can lead to water intoxication. This can lead to cerebral swelling, seizures, coma and death. In conclusion, anorexia nervosa is a life-threatening disorder that can take a person from harmless dieting to an obsession which can be fatal. Creating awareness about this issue and encouraging healthy eating habits is therefore important to prevent this issue. Parents especially have a tremendous responsibility to educate themselves and their children about this disorder and raise their children in a healthy and supportive environment. Finally, the presence of supportive family and friends is critical for people to come out of anorexia and prevent relapse.   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. Bruch, H. (2001). The golden cage. Cambridge, Massachusetts: Harvard University Press. 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), 1-3. Morgan, G.H., Barry, R., & Morgan, M.H. (2008). Myoedema in anorexia nervosa: A useful clinical sign. European Eating Disorders Review, 16, 352–354. Rome, E.S. & Ammerman, S. (2003). Medical complications of eating disorders: An update. Journal of Adolescent Health, 33(6), 418-426. Read More