Anorexia nervosa

For other uses, see Anorexia nervosa (disambiguation).

Anorexia Nervosa Classification and external resources
File:Anorexia billboard.jpg
An anti-anorexia nervosa billboard featuring recovering anorexic actress Isabelle Caro
ICD-10	F50.0-F50.1
ICD-9	307.1
OMIM	606788
DiseasesDB	749
eMedicine	emerg/34  med/144

Anorexia nervosa is a complex condition, involving psychological, neurobiological, and sociological components. It is an eating disorder characterized by an obsessive fear of gaining weight due to a distorted self image that results in a dangerously low body weight. Individuals with anorexia nervosa may use voluntary starvation, excessive exercise, or other measures such as diet pills or diuretic drugs to combat their fear. While primarily affecting adolescent females, approximately 10% of people with the diagnosis are male.

Anorexia is estimated to affect between one and five teenage women in every 100,000, and the age at which most cases develop is from 16 to 17. For boys who develop the problem (about five to ten per cent of all cases), 12 is the peak age. According to the U.S. National Institute of Mental Health (NIMH), an estimated 0.5% to 3.7% of women will suffer from this disorder at some point in their lives.

While anorexia is sometime associated with starvation, as pictured in the grotesquely gaunt image of a young girl, (at right) it can also be a hidden problem and go undiagnosed for years as the person engages in negative eating patterns and hovers on the borderline of an abnormal weight.

Many experts consider people for whom thinness is especially desirable, or a professional requirement (such as athletes, models, ballet dancers, actors) and gymnasts, to be at risk for eating disorders such as anorexia nervosa. While treatment options vary to include medication, counseling and - in extreme cases, hospitalization - cultural and media images that promote "thinness as glamorous" or other distorted views of body image and beauty must be addressed by society at large.

The condition of anorexia first came to light when it became the focus of media attention after the tragic death of Karen Carpenter, of the singing duo, The Carpenters in 1983. The popular 1970s singer died of cardiac arrest related to her low body weight and the constant demands of deprivation associated with anorexia nervosa. While the condition of aneroxia nervosa existed in the general population prior to Carpentar's untimely death it was rarely discussed and not well understood. Sometimes referred to as "the rich girl's disease," the battle against this destructive and debalitating disorder needs to be understood and addressed on many fronts.

Definition

The term anorexia is of Greek origin: a (α, prefix of negation), n (ν, link between two vowels) and orexis (ορεξις, appetite) thus meaning a lack of desire to eat or lack of appetite. Anorexia nervosa is frequently shortened to "anorexia" in both the popular media and television reports. However, the word "anorexia" by itself is insufficent to describe the disorder which is more complex than simply the term for 'reduced appetite.' In fact, a gross oversimplification of the disorder would be to describe an aorexic as someone who is 'unwilling to eat' just as it would be an oversimplification to say that someone suffering from insomnia is 'unwilling to sleep' when "unable," - due to the stressors related to the disorder - would be more accurate.

Possible causes and symptoms

Anorexia Nervosa, like other eating disorders, cannot be attributed to a single cause. The causes of the disorder are much more likely to be attributable to a combination of factors - biological, psychological, or social in nature. These can include the many pressures which lead a young person feeling unable to cope with the stress of approacing adulthood. Other issues that can possibly impact a person's anorexic response to life stressors are family relationships, the death of someone significant, problems at work or school, poor or lacking self concept, and even sexual or emotional abuse. Anorexics suffering from this condition may equate feeling ‘too fat’ with not being ‘not good enough’.

Genetics may contribute considerably to a person's predisposition towards anorexia nervosa, as can be the case with other psychiatric or medical conditions; therefore family history should be taken into account when investigating a diagnosis.

An anorexic person feeling helpless or anxious gains a sense of 'mastery' by obsessively and rigidly monitoring their diet. Their perfectionistic control of their outer needs masks their internal feelings of inadequacy and anxiety, therefore, not eating and losing weight become that person's only way of feeling 'safe and 'in control.' But it's important to remember that this kind of intense starvation is not the only symptom of an eating disorder. A person with an eating disorder may maintain a normal body weight and so their condition may go unnoticed for a long period of time. This, however, is more often the case with bulimia which is easier to hide as a person may appear to be eating normally, but in private purge what they have taken in through meals.

As with any illness, whether it be psychiatric in origin or not, finding the proper diagnosis is an important first step in securing the most appropriate and effective treatment.

Diagnosis

A mental disorder is defined as the "existence of a clinically recognizable set of symptoms or behaviors associated with distress and with interference with personal functions." While anorexia nervosa can be diagnosed using certain criteria, it should also be taken under consideration that other pyschological conditions, or the predisposition towards those conditions, such as depression or obsessive compulsive disorder can be contributing factors in and of themselves.

The most commonly used criteria for diagnosing anorexia nervosa are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD).

Although biological tests can aid in recognizing anorexia nervosa, the diagnosis is truly based on observation of the behavior, reported beliefs and experiences, and physical characteristics of the patient.

To be diagnosed as having anorexia nervosa, according to the DSM-IV-TR, a person must display:

1. Refusal to maintain body weight at or above a minimally normal weight for age and height (eg, weight loss leading to maintenance of body weight less than 85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
2. Intense fear of gaining weight or becoming obese.
3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
4. The absence of at least three consecutive menstrual cycles (amenorrhea), in women who have had their first menstrual period but have not yet gone through menopause (postmenarcheal, premenopausal females).
5. Or other eating related disorders.

Furthermore, the DSM-IV-TR specifies two subtypes:

• Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas)
• Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating OR purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas).

Treatment

Summarize some other studies here.

The first line of treatment for anorexia is usually focused on immediate weight gain, especially with those who have particularly serious conditions that require hospitalization. In particularly serious cases, this may be done as an involuntary hospital treatment under mental health law, where such legislation exists. In the majority of cases, however, people with anorexia are treated as outpatients, with input from physicians, psychiatrists, clinical psychologists and other mental health professionals.

A recent clinical review has suggested that psychotherapy is an effective form of treatment and can lead to restoration of weight, return of menses among female patients, and improved psychological and social functioning when compared to simple support or education programmes. However, this review also noted that there are only a small number of randomised controlled trials on which to base this recommendation, and no specific type of psychotherapy seems to show any overall advantage when compared to other types. Family therapy has also been found to be an effective treatment for adolescents with AN and in particular, a method developed at the Maudsley Hospital is widely used and found to maintain improvement over time.

Psychiatrists commonly prescribe medications such as serotonin-reuptake inhibitors (SSRI) or other antidepressants medication with the intent of trying to treat the associated anxiety and depression. Efficacy of their use in initial treatment of anorexia nervosa is under debate.

One study showed that supplementation with 14mg/day of zinc as routine treatment for anorexia nervosa doubled weight gains in subjects studied. Researchers hypothesize that zinc consumption increases the effectiveness of neurotransmission in various parts of the brain, including the amygdala, which ultimately increases patient appetite.

There are various non-profit and community groups that offer support and advice to people who suffer from AN or who care for someone who does. Several are listed in the links below and may provide useful information for those wanting more information or help with treatment and medical care.

It is important to address underlying issues of anxiety and depression as these can re-occur along with the weight gain.

Prevention

Forcing a person to eat, more often than not, can result in the person reacting to further stress and pressure by either withdrawing or rebelling. The best line of defense is to support the person's underlying need for a better self image and to address such issues through family or invidual counseling. While a psychiatrist can explore the best medical treatment a counselor can address behavioral issues through "talk therapy" and offer support in terms of successful stress management techniques. Treatment of this complex disorder is best tackled on different fronts, not one single treatment is going to bring instantaneous results. Anorexia, though often taking a long period of time, a lot of work and family support can be overcome and treated successfully.

Prognosis

Some people make a full recovery from anorexia, and others can improve their condition. However, anorexia can also become a chronic condition. Occasionally, anorexia can be fatal. The suicide rate of people with anorexia is also higher than that of the general population and is the major cause of death for those with the condition.

Anorexia and bulemia

often accompanied by bulemia; that is cycle of binge eating and purging... Bulimia is estimated to affect between one and two per cent of women aged 15 to 40. Like anorexia, bulimia develops from an obsessive desire to be thin. However, instead of not eating, the person alternates between frantic bingeing and drastic purging (by self-induced vomiting and the abuse of laxatives and diuretics) or periods of excessive fasting and exercise.

In the long-term, this can cause:

irregular heartbeat damaged kidneys eroded tooth enamel

Other eating disorders

The main types of eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder, and there are also many subtypes. Although anorexia is the illness that receives the most media attention, bulimia is in fact far more common.

Most people with eating disorders are females, but males also have eating disorders. The exception is binge-eating disorder, which appears to affect almost as many males as females.

Compulsive eating Compulsive eaters differ from people with bulimia in that, after binge eating, they don't try to get rid of what they've eaten. Many of them feel powerless to control their desire to keep 'comfort eating'. They may develop health problems as a result of carrying too much

References

ISBN links support NWE through referral fees

• "Anorexia Nervosa; Study challenges efficacy of SSRI treatment for adolescent anorexia nervosa"

Pain & Central Nervous System Week. Atlanta: May 16, 2005. pg. 40

• Le Grange, D."The Maudsley family-based treatment for adolescent anorexia nervosa." World Psychiatry: 2005. pg. 142-6

• Herzog, David B; Dara N Greenwood & David J Dorer et al. "Mortality in eating disorders: A descriptive study." International Journal of Eating Disorders. 2000, 28 (1): 20-26

• "DSM-IV Sourcebook: Volume 3." American Psychiatric Association. 1997.

External links

Support organizations and information

• beat: beating eating disorders UK national charity. Retrieved May 3, 2008.
• Understanding eating distress from mental health charity Mind. Retrieved May 3, 2008.
• MayoClinic eating disorders information. Retrieved May 3, 2008.
• BBC Mental Health on eating disorders. Retrieved May 3, 2008.
• Anorexia nervosa NHS Direct. Retrieved May 3, 2008.
• Anorexia Nervosa: Signs, Symptoms, Causes, Effects, and Treatments Useful information about anorexia. Retrieved May 3, 2008.

Media stories and reports

• Anorexia goes high-tech - Time magazine on pro-ana websites. Retrieved May 3, 2008.
• Fighting Anorexia: No One to Blame - Newsweek on the increasing prevalence of anorexia in young people. Retrieved May 3, 2008.
• More 4 News report on how eating disorders are increasingly affecting men as well as women.Retrieved May 3, 2008.
• "This is the story of Karen Carpenter's Anorexia from her success in the Carpenters to her eventual death in 1983. Retrieved May 3, 2008.
• Resources on Anorexia Nervosa and other Eating Disorders including an hour long program on the subject. Retrieved May 3, 2008.

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