Anorexia nervosa

From New World Encyclopedia
For other uses, see Anorexia nervosa (disambiguation).
Anorexia Nervosa
Classification and external resources
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.[1] It is an eating disorder characterized by an obsessive fear of gaining weight and 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.[2]

While anorexia is sometime associated with starvation and 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.

Many experts consider people for whom thinness is especially desirable, or a professional requirement (such as athletes, models, dancers, and actors), 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.


History

When was the disorder first named? Who gave a name to it? DId it exist before but undiagnosed? 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. This is technically incorrect, as the term "anorexia" used separately refers to the medical symptom of reduced appetite (which therefore is distinguishable from anorexia nervosa in being non-psychiatric.

Possible causes and symptoms

predisposition in a family cannot be overlooked.. More about who gets this disorder, boys?, and at what ages? Do/can they outgrow it? live with it? Prevention; diagnosing it early does this help. How does family support make a difference; what does this cost... how do some families react differently than others. (force feeding, etc.)

Anorexia Nervosa, like other eating disorders, cannot be attributed to a single cause. The cause of this disorder is much more likely to be attributable to a combination of factors, including feelings or pressures which lead a person unable to cope with the stress of young 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’.[3]

An anorexic person feeling helpless or anxious in relationship to their life finds control by obsessively and rigidly monitoring their diet. Their perfectionistic control masks their feelings of inadequacy. Not eating, and losing weight, can therefore become that person's only way of feeling 'safe and 'in control.'[4] 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. This is more often the case with bulimia. [5]

Diagnosis

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.[6]

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).

It is clear that there is no single cause for anorexia and that it stems from a mixture of social, psychological and biological factors. Genetics may contribute considerably to one's predisposition towards anorexia nervosa, whereas certain family situations or social forces may be of considerable influence as well


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.[7] 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[8] and in particular, a method developed at the Maudsley Hospital is widely used and found to maintain improvement over time.[9]

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. [10]

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.[11]

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.


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. [12]


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.[13]

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.[14]

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.[15]

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 [16]

Controversies?

Notes

  1. Lask B, and Bryant-Waugh, R (eds) (2000) Anorexia Nervosa and Related Eating Disorders in Childhood and Adolescence. Hove: Psychology Press. ISBN 0-86377-804-6.
  2. [1]
  3. [2]
  4. http://www.mind.org.uk/Information/Booklets/Understanding/Understanding+eating+distress.htm
  5. [3]
  6. "DSM-IV Sourcebook, Volume 3." American Psychiatric Association. 1997
  7. Hay P, Bacaltchuk J, Claudino A, Ben-Tovim D, Yong PY. (2003) Individual psychotherapy in the outpatient treatment of adults with anorexia nervosa. Cochrane Database Syst Rev, 4, CD003909. PMID 14583998.
  8. Lock J, Le Grange D. (2005) Family-based treatment of eating disorders. Int J Eat Disord, 37 Suppl, S64-7. PMID 15852323.
  9. Le Grange D. (2005) The Maudsley family-based treatment for adolescent anorexia nervosa. World Psychiatry, 4 (3), 142-6. PMID 16633532.
  10. [4]
  11. Birmingham CL, Gritzner S (2006) How does zinc supplementation benefit anorexia nervosa? Eating and Weight Disorders, 11 (4), e109-111. PMID 17272939
  12. http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=27
  13. Pompili, M; I Mancinelli & P Girardi et al. (2004), "Suicide in anorexia nervosa: A meta-analysis", International Journal of Eating Disorders 36 (1): 99-103, John Wiley 
  14. [5]
  15. [6]
  16. [weighthttp://www.bbc.co.uk/health/conditions/mental_health/disorders_eating.shtml]

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

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