scofieldII
Member
- Joined
- Mar 14, 2008
- Messages
- 121
Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder characterized by low body weight and body image distortion with an obsessive fear of gaining weight. Individuals with anorexia are known to commonly control body weight through the means of voluntary starvation, purging, vomiting, excessive exercise, or other weight control measures, such as diet pills or diuretic drugs. It primarily affects adolescent females, however approximately 10% of people with the diagnosis are male. Anorexia nervosa is a complex condition, involving psychological, neurobiological, and sociological components.
Presentation
There are a number of features, that although not necessarily diagnostic of anorexia, have been found to be commonly (but not exclusively) present in those with this eating disorder.
Physical
Anorexia nervosa can put a serious strain on many of the body's organs and physiological resources,[4][5][6] particularly on the structure and function of the heart and cardiovascular system, with slow heart rate (bradycardia) and elongation of the QT interval seen early on. People with anorexia typically have a disturbed electrolyte balance, particularly low levels of phosphate, which has been linked to heart failure, muscle weakness, immune dysfunction, and ultimately death. Those who develop anorexia before adulthood may suffer stunted growth and subsequent low levels of essential hormones (including sex hormones) and chronically increased cortisol levels. Osteoporosis can also develop as a result of anorexia in 38-50% of cases, as poor nutrition leads to the retarded growth of essential bone structure and low bone mineral density. Anorexia does not harm everyone in the same way. For example, evidence suggests that the results of the disease in adolescents may differ from those in adults.
Changes in brain structure and function are early signs of the condition. Enlargement of the ventricles of the brain is thought to be associated with starvation, and is partially reversed when normal weight is regained.Anorexia is also linked to reduced blood flow in the temporal lobes, although since this finding does not correlate with current weight, it is possible that it is a risk trait rather than an effect of starvation.
Other effects may include the following:
Extreme weight loss
Body mass index less than 17.5 in adults, or 85% of expected weight in children
Stunted growth
Endocrine disorder, leading to cessation of periods in girls (amenorrhoea)
Decreased libido; impotence in males
Starvation symptoms, such as reduced metabolism, slow heart rate (bradycardia), hypotension, hypothermia and anemia
Abnormalities of mineral and electrolyte levels in the body
Thinning of the hair
Growth of lanugo hair over the body
Constantly feeling cold
Zinc deficiency
Reduction in white blood cell count
Reduced immune system function
Pallid complexion and sunken eyes
Creaking joints and bones
Collection of fluid in ankles during the day and around eyes during the night
Tooth decay
Constipation
Dry skin
Dry or chapped lips
Poor circulation, resulting in common attacks of 'pins and needles' and purple extremities
In cases of extreme weight loss, there can be nerve deterioration, leading to difficulty in moving the feet
Headaches
Brittle fingernails
Bruising easily
Psychological
Distorted body image
Poor insight
Self-evaluation largely, or even exclusively, in terms of their shape and weight
Pre-occupation or obsessive thoughts about food and weight
Perfectionism
Obsessive compulsive disorder (OCD)
Belief that control over food/body is synonymous with being in control of one's life
Refusal to accept that one's weight is dangerously low even when it could be deadly
Refusal to accept that one's weight is normal, or healthy
Emotional
Low self-esteem and self-efficacy
Intense fear about becoming overweight
Clinical depression or chronically low mood
Mood swings
Interpersonal and social
Withdrawal from previous friendships and other peer-relationships
Deterioration in relationships with the family
Denial of basic needs, such as food and sleep
Influence from celebrities[10]
Behavioral
Excessive exercise, food restriction
Secretive about eating or exercise behavior
Fainting
Self-harm, substance abuse or suicide attempts
Very sensitive to references about body weight
Aggressive when forced to eat "forbidden" foods
TREATMENT
The first line 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 anorexia and in particular, a method developed at the Maudsley Hospital is widely used and found to maintain improvement over time.
Drug treatments, such as SSRI or other antidepressant medication, have not been found to be generally effective for either treating anorexia, or preventing relapse although it has also been noted that there is a lack of adequate research in this area. It is common, however, for antidepressants to be prescribed, often with the intent of trying to treat the associated anxiety and depression.
Supplementation with 14mg/day of zinc is recommended as routine treatment for anorexia nervosa due to a study showing a doubling of weight regain after treatment with zinc was begun. The mechanism of action is hypothesized to be an increased effectiveness of neurotransmission in various parts of the brain, including the amygdala, after adequate zinc intake begins resulting in increased appetite.
There are various non-profit and community groups that offer support and advice to people who suffer from anorexia or who care for someone who does.
Presentation
There are a number of features, that although not necessarily diagnostic of anorexia, have been found to be commonly (but not exclusively) present in those with this eating disorder.
Physical
Anorexia nervosa can put a serious strain on many of the body's organs and physiological resources,[4][5][6] particularly on the structure and function of the heart and cardiovascular system, with slow heart rate (bradycardia) and elongation of the QT interval seen early on. People with anorexia typically have a disturbed electrolyte balance, particularly low levels of phosphate, which has been linked to heart failure, muscle weakness, immune dysfunction, and ultimately death. Those who develop anorexia before adulthood may suffer stunted growth and subsequent low levels of essential hormones (including sex hormones) and chronically increased cortisol levels. Osteoporosis can also develop as a result of anorexia in 38-50% of cases, as poor nutrition leads to the retarded growth of essential bone structure and low bone mineral density. Anorexia does not harm everyone in the same way. For example, evidence suggests that the results of the disease in adolescents may differ from those in adults.
Changes in brain structure and function are early signs of the condition. Enlargement of the ventricles of the brain is thought to be associated with starvation, and is partially reversed when normal weight is regained.Anorexia is also linked to reduced blood flow in the temporal lobes, although since this finding does not correlate with current weight, it is possible that it is a risk trait rather than an effect of starvation.
Other effects may include the following:
Extreme weight loss
Body mass index less than 17.5 in adults, or 85% of expected weight in children
Stunted growth
Endocrine disorder, leading to cessation of periods in girls (amenorrhoea)
Decreased libido; impotence in males
Starvation symptoms, such as reduced metabolism, slow heart rate (bradycardia), hypotension, hypothermia and anemia
Abnormalities of mineral and electrolyte levels in the body
Thinning of the hair
Growth of lanugo hair over the body
Constantly feeling cold
Zinc deficiency
Reduction in white blood cell count
Reduced immune system function
Pallid complexion and sunken eyes
Creaking joints and bones
Collection of fluid in ankles during the day and around eyes during the night
Tooth decay
Constipation
Dry skin
Dry or chapped lips
Poor circulation, resulting in common attacks of 'pins and needles' and purple extremities
In cases of extreme weight loss, there can be nerve deterioration, leading to difficulty in moving the feet
Headaches
Brittle fingernails
Bruising easily
Psychological
Distorted body image
Poor insight
Self-evaluation largely, or even exclusively, in terms of their shape and weight
Pre-occupation or obsessive thoughts about food and weight
Perfectionism
Obsessive compulsive disorder (OCD)
Belief that control over food/body is synonymous with being in control of one's life
Refusal to accept that one's weight is dangerously low even when it could be deadly
Refusal to accept that one's weight is normal, or healthy
Emotional
Low self-esteem and self-efficacy
Intense fear about becoming overweight
Clinical depression or chronically low mood
Mood swings
Interpersonal and social
Withdrawal from previous friendships and other peer-relationships
Deterioration in relationships with the family
Denial of basic needs, such as food and sleep
Influence from celebrities[10]
Behavioral
Excessive exercise, food restriction
Secretive about eating or exercise behavior
Fainting
Self-harm, substance abuse or suicide attempts
Very sensitive to references about body weight
Aggressive when forced to eat "forbidden" foods
TREATMENT
The first line 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 anorexia and in particular, a method developed at the Maudsley Hospital is widely used and found to maintain improvement over time.
Drug treatments, such as SSRI or other antidepressant medication, have not been found to be generally effective for either treating anorexia, or preventing relapse although it has also been noted that there is a lack of adequate research in this area. It is common, however, for antidepressants to be prescribed, often with the intent of trying to treat the associated anxiety and depression.
Supplementation with 14mg/day of zinc is recommended as routine treatment for anorexia nervosa due to a study showing a doubling of weight regain after treatment with zinc was begun. The mechanism of action is hypothesized to be an increased effectiveness of neurotransmission in various parts of the brain, including the amygdala, after adequate zinc intake begins resulting in increased appetite.
There are various non-profit and community groups that offer support and advice to people who suffer from anorexia or who care for someone who does.
