Anorexia nervosa is an eating dissorder characterised by preoccupation with body weight and food, behavior directed toward to losing weight, peculiar patterns of handling food, weight loss, intence fear of gaining body weight,disturbance of body image and amenorrhea. Anorectic patients lose weight usually by stoping eating fat-containing foods or high corbohybrate-containing foods and they also reduse the total amount of food intake. This restrictive eating is usually accompanied by other actions such as overuse of diuretics, laxatives, diet pills, enemas and excessive exercise. Anorexia nervosa can co-occur with a large variety of other psychological dissorders including substance abuse depression and anxiety dissorders. Anorectics can experience an extensive variety of physical health problems as well such as heart and kidney diseases. Anorexia nervosa occurs usually in females during the adolescence but it occurs sometimes in adulthood as well. Anorexia nervosa rarerly occurs in males.
Medical descriptions of anorexia nervosa can be found in the later part of 17th century but the term anorexia nervosa was established in 1873 by William Gull and Lasegue as a consequence of self-starvation due to psychological causes. Even though anorexia nervosa was well-known to behavioral scientists for many years, the general public learned about the disease in the late 1970's, when American mass media begun to reffer about this topic. In 1978, "The Golden Cage" was published by the psychologist Hidle Bruch. This was the first book that refered to anorexia nervosa. The book was based in seventy real cases of anorectic patients. Studies that took place at the samee period showed that anorexia nervosa is also related by the culture of the Western industrialized society. Today there is a great amount of literature and studies that reffer to eating dissorders and in anorexia nervosa. Many behavioral scientists are specialised and many clinics are established in order to treat and support patients that suffer from eating dissorders.
It may seem very easy to distinguish an anorectic person and the diagnostic criteria may seem obvious as well. However the diagnosis is frequently a very difficult task. APA (American Psychiatric Association) in DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) indicates the criteria in four groups of symptoms. These groups are:
It is a very rare phenomenon for a patient that suffers from anorexia to recognize himself as an ill person. Therefore in order to have a diagnose it is necessary to have any possible information from the patients family and other sources.
The Psychological and Behavioral Signs of Anorexia Nervosa.
An anorectic patient is mor vulnerable to psychological and behavioral malfunctions. As a result anorexia nervosa can have dangerous effects on all aspects of a persons's life.
The patient becomes extremely underweight which leads to social withdrawal and depretion. The patient usually have difficulty in communicating and interacting with others because he becomes irretable. An anorectic also can't concentrate very well and he is easily distracted. People with anorexia nervosa become obsessed with anything that have to do with food. They collect recipes, they calculate the amount of calories of every food they consume and this way they become compulsive about eating rituals. This way they become more vulnerable to express obsessive compulsive dissorder. Finaly anorectics may express sleep disorders and as a result they feel fatigue during the day.
Reasons that lead to Anorexia Nervosa
There is not any specific explanation about what causes anorexia nervosa. However scientists agree that anervosa is "made" by an interaction of cultural, psychological, familial and biological factors that may react when a person is vulnerable.
In western societies, being vary thin is a sign of beauty for women and it represents happiness, success and self control. The mass media bombardise women with messages that promote dieting and other ways in order to become just like their role models. However this is almost impossible for most women because it does not fit with the inherited and biological factors that try to maintain the natural body weight. As a result women (most of them teenagers) are not satisfied with their body shape and weight.
On the other hand cultural presure has also increased in males in western societiesbecause they try to become muscular and lean. Additionally in some occupations such as modeling, dancing and sports the presure to keep a specific body shape is really strong.
Researches showed hat people that come from families with some spicific characteristics are more vulnerable to develop anorexia nervosa. Families of anorectics most of the times seem to be rigid, overprotective or suffocating in their closeness. In these cases anorexia nervosa develops as a strungle of individuality and independence. This way we can understand why teenagers are more vulnerable. Some other characteristics of families that may be increased chance of developing anorexia nervosa are overvaluing thinness and the general appearance, being physically or sexually abusive and criticizing a child's shape and weight.
Studies have shown that people who have relatives suffering from anorexia nervosa are 8 times more vulnerable to develop themselves. However scientists do not know exactly whuch is the inherited factor. In addition it has been recorded that most anorectics come from families with a history of alcohol abuse or depresion.
The characteristics of a person that is more likely to develop anorexia nervosa are poor body image, low self-esteem, feelings of inatractiveness, depression, need for control, difficulty in expressing feelings, perfectionism, need to feel unique and avoidance of conflict with others. Anorexia nervosa patients seem to be emotionally driven not only towards eating and weight loss but in other perspectives of their life as well, such as at work, at school or their career.
One of the problems that make difficult to distinguish the anorexia nervosa traits is that losing weight causes the development of some psychological disturbances itself. Some of them are anxiety, depression, mood swings, irretability, personality changes, social withdrawal, obesive thinking and feelings of inadequancy. As a result some of the characteristics that occur in anorectics might be a result and not a cause of the dissorder
Anorexia nervosa is a clinical condition tha t may be caused by many different factors. There is a wide variety of treatments of anorexia nervosa and many approaches in order to confront any patient's needs. Usually treating includes medical help in order to gain weight and psychological help in order to solve the issues that caused the anorexia nervosa. The type of treatment is determined by the period that the person had the dissorder, overall medical condition, the patient's age, current living arrangements and severity of other associated disorders such as personality disorders, depression and problems in controling impulses. The treatments aim to normalize patient's eating and help him to cope with these new weight and eating changes, bring patient's weight to a normal level and deal with the problems that caused this bad situation. The main types of treatment that are used in anorexia nervosa are hospitalisation, medication, psychotherapy and some support groups.
Support groups seem to be very useful when they are led by profesionals because we are able to have better results and the therapy aims exactly where the problem is. Support groups can provide patients with anorexia nervosa and their family mutual support and advises that may help dealing with the disorder. Support groups can also in preparing patients for the therapy when they are afraid of it. Finally support groups may have contrary effects if they foster an "anorexic identity" to patients.
Individual psychotherapy is the main way of treatment in anorexia nervosa, especially for adolescents and people that don't leave with their parents. Individual therapy is responsible for learning how to solve problems, identify concerns, test new skills and overcome fears. There is a wide variety of individual psychotherapy. Cognitive behavioral approaches are very helpfull in order to develop patterns of behavior and ways of healthy thinking.
Family therapy is a very usefull tool for therapists and it is used almost in every case that the patient with anorexia nervosa is young or generally when the person is living at ahome with his/her parents. Family therapy can be very useful in families with an anorectic person because members can be informed about anorexia nervosa, they develop strategies in order to cope and overcome the situation, it helps the family members to overcome the guilt, it inproves communication between the members and access the the impact of the disorder on the family.
Marital therapy is a very useful tool as well because it is used almost in every case that the anorectic patient is maried. Marital therapy tries to strengthen tha relationship of the couple. This approach focuses on identifying and resolving communication problems and suggests practical ways in order to deal with the dissorder.
Group therapy is usualy a part of hospital treatment. There is a wide variety of groups, each with different orientations. Some of these groups are "task- oriented" which means that they focus on a specific task. Other groups are oriented to understand the patient which factors led them in anorexia nervosa. Group therapies can assist in order to deal with other emotinal symptoms which are associated with anorexia nervosa such as depression, anger and anxiety.
Many medications have been tried in order to deal with anorexia nervosa but medication alone ineffective. The best medication appears to be gaining weight because depression as all the other emotional disorders are often a result of starvation. In addition starvation worsen the side effects of antidepressants and decrease the effectiveness. However, occasionally, medication may be required to deal with overwhelming anxiety, obsessions, depression, or gastric discomfort following meals.
When the medical condition is severebecause of undernutrition hospital treatment is required. However, it may be required to
- Interrupt bingeing and vomiting
- Interrupt steady weight loss or promote weight gain if there has been a failure to gain weight in outpatient care
- Control weight gain that is occurring too rapidly
- Address other serious psychological problems reflected by severe self-destructive behavior, suicidal behavior, depression or substance abuse
- Evaluate and treat physical complications
Inpatient treatment is the preferred treatment for patients fo anorexia nervosa who:
- Are seriously emaciated
- Require close medical monitoring
- Fail to progress in partial care
- Are at serious risk for self-harm
Anorexia nervosa is a very serious desease that develops usualy during the adolescence in women. Anorexia is causes by a combination of psychological, genetic, family and cultural factors. The aim for the future is to adjust maladaptive interactions, early diagnosis and early appropriate intervantion in order to prevent serious medical and psychological problems from developing.