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  • What is Anorexia Nervosa?

What is Anorexia Nervosa?

Anorexia nervosa is a condition of a disordered pattern of eating. It is a debilitating mental disorder. In this, the individual develops an inappropriate fear of gaining weight. As the term indicates that the individual has a loss of appetite due to some emotional reasons. However, in anorexia nervosa, the individual does not actually lose their appetite rather they are fighting with their urge to eat. They used to starve to subdue their fear. This starvation would rather result in making the individual become overly obsessed with food. The most characteristic feature of anorexics is their decreased body weight. The preoccupation with eating, weight and body shape results in numerous psychological and neurobiological consequences. In the general population, females are more likely to develop this disorder with respect to males. Another shocking fact about anorexics is their inclination towards suicide with rates reported 12 per 100000/year.

Six Stages of Anorexia Nervosa development

In order to track the development of anorexia nervosa let’s look at a hypothetical example of how a young girl’s episode of dieting would shift towards anorexia nervosa by looking at the following

Stage 1: Waking up and choosing one’s favorite dress in which she fails to fit in

Stage 2: Lack of satisfaction with one’s figure

Stage 3: Plans for dieting (Missing meals and getting overly conscious of caloric count)

Stage 4: Excessive exercising

Stage 5: Ignoring others praise for losing some pounds and still perceiving oneself as obese

Stage 6: Continue rigid dietary rules and food restriction despite health issues e.g. missing menstrual cycles

Core Symptoms of Anorexia Nervosa

Anorexia nervosa is difficult to detect during the early stage as it begins with an innocent diet just as you have seen in the above example. The striving for unachievable perfection makes the individual susceptible to reach the point of alarming weight loss. Following are the core symptoms to diagnose an individual with anorexia nervosa:

1: Decreased energy intake that results in low body weight than is expected with respect to age, development and physical health

2: Increased fear of gaining weight or getting obese

3: Behaviors that prevent weight gain are adopted

4: The individual perceives his body shape as obese despite having significantly low body weight

Other Symptoms of Anorexia nervosa

  • This decreased intake of energy is usually is accomplished by setting rigid dieting schedules and intermittent fasting for long hours.
  • To overcome the fear certain unhealthy behaviors are also adopted. These behaviors that are frequently common in anorexics include self-induced vomiting, using certain medications to lose weight and indulging in an excessive workout.
  • They are failed to get rid of their fat-feeling and are prone to perceive themselves as not been up to mark always.
  • Individuals with anorexia nervosa often believe that their body shape is a determinant of their self-worth. They used to inordinately rely on their body weight for their self-worth.
  • One of the reasons for their inclination towards suicidal behavior is their low self-worth.
  • This reduction in weight results in numerous psychological and medical issues. Common psychological problems include difficulty in concentration, changes in thinking processes, mood irritability, etc. One common medical issue being faced by females is not having a proper menstrual cycle.
  • The body weight can be calculated by the use of a BMI calculator that gives an estimate of weight relative to height. A BMI of 17kg/m2 has been considered to indicate thinness.

Complications of anorexia nervosa

  • A lot of complications can arise if this disorder is not treated. Most of these are related to less dietary intake and excessive purging behavior.
  • Disturbance in electrolytes of the body is an important issue.
  • The cardiovascular system will be disturbed. Decreased heart rate, QT interval prolongation, and arrhythmia can arise.
  • The immune system of the body is compromised and these patients are prone to develop infections.
  • The stomach and other parts of GIT are disturbed. Gastritis and acidity are common findings. In severe cases, muscle atrophy of GIT is also present
  • Regarding the muscular system, excessive fatigue and muscle mass waste are present.
  • Menstrual irregularities are also common.
  • Another complication can arise from treatment. When we start re-feeding excessively, there is a high chance of developing electrolyte imbalance.
  • Skin changes and lower legs swelling
  • Teeth erosions are also present especially form the inner side of teeth due to excessive vomiting.

Causes of anorexia nervosa

In regard to genetic factors, it has been found that eating disorders used to run in families and First-degree relatives of young women with anorexia nervosa are more than ten times more likely than average to have the disorder themselves. Also, research has shown that common features of eating disorders i.e. lack of satisfaction with one’s body, desire to be skinny, are heritable.

Environmental Causes

The environmental or socio-cultural factors often have a great influence in setting the stage for eating disorders. The genetic and environmental factors may interact with each other in making the person susceptible to it. Common environmental factors include interactions with parents or constraints from the family and criticism from the peer group. During the past few years, increased focus is directed towards portraying a perfect body shape. Among various cultures, the token of acceptance and beauty is a thin toned body. This is more likely to be true for females due to which female dieters are greater in number as compared to males.

Neurobiological Causes

In neurobiological factors, the region of the brain involved in regulating hunger eating is the hypothalamus. It has been found in research that anorexics do have a lesion in the lateral hypothalamus and have disturbed levels of cortisol. The cortisol level has not been itself responsible for causing the disorder rather its level declines due to self-starvation in anorexia nervosa.

Cognitive/ Thinking pattern

The cognitive factors in anorexia nervosa primarily focus on the feeling of getting fat and disruption in the perception of one’s body shape with which the anorexics become overly obsessed. Both of these factors motivate the individual to lose weight. Also, the unhealthy behaviors mentioned above further reinforce this weight loss as they reduce the anxiety caused by the fear of getting fat.

Role of Personality

Personality has also been influential in eating disorders. In regard to anorexia nervosa, it has been found that since anorexics individuals set a standard of unachievable perfection for themselves so researchers have shown a significant positive link between anorexia nervosa and perfectionism especially in reference to females.

Treatment Of Anorexia Nervosa

Physical management

In lieu of multiple physical complications of this disorder, physical management of these patients focuses on multiple areas

Weight restoration

The most initial treatment goal in these patients is the restoration of weight. These patients markedly weight. The task is to build a 0.5 kg body weight per week. To achieve this, we need 500 to 1000 calories extra. There is no need to be over-enthusiastic. A lot of complications can arise if re-feeding is not monitored properly

Minimize the risk of bodily complications

Regular monitoring of bodily symptoms and lab investigations is necessary especially the re-feeding period. Cardiac functions, renal functions, etc. need to be evaluated regularly

Drug treatment:

The main treatment is non-pharmacological. Medicines are required to manage the physical complications of this disorder. According to some researches SSRIs, mirtazapine, and olanzapine are helpful.

Psychological Treatment

The main goal of treatment is to help the individual to gain weight in order to overcome the various complications he or she is facing due to his or her rigid dietary patterns.

Family-Based Therapy (FBT)

Family-based therapy (FBT) involves psycho-educating the family about the disorder. Two major aims of FBT are as follows:
To improve the conflicting relationship between the patient and the family.
Another goal is to shift the responsibility of the patient’s diet pattern completely to the family so that a proper nutritional intake is ensured.

Cognitive Behavior Therapy (CBT)

The focus of cognitive behavior therapy in the case of anorexia nervosa is directed towards changing the distorted thinking patterns and improving the dietary patterns of a patient by the use of reinforcement strategies. Following are the main goals of CBT in anorexia nervosa:

The cognitive aspect focuses on enhancing the motivation for change and disturbance in thoughts concerning the experience of body shape and weight e.g., challenging their irrational belief that if they would not lose weight their acceptance would not be guaranteed”. The work has also been done at the schema level aimed at challenging the tie between personal identity and the illness.
Behavioral modification is done by the incorporation of reinforcement schedules in order to establish a regular pattern of eating.

Case Study

A.N a 23 years old, unmarried female who first came to a psychiatric hospital at the age of 14. At that time she was diagnosed with major depressive disorder. Her symptoms were engaging in food restriction but did not have a distorted body image. No significant weight loss was present and her BMI was also normal i.e. near 50th percentile. She was then prescribed with (fluoxetine 20 mg daily) and was given therapy on an outpatient basis. After improvement, she didn’t come for treatment. Then A.N’s parents brought her back about two years later at which time she endorsed poor body image, has a strict exercising schedule and her food intake was also markedly reduced. She didn’t listen to her family to have a proper nutritional intake and was manipulative in order to promote her excessive exercise and food restrictions. She was markedly thin and her BMI had dropped also to a level of 17. On further evaluations, there was swelling on both lower legs. She was satisfied with her body appearance. Despite her very thin look, she considered herself fat. The diagnosis of anorexia nervosa was made she was hospitalized. At the start, she was very reluctant to get treatment. However, after some sessions, she agreed with the treatment plan. She started taking regular and planned meals. After therapy and all other physical work, her condition started improving.

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