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Anorexia Nervosa

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Anorexia nervosa is an eating disorder where people starve themselves. Anorexia usually begins in young people around the onset of puberty although it may occur in adulthood as well. Individuals suffering from anorexia have extreme weight loss. People suffering from anorexia are very skinny but are convinced that they are overweight. Anorexics have an intense fear of becoming fat. Their dieting habits develop from this fear. People with anorexia continue to think they are overweight even after they become extremely thin or ill. The symptoms, diagnosis, causal factors, course and recovery, treatment, and prevalence of anorexia nervosa will help us in understanding this disease.

There are many symptoms of anorexia nervosa. A person with anorexia maintains a body weight at least 15 percent below that expected for the person's height. The loss is self-induced weight loss caused by avoiding fattening foods and may involve excessive exercise, using laxatives or diuretics or self-induced vomiting. The person feels a strong, almost overwhelming fear of putting on weight. They are preoccupied with the shape or size of their bodies. They may invent rules for themselves regarding how much food is allowed and how much exercise is needed after eating certain amounts of food. Those suffering from anorexia pursue a very low 'ideal' weight. The weight loss may cause hormonal disturbances and women with anorexia nervosa may stop having periods (Powell & Sharpe, 2005).

People that sufferer from anorexia may feel bloated or small after a little meal. Some people lose interest in socializing with friends. Other side effects that people with anorexia can have consist of tiredness, feeling cold, constipation and stomachache. Some people also develop additional disorders such as bulimia (Powell & Sharpe, 2005).

There are other known physical, behavioral, and psychological characteristics that people with anorexia nervosa may experience. Some of the physical symptoms include a pale complexion; skin, nail and hair problems; the loss of periods in females; the growth of fine body hair; and insomnia. Other behavioral characteristics consist of odd eating habits; frequent measurement of body weight; obsessive reading of nutritional information on food containers; and dressing in layers to hide body shape. The psychological characteristics include depression; suicidal ideas; perfectionism; difficulty concentrating; mood swings; and irritability.

According to the Diagnostic and Statistical Manual of Mental Disorders there are two subtypes of anorexia nervosa. The restricting type means that during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior; that include self-induced vomiting or the misuse of laxatives, diuretics, or enemas. The binge-eating/purging type means that during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating or purging behavior.

There are no specific tests to diagnose anorexia. A medical history and physical examination, including assessing body mass index to determine whether the person is underweight, will be done. A mental health assessment may also be taken to help the doctor decide whether anorexia and associated medical conditions, such as depression, are present. Structured interviews may be given to help the doctor with their diagnosis.

The cause of anorexia nervosa is not completely known. We do know that it is a disorder that has many causes that come together to produce the illness. Anorexia nervosa is thought to be a combination of genetic, neuroendocrine, physiological, and psychosociological influences (Levey & Williams-Wilson, 2005). According to Dr. Peter Rowan, the recognized ingredients include the nature of the personality of the person, the aspects of their family and its members and relationships, and stresses and problems occurring outside home, often at school or work. There is an increased risk in families in which there are other anorexics, therefore the probably indicates a genetic predisposition. The triggering cause is weight loss from any cause, the most usual being a normal weight reducing diet. In the months that precede the start of anorexia increases in the problems or pressures that create anxiety or unhappiness have been found to occur.

Anorexia Nervosa is a condition that can vary from person to person. One of the main goals of recovery is for the person to regain a normal weight with normal eating patterns. Underlying psychological issues, which are different for each person, must also be managed as they are discovered (Rowan,P.).

There are no known treatments that have demonstrated that they are efficient in treating anorexia. Commonly, the disorder has been present for some time prior to presentation for treatment. Many patients have denial of the seriousness of the illness. Families often prefer physiological over psychological explanations for the disorder. The family's communication patterns are frequently dysfunctional.

Anorexia nervosa should be treated with a combination of approaches. Realistic and flexible goals are essential. Long-term follow-ups may be necessary. Types of treatment include: inpatient hospitalization; day treatment/partial hospitalization; outpatient medical management for patients with chronic conditions; and education-based interventions which include, diet /meal planning, nutritional management, or self-help interventions (Levey & Williams-Wilson, 2005).

Psychotherapy is a critical part of treatment for anyone who has anorexia nervosa. This therapy forms a strong therapeutic relationship, based on trust and understanding, and is conducted over an extended time frame. The following are types of psychotherapy that clinicians have found useful: individual, clinical, psychodynamic, self, interpersonal, cognitive-behavioral, group, family therapy and couples therapy (Levey & Williams-Wilson, 2005).

Throughout treatment medical complications must also be managed. Typical patients with anorexia require ongoing physician monitoring during treatment, however what needs monitored will depend on their underlying conditions. Common conditions of anorexia nervosa that require repeated monitoring include the following: electrolyte status and dehydration; amenorrhea and osteoporosis; frequent dental evaluations; input into nutritional support; and infertility and pregnancy (Levey & Williams-Wilson, 2005).

A significant number of patients with eating disorders also have personality disorders. According to Levey and Williams-Wilson, "when personality pathology is present in individuals with the binge-eating/purging type of anorexia nervosa, they are most likely to exhibit cluster B personality pathology (particularly borderline or histrionic personality



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