ANOREXIA NERVOSA

 

INTRODUCTION

Anorexia nervosa is an eating disorder motivated by the desire to maintain as low a body weight as possible. Sufferers will often restrict their food intake or even starve themselves completely to prevent weight gain, otherwise they may exercise excessively.

DEFINITION 

Anorexia nervosa is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) diagnosis assigned to individuals who become preoccupied with maintaining a low body weight. A serious psychological disorder, anorexia nervosa is characterized by abnormal attitudes towards food that affect the sufferer’s behavior and eating habits, often with physical, psychological and social consequences.

PREVALENCE AND INCIDENCE

Estimated to affect young women more often than males, anorexia nervosa is diagnosed in approximately 0.4 per cent of young females each year. The disorder also affects men but less is known about the prevalence of anorexia nervosa among males. However, the condition is thought to affect women and men at a ratio of 10:1.

Recent findings: In Western settings, a substantial proportion of young people have reported an eating disorder. Overall, 5.5--17.9% of young women and 0.6-2.4% of young men have experienced a DSM-5 eating disorder by early adulthood. Lifetime DSM-5 anorexia nervosa was reported by 0.8-6.3% of women and 0.1-0.3% of men.  Gender and sexual minorities were at particularly high risk. Emerging studies from Eastern Europe, Asia, and Latin America show similar high prevalence. During the COVID-19 pandemic, the incidence of eating disorders has still increased.

CAUSES

The exact cause is not known. The following factors may play a role:

• Genetic: Certain genetic changes confer a predisposition

• Neurochemical factors - Serotonin, norepinephrine and dopamine dysfunction

• Environmental: Socio- cultural influences that project thinness as a desirable trait and peer pressure which encourages associated behavior

• Psychological factors include:

o Tendency towards depression and anxiety

o Difficulty in handling stress

o Excessive worrying and feeling scared or doubtful about the future

o Perfectionism – setting strict, demanding goals or standards

o Being very emotionally restrained

o Having feelings of obsession and compulsion

o Excessive figure consciousness 

SIGNS AND SYMPTOMS

Not eating enough food and over conscious of the physical appearance is the first sign of Anorexia. The other symptoms include:

 Extreme weight loss

 Thin appearance

 Intense fear of gaining weight

 Bingeing and purging

 Abnormal blood counts

 Fatigue

 Insomnia

 Dizziness or fainting

 Bluish discoloration of the fingers

 Hair that thins, breaks or falls out

 Soft, downy Hair covering the body

 Amenorrhea (absence of menstruation)

 Dry or yellowish skin

 Intolerance of cold

 Irregular heart rhythms

 Low blood pressure

 Dehydration

 Osteoporosis

 Swelling of arms or legs

DIAGNOSTIC CRITERIA FOR ANOREXIA NERVOSA

For anorexia nervosa to be diagnosed, a number of criteria need to be met. There are three specific features of the disorder, namely:

 The sufferer’s weight is significantly low, less than the minimal normal or expected body mass, taking into account the individual’s height and age.

 The sufferer displays an intense fear of gaining weight or becoming fat and this fear does not usually improve, even when the individual loses weight.

 The sufferer displays a distorted view of their body weight and shape, either feeling overweight all over or singling out specific areas as being too fat.

TREATMENT AND MANAGEMENT

Helping the patient acknowledge that they have a disease is the most difficult aspect of treating anorexia. Many people with this condition refuse to acknowledge that they suffer from an eating disorder. They frequently wait until their disease is critical or life-threatening before seeking medical attention. This is why it’s essential to identify anorexia early and begin appropriate treatment. The type of treatment chosen will depend on the needs of the patient. The following strategies are typically used in combination with anorexia treatment:

PSYCHOTHERAPY

• Individual therapy: Adults have been proven to benefit from Cognitive Behavioral Therapy CBT. Normalizing eating habits and other activities to promote weight gain is the major objective. The second objective is to assist in altering incorrect ideas and attitudes that support restrictive eating.

• Family-based therapy: This type of therapy is most helpful for teenagers with anorexia. This approach helps parents to assist their child with re-feeding and weight maintenance until the child can make responsible decisions about their wellbeing because a child with anorexia is often unable to do so while struggling with this dangerous illness.

MEDICATION

• There are presently no approved drugs to treat anorexia. To treat the anxiety and depression that are frequently accompanied by anorexia, certain healthcare professionals may prescribe medication. Sometimes medical professionals will recommend drugs to assist regulate periods and to help address incorrect attitudes toward eating and body image.  Some antidepressants may also promote appetite and sleep. 

• Nutrition counseling

• This plan aims to re-establish healthy eating patterns, develop a healthy perspective on food and weight management, and stress the value of eating a balanced diet and good nutrients.

• Hospitalization

• Treatment for extreme weight loss that has led to starvation and other major mental or physical health issues, such as heart conditions, severe depression, and suicidal thoughts or actions, may require hospitalization.

Written by: Inayat Bashir.