Anorexia Nervosa

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Anorexia Nervosa By: Motlagosebatho :

Anorexia Nervosa By: Motlagosebatho

What is anorexia nervosa?:

What is anorexia nervosa? Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder that has neurobiological, psychological, and sociological components. This condition is characterized by low body weight and image distortion with an obsessive fear of gaining weight. Individuals suffering from anorexia control their body weight by means of purging, voluntary starvation, vomiting, excessive exercise, diet pills or diuretic drugs. Anorexia occurs predominantly in adolescent females, however approximately 10% of people with this diagnosis are male.

Subtypes of Anorexia Nervosa:

Subtypes of Anorexia Nervosa Restricting Type During this period of anorexia nervosa, the individual has not regularly engaged in binge-eating or purging behaviour (self-induced vomiting, over exercise or the misuse of laxatives or diuretics). This type of anorexia is less common as persons tend to limit their food selection, take in as few calories as possible & often exhibit traits of OCD (Obsessive Compulsive Disorder). A recent study reviewing subtypes of anorectic patients found that restricting type anorectic patients seemed less likely to recover than those of the binge-eating type.

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Binge-Eating Type or Purging Type During this period of anorexia nervosa, the person has regularly engaged in binge-eating or purging behaviour (self-induced vomiting, over-exercise or the misuse of laxatives or diuretics). This type of anorexia accounts for more than 50% of all anorectic patients. It is associated with substance abuse, impulse control disorders, major depression & personality disorders. Those who binge – eat & purge tend to have a family history of obesity and also share features of Bulimia Nervosa.

Diagnosis and clinical features:

Diagnosis and clinical features Anorexia is typically diagnosed by a clinical psychologist, psychiatrist or other suitably qualified clinical. To be diagnosed as having anorexia nervosa, a person must display: Refusal to maintain body weight at or above a minimally normal weight for age and height. Intense fear of gaining weight or becoming obese. The absence of at least three consecutive menstrual cycles (amenorrhea), in women who have had their first menstrual period but have not yet gone through menopause. Or who display other related disorders.

Physiological Consequences of Anorexia Nervosa:

Physiological Consequences of Anorexia Nervosa Hair hair thins and gets brittle Heart low blood pressure slow heart rate fluttering of the heart (palpitations) heart failure Blood anaemia and other blood problems Muscles and Joints weak muscles swollen joints fractures osteoporosis

Physiological Consequences of Anorexia Nervosa:

Physiological Consequences of Anorexia Nervosa Kidneys kidney stones kidney failure Body Fluids low potassium low magnesium low sodium z inc deficiency causes a decrease in appetite Brain and Nerves Can't think right The brain loses both white and gray matter during severe weight loss during semi starvation Enlargement of the brain ventricles is also thought to be associated with starvation Anorexia is also linked to reduced blood flow in the temporal lobes Intestines constipation bloating

Physiological Consequences of Anorexia Nervosa:

Physiological Consequences of Anorexia Nervosa Hormones periods stop bone loss problems growing trouble getting pregnant If pregnant, higher risk for: miscarriage having a C-section baby with low birth weight postpartum depression Skin bruise easily dry skin growth of fine hair all over body get cold easily yellow skin nails get brittle

Psychological Effects of Anorexia Nervosa:

Psychological Effects of Anorexia Nervosa Anorexic eating behaviour stems from feelings of fatness & unattractiveness. It’s maintained by various cognitive biases that alter how the affected individual evaluates &thinks about their body, food & eating. Distorted body image Poor insight Obsessive thoughts about food & 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 Anorexics tend to over-estimate their “fatness” weight. They lack an occasional over-confidence or self-esteem boosting bias type of personality trait.

Emotional Effects of Anorexia Nervosa:

Emotional Effects of Anorexia Nervosa Low self-esteem Intense fear of becoming overweight (obese) Clinical depression or chronically low mood Mood swings

Behavioural Effects of Anorexia Nervosa:

Behavioural Effects of Anorexia Nervosa 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 of Anorexia Nervosa :

Treatment of Anorexia Nervosa In view of the complicated psychological, emotional, physiological & medical implications, treatment for anorexia nervosa should be a comprehensive plan including the following; Hospitalization The nutritional state of the anorectic patient should be restored as further dehydration, starvation & electrolyte imbalance could become fatal. Daily fluid intake & urine output should be recorded as should any vomiting tendencies in order to prevent the development of Hypokalemia . Food regurgitation & constipation is relieved when normal eating patterns are restored. Psychotherapy Restoration of weight Return of menses among female patients Improved psychological functioning Improved social functioning

Regulation of metabolism:

Regulation of metabolism hormone carbohydrate proteins fats insulin Increases glucose availability Decreases protein synthesis Increases the synthesis of fat and the storage glucagon Stimulates glycogenolysis Increases gluconeogenesis promotes the use of fat for energy thyroxin Promotes glycolysis Promotes glyconeogenesis Accelerates the oxidation of free fatty acids cortisol Decrease glucose use by the cells Stimulates gluconeogenesis Mobilizes fats

References:

References http://en.wikipedia.org/wiki/Anorexia_nervosa (30 July 2008) http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2323514#id3472293 (30 July 2008) http://archinte.ama.assn.org/cgi/content/abstract/149/4/877 (30 July 2008) http://www.psychosomaticmedicine.org/cgi/content/abstract/24/4/187 (30 July 2008) http://jcem.endojournals.org/cgi/content/abstract/68/3/548 (30 July 2008)