Anorexia

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Anorexia
Defintion
Anorexia is a chronic eating disorder brought about by subjectively unpleasant food,
surroundings, or company, or emotional states such as anxiety, irritation, anger, or fear; it may also be a
symptom of a physical disorder or emotional disturbance.
Anorexia nervosa, which usually occures in adolescent females, is characterized by refusal to
maintain a normal minimal body weight, fear of gaining weight or becoming obese, disturbance of body
image, undue reliance on body weight or shape for self-evaluation, and amenorrhea. The two subtypes
include one characterized by dieting and exercise alone and one also characterized by binge eating and
purging.

Symptomps
The earliest warning signs of anorexia can be very difficult to distinguish from
normal eating or dieting behavior. Anorexia symptoms may also be concealed,
attributed to other health conditions or dismissed as side effects of prescription
drugs.



extreme weight loss



thin appearance



abnormal blood counts



elevated liver enzymes



fatigue



dizziness or fainting



seizure



brittle nails



hair that thins, breaks or falls out



absence of menstruation (amenorrhea)

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development of fine hair on the extremities (lanugo)



constipation



dry skin



intolerance of cold



irregular heart rhythms



low blood pressure



dehydration



osteoporosis, the loss of bone calcium, which may result in broken bones

Most early signs of anorexia center on preoccupation with food or dieting.
Behavior may appear obsessive or compulsive, and begin to consume more time.
Criteria for diagnosis of anorexia nervosa identified by the American Psychiatric Association are as
follows:
1) intense fear of becoming obese that does not diminish as weight loss progresses;
2) disturbance of body image, such as claiming to feel fat even when emaciated;
3) refusal to maintain body weight over a minimal normal weight for age and height;
4) no known physical illness that would account for the weight loss; and
5) amenorrhea in postmenarchal females. It is often accompanied by self-induced vomiting or use of
laxatives and/or diuretics (see also BULIMIA NERVOSA) and extensive exercise.
Accompanying physical signs in addition to profound weight loss include hypotension,
bradycardia, edema, lanugo, metabolic changes, and endocrine disturbances.

Causes
The cause of anorexia nervosa is unknown, but it is thought to be a complex of psychological,
social, and biological factors. There are numerous theories, such as that the victim is attempting to control
some aspects of life in an environment where it is difficult to exert control; that it is an attempt to
manipulate others and gain attention; and social pressures, conflicting roles, and family disorders that
serve as stimuli. Other theorists hypothesize that the disorder is a defense against sexual maturation,
related to a fear of sexual intimacy. Society's obsession with physical appearance is also thought by some

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to play a role. Researchers are studying whether there could be a genetic component, as well as whether
malfunction of the hypothalamus might play a role.
Anorexia is a complex disorder that does not have a single cause. Research suggests that some
people have a predisposition toward anorexic and that something then triggers the behavior, which then
becomes self-reinforcing. Hereditary, biological, psychological and social factors all appear to play a role.


Heredity. Twin studies show that if one twin has anorexia nervosa, the other has a greater
likelihood of developing the disorder. Having a close relative, usually a mother or a sister, with
anorexia nervosa also increases the likelihood of other (usually female) family members
developing the disorder. However, when compared to many other diseases, the inherited
component of anorexia nervosa appears to be fairly small.



Biological factors. There is some evidence that anorexia nervosa is linked to abnormal
neurotransmitter activity in the part of the brain that controls pleasure and appetite.
Neurotransmitters are also involved in other mental disorders such as depression. Research in this
area is relatively new and the findings are unclear. People with anorexia tend to feel full sooner
than other people. Some researchers believe that this is related to the fact that stomach of people
with anorexia tends to empty more slowly than normal; others think it may be related to the
appetite control mechanism of the brain.



Psychological factors. Certain personality types appear to be more vulnerable to developing
anorexia nervosa. Anorectics tend to be perfectionists who have unrealistic expectations about
how they “should” look and perform. They tend to have a black-orwhite, right-or-wrong, all-ornothing way of seeing situations. Many anorectics lack a strong sense of identity and instead take
their identity from pleasing others. Virtually all anorectics have low-self worth. Many experience
depression and anxiety disorders, although researchers do not know if this is a cause or a result of
the eating disorder.



Social factors. Anorectics are more likely to come either from overprotective families or
disordered families where there is a lot of conflict and inconsistency. Either way, the anorectic
feels a need to be in control of something, and that something becomes body weight. The family
often has high, sometimes unrealistic and rigid, expectations. Often something stressful or
upsetting triggers the start of anorexic behaviors. This may be as simple as a family member as
teasing about the person’s weight, nagging about eating junk food, commenting on how clothes
fit, or comparing the person unfavorably to someone who is thin. Life events such as moving,
starting a new school, breaking up with a boyfriend, or even entering puberty and feeling
awkward about one’s changing body can trigger anorexic behavior. Overlaying the family
situation is the unrelenting media message that thin is good and fat is bad; thin people are
successful, glamorous, and happy, fat people are stupid, lazy, and failures.

Treatment
The treatment of anorexia nervosa is difficult and lengthy. The primary goals are restitution of
normal nutrition and resolution of underlying psychological problems. Modes of therapy that can be used

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include behavior therapy, behavioral contracts, psychoanalysis, group therapy, insight-oriented therapy,
and family therapy.

 Cognitive behavior therapy (CBT) is designed to change the individual’s thoughts and
feelings about his or her body and behaviors toward food, but it does not address why
those thoughts or feelings exist. This therapy is relatively short-term.
 Psychodynamic therapy, also called psychoanalytic therapy, attempts to help the
individual gain insight into the cause of the emotions that trigger their anorexic behavior.
This therapy tends to be longer term that CBT.
 Interpersonal therapy is short-term therapy that helps the individual identify issues and
problems in relationships. The individual may be asked to look back at his or her family
history to try to recognize problem areas and work toward resolving them.
 Family and couples therapy is helpful in dealing with conflict or disorder that may be a
factor in perpetuating anorexic behavior. Family therapy is especially useful in helping
parents who are anorectics avoid passing on their attitudes and behaviors on to their
children.

Key terms
Amenorrhea
Absence of the menses in a female who has begun to have menstrual periods.
Body dysmorphic disorder
A psychiatric disorder marked by preoccupation with an imagined physical defect.
Hyperalimentation
A method of re-feeding anorectics by infusing liquid nutrients and electrolytes directly
into central veins through a catheter.
Lanugo
A soft, downy body hair that develops on the chest and arms of anorexic women.
Neurotransmitter
One of a group of chemicals secreted by a nerve cell (neuron) to carry a chemical
message to another nerve cell, often as a way of transmitting a nerve impulse. Examples
of neurotransmitters include acetylcholine, dopamine, serotonin, and norepinephrine.
Purging
The use of vomiting, diuretics, or laxatives to clear the stomach and intestines after a
binge.
Russell's sign
Scraped or raw areas on the patient's knuckles, caused by self-induced vomiting.

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Superior mesenteric artery syndrome
A condition in which a person vomits after meals due to blockage of the blood supply to
the intestine.

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