How to Get Rid of Anorexia Nervosa DisorderTweet
These are dangerously thin people, only they fail to recognize as such. Avoiding food is an obsession with them. They would rathger stick to certain low calorie food or would carefully weight and portion food. People with anorexia may repeatedly check their body weight, and many engage in other techniques to control their weight such as intense and compulsive exercise or vomiting. Girls with Anorexia often experience a delayed onset of their first menstrual period. If things get worse, it can even cause death.
Anorexia Nervosa Diagnosis
The main clinical criteria for diagnosis are:
- a bodyweight more than 15% below the standard weight, or a body mass index (BMI) below 17.5 (ICD-10)
- weight loss is self-induced by avoidance of fattening foods, vomiting, purging, exercise, or appetite suppressants
- a distortion of body image so that the patient regards herself as fat when she is thin
- a morbid fear of fatness
- amenorrhoea in women.
Clinical features include:
- onset usually in adolescence
- a previous history of chubbiness or fatness
- the patient generally eats little
- amenorrhoea - an early symptom; in 20% it precedes weight loss
- binge eating
- usually a marked lack of sexual interest
The physical consequences of anorexia include sensitivity to cold, constipation, hypotension and bradycardia. In most cases, amenorrhoea is secondary to the weight loss. Vomiting and abuse of purgatives may lead to hypokalaemia and alkalosis.
Case register data suggest a rate of 1-10 per 100 000 females aged between 15 and 34 years. Surveys have suggested a prevalence rate of 1-2% among schoolgirls and university students. However, many more young women have amenorrhoea accompanied by less weight loss than the 15% required for the diagnosis. The condition is much less common among men (ratio of 1 : 10). The onset in women is usually at between 16 and 17 years of age and it seldom occurs after the age of 30 years.
Anorexia occurs in 1 % to 2% of the female population and in 0.1 % to 0.2% of the male population. This disorder occurs primarily in adolescents and young adults but may also affect older women. The occurrence among males is rising, but this disorder mains more prevalent in females. The prognosis varies but improves if the patient is diagnosed early, or if she wants to overcome the disorder and voluntarily seeks help. Mortality ranges from 5% to 15%- one-third of these deaths can be attributed to suicide.
Anorexia nervosa and Bulimia nervosa
Cause of Anorexia nervosa
Genetic. Six to ten per cent of siblings of affected women suffer from anorexia nervosa. There is an increased concordance amongst monozygotic twins, suggesting a genetic predisposition.
Hormonal. The reductions in sex hormones and the hypothalamic-pituitary-adrenal axis are secondary to malnutrition and usually reversed by refeeding.
Individual. Anorexia nervosa has often been seen as an escape from the emotional problems of adolescence and a regression into childhood. Patients will often have had dietary problems in early life. Perfectionism and low self-esteem are common antecedents. Recent studies suggest that survivors of childhood sexual abuse are at risk of developing an eating disorder, usually anorexia nervosa, in adolescence.
Family. Families of such patients are allegedly characterized by overprotection, inflexibility and lack of conflict resolution. Anorexia is alleged to prevent dissension in families. However, a recent case control study suggested that there is no more evidence of these factors in families of anorexia nervosa than in control families with a child with an established physical disease.
Prognosis of Anorexia nervosa
The condition runs a fluctuating course, with exacerbations and partial remissions. Long-term follow-up suggests that about two-thirds of patients maintain normal weight and that the remaining one-third are split between those who are moderately underweight and those who are seriously underweight. Indicators of a poor outcome include:
- a long initial illness
- severe weight loss
- older age at onset
- bulimia (see below), vomiting or purging
- difficulties in relationships.
Suicide has been reported in 2-5% of patients with chronic anorexia nervosa. The mortality rate per year is 0.5% from all causes. More than one-third have recurrent affective illness, and various family, genetic and endocrine studies have found associations between eating disorders and depression. Fifty per cent of patients make a full recovery, 30% a partial recovery and 20% none.
Treatment of Anorexia nervosa
Treatment can be conducted on an outpatient basis unless the weight loss is severe and accompanied by marked physical symptoms, dizziness and weakness and/or electrolyte and vitamin disturbances. Hospital admission may then be unavoidable and may need to be on a medical ward initially. Rarely the patient's weight loss may be so severe as to be life-threatening.
A team approach to care - combining aggressive medical management. nutritional counseling, and individual, group. or family psychotherapy or behavior modification therapy - is the most effective treatment for anorexia nervosa. Even so, treatment results may be discouraging. Many clinical centers are developing inpatient and outpatient programs specifically aimed at managing eating disorders. If the patient cannot be persuaded to enter hospital, compulsory admission may have to be used. Inpatient treatment goals include:
- establishing a good relationship with the patient
- restoring the weight to a level between the ideal bodyweight and the patient's ideal weight
- the provision of a balanced diet, building up to 12.6 MJ (3000 calories) in three to four meals per day
- the elimination of purgative and/or laxative use and vomiting.
Outpatient treatment can be conducted on cognitive behavioural or dynamic psychotherapeutic lines or on a combination of both. Setting up a therapeutic alliance is vital. Individual psychotherapy is better than family therapy if the patient has left home, and vice versa. Motivational enhancement techniques are being used with some success.
All forms of psychotherapy, from psychoanalysis to hypnotherapy, have been used in treating anorexia nervosa, with varying success. To be successful, psychotherapy should address the underlying problems of low self esteem, guilt. anxiety, feelings of hopelessness and helplessness, and depression.
Treatment may include behavior modification (privileges depend on weight gain); curtailed activity for physical reasons (such as arrhythmias); vitamin and mineral supplements; a reasonable diet with or without liquid supplements; subclavian, peripheral, or enteral hyperalimentation (enteral and peripheral routes carry less risk of infection); and group, family, or individual psychotherapy.
Drug treatment has met with limited success, except to symptomatically treat insomnia and depressive illness.
- Maintain one-on-one supervision of the patient during meals and for 1 hour afterward to ensure compliance with the dietary treatment program. For the hospitalized anorexic patient, food is considered a medication.
- Teach the patient how to keep a food journal, including the types of food eaten, eating frequency, and feelings associated with eating and exercise.
- Negotiate an adequate food intake with the patient. Make sure she understands that she'll need to comply with this contract or lose privileges. Frequently offer small portions of food or drinks if the patient wants them. Allow the patient to maintain control over the types and amounts of food she eats, if possible.
- During an acute anorexic episode, nutritionally complete liquids are more acceptable than solid food because they eliminate the need to choose between foods - something many anorexic patients find difficult. If tube feedings or other special feeding measures become necessary, fully explain these measures to the patient, and be ready to discuss her fears or reluctance; limit the discussion about food itself.
- Because the patient and her family may need therapy to uncover and correct dysfunctional patterns, refer them to Anorexia Nervosa and Related Eating Disorders, a national information and support organization. This organization may help them understand what anorexia is, convince them that they need help, and help them find a psychotherapist or medical physician who is experienced in treating this disorder.
- Expect a weight gain of about 1 1b(0.5 kg) per week.
- If edema or bloating occurs after the patient has returned to normal eating behavior, reassure her that this phenomenon is temporary. She may fear that she is becoming fat and stop complying with the plan of treatment.
- Encourage the patient to recognize and express her feelings freely. If she understands that she can be assertive, she gradually may learn that expressing her true feelings won't result in her losing control or love.
Facts and Tips about Anorexia Nervosa
- Anorexia nervosa is a psychiatric disorder that explain an eating disorder leading by extremely low body weight and body image distortion with an obsessive fear of gaining weight.
- Unnecessary and excessive fear of weight gain, heavy work outs and exercise, controlling hunger unnecessarily, Very thin body and dry skin, Abnormal weight loss which are symptoms of anorexia Nervosa.
- Result of anorexia nervosa people do some efforts like control body weight generally by voluntary starvation, extreme exercise, or other weight control measures for example diet pills or diuretic drugs.
- In case of anorexia nervosa people have some risk factor such as delayed menstruation, difficulty in breathing, weakness and dizziness, bone loss, anemia, miscarriage, stomach disorders, hair loss, scaly and dry skin.
- Accepting society's attitudes about thinness, feeling increased concern or attention to weight and shape, having eating and gastrointestinal problems during early childhood which are cause of anorexia nervosa.
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