Anorexia Nervosa - Causes, Symptoms And TreatmentThe key feature of anorexia nervosa is sell imposed starvation, resulting from a distorted body image and an intense, irrational fear of gaining weight. An anorexic patient is preoccupied with her body size, describes her sell as "fat," and commonly expresses dissatisfaction with a particular aspect of her physical appearance. Although the term anorexia suggests that the patient's weight loss is associated with a loss of appetite, this is rare. Indeed, anorexia nervosa and bulimia nervosa can occur simultaneously. In anorexia nervosa, the refusal to eat may be accompanied by compulsive exercising, sell induced vomiting, or abuse of laxatives or diuretics.
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.
Information on the signs and symptoms of anorexia nervosa
The patient's history usually reveals a 25% or greater weight loss for no organic reason, coupled with a morbid dread of being fat and a compulsion to be thin. Such a patient tends to be angry and ritualistic. She may report amenorrhea, infertility, loss of libido, fatigue, sleep alterations, intolerance to cold, and constipation.
Hypertension and bradycardia may be present. Inspection may reveal an emaciated appearance, with skeletal muscle atrophy, loss of fatty tissue, atrophy of breast tissue, blotchy or sallow skin, lanugo on the face and body, and dryness or loss of scalp hair. If the patient is also bulimic, inspection may reveal calluses on the knuckles and abrasions and scars on the dorsum of the hand, resulting from tooth injury during sell-induced vomiting. Other signs of vomiting include dental caries and oral or pharyngeal abrasions.
Palpation may disclose painless salivary gland enlargement and bowel distention. Slowed reflexes may occur on percussion. Oddly, the patient usually demonstrates hyperactivity and vigor (despite malnourishment). She may exercise avidly without apparent fatigue.
During psychosocial assessment. the anorexic patient may express a morbid fear of gaining weight and an obsession with her physical appearance. Paradoxically. she may also be obsessed with food preparing elaborate meals for others. Social regression, including poor sexual adjustment and fear of failure. is common Like bulimia nervosa, anorexia nervosa is commonly asodated with depression. The patient may report feelings of despair, hopelessness and worthlessness as well as suicidal thoughts.
Information on the causes of anorexia nervosa
No one knows what causes anorexia nervosa. Researchers in neuroendocrinology are seeking a physiologic cause but have found nothing definite. Clearly, social attitudes that equate slimness with beauty play some role in provoking this disorder; family factors are also implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over one's life.
For characteristic findings in patients with anorexia nervosa. see Diagnosing anorexia nervosa.
Abnormal findings that may accompany a weight loss exceeding 30% of normal body weight include:
Anorexia nervosa treatment
Appropriate treatment aims to promote weight gain or control the patient's compulsive binge eating and purging. Malnutrition and the underlying psychological dysfunction must be corrected, Hospitalization in a medical or psychiatric unit may be required to improve the patient's precarious physical condition. The hospital stay may be as brief as 2 weeks or may stretch from a few months to 2 years or longer
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
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.
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.
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