ANOREXIA NERVOSA

Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation (immoderate food restriction), inappropriate eating habits, obsession with having a thin figure and excessive weight loss (irrational fear of weight gain).It is often accompanied by a distorted body self-perception. 

Due to the fear of gaining weight, individuals with this disorder restrict the amount of food they consume or exercise excessively. People with anorexia nervosa, often equate thinness with self-worth. Anorexia nervosa, like other eating disorders, can take over an individual’s life; such persons may think about food all the time, spend hours agonizing over options in the grocery store and exercise to exhaustion.
Anorexia nervosa is nine (9) times more common in females than in males. It is one of the most common psychiatric diagnoses in young women. It typically appears in early to mid-adolescence. Between 5-20% of individuals struggling with anorexia nervosa will die. It has one of the highest death rates of any mental health condition. 
TYPES OF ANOREXIA NERVOSA               
 There are two types of anorexia nervosa -    
Restricting type - weight loss is achieved by restricting calories (following drastic diets, fasting, and exercising to excess).                                    Purging type - weight loss is achieved by vomiting or using laxatives and diuretics.

SYMPTOMS                                                               

 No matter how weight loss is achieved, anorexia nervosa has a number of physical, emotional and behavioral signs and symptoms.

Physical symptoms-

·        Extreme weight loss

·        Thin appearance

·        Fatigue

·        Insomnia

·        Dizziness or fainting

·        Constipation

·        Dry skin

·        Intolerance of cold

·        Irregular heart rhythms

·        Low blood pressure

·        Dehydration

·        Soft, downy hair covering the body

·        Absence of menstruation

·        Bluish discoloration of the fingers

·        Hair that thins, breaks or falls out

·        Swelling of arms or legs

·        Osteoporosis

·        Abnormal blood counts

Emotional and behavioral symptoms-

·        Refusal to eat

·        Denial of hunger

·        Fear of gaining weight

·        Social withdrawal

·        Irritability

·        Preoccupation with food

·        Reduced interest in sex

·        Lying about how much food has been eaten

·        Excessive exercise

·         Depressed mood

·        Possible use of laxatives, diet aids or herbal products

·        Flat mood (lack of emotion)

WARNING SIGNS/RED FLAGS TO WATCH FOR

ü Skipping meals

ü Making excuses for not eating

ü Eating only a few certain "safe" foods, usually those low in fat and calories

ü Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).

ü Cooking elaborate meals for others but refusing to eat

ü  Preoccupation with weight, food, calories, fat grams, and dieting.

ü Refusal to eat certain foods, progressing to restrictions against whole categories of food

ü Repeated weighing of themselves

ü Frequent checking in the mirror for perceived flaws

ü Complaining about being fat

ü Not wanting to eat in public

ü Excessive, rigid exercise regimen despite weather, fatigue, illness, or injury.

ü Withdrawal from usual friends and activities.

ü In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

CAUSES                                              

The exact cause of anorexia nervosa is unknown. Combinations of biological, psychological and environmental factors have been implicated.

·        Psychological - Emotional characteristics may contribute to anorexia nervosa. Young women with obsessive-compulsive personality traits make it easier for them to stick to strict diets and forgo food despite being hungry. They may also have an extreme drive for perfectionism, which means they may never think they're thin enough

·        Biological - There may be genetic changes that make some people more vulnerable to developing anorexia. However, this is not fully clear as no gene locus specifically has been identified. There's also some evidence that serotonin, one of the brain chemicals involved in depression may play a role in anorexia. .

·        Environmental - Modern Western culture emphasizes thinness. Images of thin models and actors splashed all over the media may contribute. Peer pressure may help fuel the desire to be thin, particularly among young girls.

RISK FACTORS                                                 

  Certain risk factors increase the risk of anorexia nervosa, including:

·        Female sex - More common in girls and women. However, males have been increasingly developing eating disorders; this may be attributable to growing social pressures.

·        Young age - More common among teenagers. Still, people of any age can develop this eating disorder, though it's rare in people older than 40.

·        Genetics - Changes in certain genes may make people more susceptible to anorexia nervosa.

·        Family history of eating disorders

·        History of physical or sexual abuse

·        Body dissatisfaction

·        Strict dieting

·        Low self-esteem

·        Weight changes - People who lose weight on purpose or unintentionally usually receive positive comments from others and negative comments if weight is gained. Such changes and comments may trigger someone to start dieting to an extreme.

·        Perfectionism

·        Troubled family relationships

·        Transitions - Be it a new school, home or job, a relationship breakup, or the death or illness of a loved one, change can bring emotional stress and increase the risk of anorexia nervosa.

·        Sports, work and artistic activities- Actors athletes, and television personalities, dancers, and models are at higher risk of anorexia nervosa. Sports associated with anorexia nervosa include running, wrestling, figure skating and gymnastics.

·        Media and society - The parade of skinny models and actors in the media is a contributory factor. These images may seem to equate thinness with success and popularity.

COMPLICATIONS                                      

If a person with anorexia nervosa becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. Complications of anorexia include:

Ø Anemia

Ø Heart problems –  mitral valve prolapse, abnormal heart rhythms and heart failure

Ø Bone loss, increasing risk of fractures later in life

Ø In females, absence of a period (amenorrhea)

Ø In males, decreased testosterone

Ø Gastrointestinal problems, such as constipation, bloating or nausea

Ø Electrolyte abnormalities, such as low blood potassium, sodium and chloride

Ø Kidney problems

Ø Neurological disorders- seizures, tremors

Ø Death

In addition to the physical effects, mental effects predominate –

Ø Depression

Ø Anxiety disorders

Ø Personality disorders

Ø Obsessive-compulsive disorders

TREATMENT                                       

People with anorexia nervosa, may need several types of treatment. For those in immediate danger, they may need treatment in a hospital emergency room for issues such as dehydration, electrolyte imbalances, heart rhythm disturbance or psychiatric problems.                A team approach to treatment is often best since anorexia nervosa involves both mind and body. The team may include medical doctors, psychologists, counselors, and dieticians. Family support and participation also makes a big difference in treatment success.

Treating anorexia nervosa involves –

·        Restoring the person to a healthy weight

·        Treating the psychological disorders related to the illness;  

·        Reducing or eliminating behaviors or thoughts that originally led to the disordered eating

Medical care                                          

 This involves frequent monitoring of vital signs, hydration level and electrolytes, as well as related physical conditions. In severe cases, they may initially require feeding through a tube that's placed in their nose and goes to the stomach (nasogastric tube). Outpatient treatment is an option when they are not in immediate medical danger.                  

Nutritional treatment for anorexia                  

  A second component of anorexia nervosa treatment is nutritional counseling. A nutritionist or dietician will teach them about healthy eating and proper nutrition. The nutritionist will also helps in developing and following meal plans that include enough calories to reach or maintain a normal, healthy weight. The family will also likely be involved in helping to maintain healthy-eating habits.

Psychotherapy                                 

 Individual, family-based and group therapy may all be beneficial.

·        Individual therapy - This helps to deal with behavior and thoughts that contribute to anorexia. Also it assists the person to attain healthier self-esteem and learn positive ways to cope with distress and other strong feelings. A type of talk therapy called cognitive behavioral therapy (CBT) is commonly used. Counseling is crucial to treatment of anorexia nervosa.

·        Family-based therapy -It begins with the assumption that the person with the eating disorder is no longer capable of making sound decisions regarding his or her health. The family is involved in making sure that healthy-eating patterns are followed. It can help to resolve family conflicts and muster support from concerned family members.

·        Group therapy - This therapy gives a way to connect to others facing eating disorders. Informal support groups may sometimes be helpful.

Medications                                         

There are no medications specifically designed to treat anorexia. However, antidepressants or other psychiatric medications can help treat other mental disorders they may also have, such as depression or anxiety.

Lifestyle and home remedies                          

 In addition to professional treatment follow these steps:

·        Stick to the treatment plan - Don't skip therapy sessions and try not to stray from meal plans, even if they make you uncomfortable.

·        Talk to your doctor about appropriate vitamin and mineral supplements especially if you're not eating well.

·        Don't isolate yourself from caring family members and friends

·        Resist urges to weigh yourself or check yourself in the mirror frequently. These may fuel your drive to maintain unhealthy habits.

Alternative medicine

This is not well studied as a treatment for people with eating disorders; however they can help reduce anxiety and increasing a sense of well-being and promoting relaxation. Examples include -  

Ø Acupuncture

Ø Massage

Ø Yoga

Ø Meditation

PREVENTION                                     

There's no guaranteed way to prevent anorexia nervosa or other eating disorders. If you notice a friend or family member with low self-esteem, severe dieting habits and dissatisfaction with appearance, consider talking to him or her about these issues.