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Anorexia Nervosa - Causes, Symptoms And Treatment

Alternative names :- Eating disorder - anorexia

The key feature of anorexia nervosa is self-imposed starvation resulting from a distorted body image and an intense and irrational fear of gaining weight, even when the patient is obviously emaciated. An anorexic patient is preoccupied with her body size, describes herself 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. Anorexia nervosa and bulimia nervosa can occur simultaneously. In anorexia nervosa, the refusal to eat may be accompanied by compulsive exercising, self-induced vomiting, or abuse of laxatives or diuretics. Anorexia occurs in 5% to 10% of the population; about 95% of those affected are women. This disorder occurs primarily in adolescents and young adults but also may affect older women. The occurrence among males is rising.

The prognosis varies but improves if the patient is diagnosed early or if she wants to overcome the disorder and seeks help voluntarily. Mortality ranges from 5% to 15%-the highest mortality associated with a psychiatric disturbance. One-third of these deaths can be attributed to suicide.

Causes

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 also are implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over one's life.

Signs and symptoms

• self-imposed food intake restrictions, often hidden
• Weight loss of at least 15 per cent below the normal ideal body weight for a person of the same age and height.
• loss of fatty tissue
• Absent or irregular periods
• Loss of scalp hair
• inappropriate use of laxatives, enemas, or diuretics (water pills) in an effort to lose weight
• Other side effects include tiredness, feeling cold, constipation and stomachache.

Treatment

Appropriate treatment aims to promote weight gain or control the patient's compulsive binge eating and purging and to correct malnutrition and the underlying psychological dysfunction. Hospitalization in a medical or psychiatric unit may be required to improve the patient's precarious physical condition. The facility stay may be as brief as 2 weeks or may stretch from a few months to 2 years or longer.

Treatment will vary depending on the individual circumstances. There is no one single treatment that has proven to be effective in all cases. Treatment aims to:

• restore healthy eating patterns.
• enlist family support.
• treat any physical complications or associated mental health problems.

Special considerations

• During hospitalization, regularly monitor vital' signs, nutritional status, and intake and output. Weigh the patient daily - before breakfast if possible. Because the patient fears being weighed, vary the weighing routine. Keep in mind that weight should increase from morning to night.
• Help the patient establish a target weight, and support her efforts to achieve this goal.
• Anticipate a weight gain of about 1 Ib (0.5 kg) per week.
• Teach the patient how to keep a food journal, including the types of food eaten, eating frequency, and feelings associated with eating and exercise.
• Advise family members to avoid discussing food with the patient.