Tag Archives: anorexia

Anorexia

  1. Symptoms: 2 main types are restricting (not engaged in binge eating or purging in the last 3 months) or binge eating/purging type (regular binging and purging)
    1. Classic Symptoms: significantly low weight (a BMI below 18.5; emaciation= 25-30% below regular body weight), distorted view of his/her body, intense fear of gaining weight
    2. Commonly associated symptoms: Amenorrhea (cessation of menstruation), obsessive preoccupation with food, occasional purging, “successful” struggle for control over persistent hunger, struggle for control, act impulsively, conforming and controlling; symptoms of depression (sad mood, irritability, insomnia, social withdraw, diminished interest in sex)
    3. Difficulties associated with Anorexia: mood disturbance; sexual problems; lack of impulse control; medical issues such as: constipation, abdominal pain, intolerance, lethargy, low blood pressure and low body temperature, lanugo (fine, downy hair on face and trunk of the body), anemia, infertility, inpaired kidney functioning, cardiovascular problems, dental erosion, bone loss, electrolyte imbalance leading to cardiac arrest or kidney failure
  2. Diagnosis: Must meet the following 3 criteria:
    1. Restriction of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health
    2. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
    3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight r shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
  3. Course and Outcome: 5% of people with anorexia die of starvation, suicide, or medical complications; at a 10-20 year follow-up nearly half of patients have returned to normal range, 20%  remain significantly below healthy body weight, the remainder are at an intermediate body weight; 5% of patients starve themselves to death or die of related complications including suicide; half of all women with a history of anorexia continue to be preoccupied with diet, weight, and body weight, notwithstanding weight gain;
  4. Frequency of Disorder: females are ten times more likely than males to have an eating disorder; 1995-1996 there were 54 cases per million people; 12 month prevalence of anorexia is .4 among females, similar to .9 estimate based on a recent US survey; difficult to establish prevalence in men
  5. Etiology: Typically in adolescents or early adulthood; caused by hormonal changes. Autonomy struggles, various sexual problems;
    1. Social factors: high standards of beauty for extreme thinness; working in fields that emphasize weight and appearance (models, ballet dancers, gymnasts); in adolescence culture puts an emphasis on appearance, beauty, and thinness; greater exposure to popular media, endorse more gender-role stereotypes, internalize societal standards; white women; industrialized societies; troubled family relationships; enmeshed families (overly involved in each others’ lives; child abuse
    2. Psychological factors: control issues, depression/dysphoria, body image dissatisfaction, reactions to dietary restraints; overly conforming, eager to please; perfectionism; lack of interoceptive awareness; low self-esteem; dietary restraint; weight suppression
    3. Biological factors: gene influence on personality characteristics such as anxiety; certain body types; genetic influence on pathology after puberty; hypothalamus
  6. Treatment(s): family therapy, Maudsley method (parents take complete control over the anorexic child’s eating, planning meals, preparing food, and monitoring food), age appropriate autonomy is returned to the teenager as eating and weight improve; 2 goals:
    1. Help patient gain minimal weight; if too severe they may be hospitalized and receive feeding that is forced or through intravenous methods or participate in a strict behavior therapy program that make rewards contingent on weight gain
    2. Address the broader eating difficulties
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