Anorexia Nervosa

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Anorexia Nervosa
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What is Anorexia Nervosa

• What is anorexia?
• Eating disorder with psychological aetiology
• More common in females
• Weight loss leads
• abnormalities of heart rhythm
• abdominal symptoms
• anaemia
• hormonal and electrolyte imbalances
• Poorly understood, no universally accepted
  treatment
• One of a spectrum of eating disorders
• Beyond, out of control dieting
• Weight loss becomes an indication of mastery and
  control
• Primary drive .. to control ones body and
  overcome fears
• Compulsive behaviour, Obsessive personality
  (similar to addiction)
• Usually presents in adolescence but sometimes in
  younger children

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Cause

• No known cause
• May be genetic predisposition
• Demands of society and peer group
• Demands of parents re perfection
• Poor self image
• ?? Family dysfunction
• Members interdependent on each other
• Cannot achieve an identity as an individual
• They are not individuals, only a member of a
  family
• Fear of growing up (perhaps of independence)
• Maturational process affected by diet
•  
• Some limited evidence for hypothalamic
  dysfunction (reduction in serotonin)

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Predisposing factors

• low self esteem, trying to change the way s/he
  is
• feelings of ineffectiveness / perfectionism
  (changing my body will make me a more effective
  person). Search for perfectionism. I ought to be
  perfect
• Feeling it is necessary to maintain control over
  their body and lives. A focus on something that
  can be controlled. Leads to an extreme fear of
  increasing weight
• Fear of maturation (adolescence). Lack of ways to
  deal with physical changes, dieting .. a coping
  mechanism
• Weight obsession in society, obesity intolerable,
  thinness is perfect. Overweight people seen as ..
  slow, lazy, sloppy.

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Warning signs of an eating disorder

• A preoccupation with food and weight (i.e.
  counting calories, excessive dieting, weighing
  oneself several times per day)
• Claims of "feeling fat" when weight is normal or
  even low individual experiences "body
  distortion" (they perceive their shape to be
  something other than it is)
• Guilt and shame about eating, not wanting to eat
  in front of other people
• Evidence of binge-eating, hoarding of food, use
  of laxatives, diuretics, purgatives, and emetics
  
• Excessive exercise exercising to lose weight not
  to get fit
• Emotional changes moodiness, depression,
  irritability, social withdrawal
• Extreme concern about appearance
• An over-sensitivity to criticism of any kind
• A need for perfection, an inflexibility thinking
  in extremes (i.e. If I'm not thin, I'll be
  obese).

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Characteristics

• Sometimes difficult to diagnose
• Patient tries to hide condition
• Denial and secrecy
• Do not seek help themselves
• By presentation, lack insight, provide unreliable
  information

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Four criteria

• Refusal to maintain weight at min. desirable
  level
• Intense fear of gaining weight, becoming fat,
  although underweight
• Gross distortion of self perception, weight loss
  not seen
• In post menarche .. amenorrhoea.
• Two subtypes
• Binge-eating / purging type (vomiting, laxatives
  etc.)
• Restricting type (just dieting).

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Specific Signs of Anorexia Nervosa

• Significant weight loss in the absence of related
  illness
• Significant reduction in eating, coupled with a
  denial of hunger
• Dieting when not "over" weight
• Signs of starvation
• Amenorrhoea in women
• Unusual eating habits preference for foods of a
  certain texture or colour, compulsively arranging
  food, unusual mixtures of food.

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Bulimia Nervosa

• Evidence of binge-eating actual observation,
  verbal reports, large amounts of food missing,
• Frequent weight fluctuations
• Evidence of purging vomiting, laxative/diuretic
  abuse, emetics, frequent fasting, excessive
  exercise
• Swelling of parotid glands under the jaw (caused
  by frequent vomiting)
• Frequent, unusual dental problems.

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The Physical Effects of Starvation

• lowered heart rate and body temperature
• bradycardia, hypotension, cardiomyopathy
• overall lowering of body metabolism (the rate at
  which the body burns calories)
• anaemia
• irregular menstruation or loss of menses
• growth of fine downy body hair on the face, back,
  arms and legs loss of hair from scalp
• brittle nails
• dry, pasty skin (yellow colour)
• fatigue
• swelling and puffiness in fingers, ankles, and
  face
• amenorrhoea, hormonal imbalance
• long term renal and liver damage

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The Physical Effects of Bingeing and Purging

• Strenuous over exercise dangerous
• Electrolyte imbalance and protein loss
• hypokalaemia
• Irritability
• Depression
• Muscle weakness
• Dysrhythmias
• Convulsions
• Heart, renal failure
• Gastrointestinal, bloating, constipation,
  oesophagitis
• fluid and electrolyte loss, cramp
• Weakness
• Rebound oedema after fluid loss
• Nutritional deficiencies
• Dental, loss of enamel (vomiting), Ipecac
  contains a muscle poison emetine

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Complications

• Death
• Cardiac disease and electrolyte imbalance
• Depression, social withdrawal
• Sleep problems
• Reduced attention and concentration

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Diagnosis of Eating Disorders

• Listen in a non-judgmental and caring manner
• Diagnose eating disorders by the appearance of
  specific symptoms, not the exclusion of "real"
  physical illnesses. Eating disorders are
  invariable characterised by a drive for thinness,
  an excessive fear of becoming fat, and harmful
  attitudes towards the body, self, and food
• Eating disorders also occur in males, and the
  symptomatology in males is fairly similar to that
  seen in females. Eating disorders occur in
  individuals of all ages, backgrounds, and
  weights.

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Treatment and Support

• Priority to (a) identify early (b) treat by
  trained therapists and (c) supplemented by
  support groups for individuals with eating
  disorders, family and friends
• Eating disorders have biological, psychological,
  familial, and sociocultural components.
  Consequently, effective treatment of eating
  disorders should involve a collaboration among
  health professionals
• Goal (a) restore and maintain a normal weight
  (b) develop normal eating patterns (c) overcome
  unhealthy attitudes about the body, the self, and
  relationships (d) uncover and resolve
  experiences of trauma and abuse (e) strengthen
  coping skills and (f) help family and friends
  assist the person in the process of overcoming
  the eating disorder

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Further reading

• Bakker, R., B. van Meijel, et al. (2011).
  "Recovery of Normal Body Weight in Adolescents
  with Anorexia Nervosa The Nurses' Perspective on
  Effective Interventions." Journal of Child
  Adolescent Psychiatric Nursing 24(1) 16-22.
• Brewerton, T. D. and C. Costin (2011). "Long-term
  Outcome of Residential Treatment for Anorexia
  Nervosa and Bulimia Nervosa." Eating Disorders
  19(2) 132-144.
• Hambrook, D., A. Oldershaw, et al. (2011).
  "Emotional expression, self-silencing, and
  distress tolerance in anorexia nervosa and
  chronic fatigue syndrome." British Journal of
  Clinical Psychology 50(3) 310-325.
• Matzkin, V., N. Slobodianik, et al. (2007). "Risk
  factors for cardiovascular disease in patients
  with anorexia nervosa." International Journal of
  Psychiatric Nursing Research 13(1) 1531-1545.
• Mitchison, D., P. Hay, et al. (2013).
  "Self-reported history of anorexia nervosa and
  current quality of life findings from a
  community-based study." Quality of Life Research
  22(2) 273-281.
• Nilsson, K. and B. Hägglöf (2006). "Patient
  perspectives of recovery in adolescent onset
  anorexia nervosa." Eating Disorders 14(4)
  305-311.
• Paulson-Karlsson, G., I. Engström, et al. (2009).
  "A pilot study of a family-based treatment for
  adolescent anorexia nervosa 18- and 36-month
  follow-ups." Eating Disorders 17(1) 72-88.
• Ross, J. A. and C. Green (2011). "Inside the
  experience of anorexia nervosa A narrative
  thematic analysis." Counselling Psychotherapy
  Research 11(2) 112-119.
• Wentz, E., I. Gillberg, et al. (2012). "Somatic
  problems and self-injurious behaviour 18 years
  after teenage-onset anorexia nervosa." European
  Child Adolescent Psychiatry 21(8) 421-432.
• Westwood, L. M. and S. E. Kendal (2012).
  "Adolescent client views towards the treatment of
  anorexia nervosa a review of the literature."
  Journal of Psychiatric Mental Health Nursing
  19(6) 500-508.
• Williams, S. and M. Reid (2010). "Understanding
  the experience of ambivalence in anorexia
  nervosa the maintainer's perspective."
  Psychology Health 25(5) 551-567.
• Williams, S. and M. Reid (2012). "It's like
  there are two people in my head A
  phenomenological exploration of anorexia nervosa
  and its relationship to the self." Psychology
  Health 27(7) 798-815.
• Zugai, J., J. Stein-Parbury, et al. (2013).
  "Effective nursing care of adolescents with
  anorexia nervosa a consumer perspective."
  Journal of Clinical Nursing 22(13/14) 2020-2029.