An eating disorder
Anorexia nervosa
Anorexia nervosa is an eating disorder characterized by immoderate food restriction, inappropriate eating habits or rituals, obsession with having a thin figure, and an irrational fear of weight gain, as well as a distorted body self-perception. It typically involves excessive weight loss and is diagnosed approximately nine times more often in females than in males. Due to their fear of gaining weight, individuals with this disorder restrict the amount of food they consume (Hebebrand J. 2004).
There are four key features according to AN. First, the person refuses to maintain a minimally normal body weight; below 12 of body mass index. Second, despite being dangerously underweight, the person with anorexia is intensely afraid of gaining weight or becoming fat. Third, she has a distorted perception about the size of her body, although emaciated, she looks in the mirror and sees herself as fat or obese. And fourth, she denies the seriousness of her weight loss (Hockenbury&Hockenbury2012).
Patients with anorexia nervosa often experience dizziness, headaches, drowsiness, fever, and a lack of energy. To counteract these side effects, particularly the latter, individuals with anorexia may engage in other harmful behaviors, such as smoking, excessive caffeine consumption, and attempting to take diet pills, along with an increased exercise regimen.
Symptoms
A person with anorexia nervosa may exhibit a number of signs and symptoms, the type and severity of which may vary in each case and may be present but not readily apparent.
The Term Paper on Anorexia Nervosa A Complex Disorder Both
... be affected by eating disorders, regardless of their socioeconomic background (Eating Disorder Resource Center, 1997). Anorexia nervosa is one such disorder characterized by extreme weight loss.It is the ... of the seriousness of the current low body weight (Blackman, 1996). Anorexia nervosa may be a primary disorder in which other psychiatric conditions are secondary, ...
Symptoms of a person with anorexia nervosa may include:
* Refusal to maintain a normal body mass index for their age
* Amenorrhea, a symptom that occurs after prolonged weight loss; causes menses to stop, hair becomes brittle, and skin becomes yellow and unhealthy
* Fearful of even the slightest weight gain and takes all precautionary measures to avoid weight gain and becoming overweight
* Obvious, rapid, dramatic weight loss
* Lanugo: soft, fine hair growing on the face and
* Obsession with calories and fat content of food
* Preoccupation with food, recipes, or cooking; may cook elaborate dinners for others, but not eat the food themselves
* Food restriction despite being underweight
* Food rituals: cuts food into tiny pieces; refuses to eat around others; hides or discards food
* Purging: May use laxatives, diet pills, ipecac syrup, or water pills; may engage in self-induced vomiting; may run to the bathroom after eating in order to vomit and quickly get rid of ingested calories.
* Perception of self as overweight despite being told by others they are too thin
* Intolerance to cold and frequent complaints of being cold. Body temperature may lower (hypothermia) in an effort to conserve energy
* Depression: may frequently be in a sad, lethargic state
* Solitude: may avoid friends and family; becomes withdrawn and secretive
* Hair loss or thinning
* Fatigue
* Rapid mood swings
* Exercising all the time, even when the weather is bad, they are hurt, or their schedule is busy
* Refusing to eat around other people
* Confused or slow thinking, along with poor memory or judgment
* Dry mouth
* Extreme sensitivity to cold (wearing several layers of clothing to stay warm)
* Loss of bone strength
Hypokalaemia, a drop in the level of potassium in the blood, is a sign of anorexia nervosa. A significant drop in potassium can cause abnormal heart rhythms, constipation, fatigue, muscle damage and paralysis.
The Essay on Anorexia Nervosa Weight Patients Individuals
Introduction: Eating Disorders Anorexia ANOREXIA NERVOSA Introduction: Eating Disorders are characterized by sever disturbances in eating behavior. The essential features of Anorexia Nervosa are that the individual refuses to maintain a ... restricted diet that is sometimes limited only to few foods. Additional methods of weight loss include purging (self-induced vomiting or the ...
Between 50% and 75% of individuals with an eating disorder experience depression. In addition, one in every four individuals who are diagnosed with anorexia nervosa also exhibit obsessive-compulsive disorder (Lee S, Ng KL, Kwok K, Fung 2010).
Causes of eating disorder
Biological:
Obstetric complications: various prenatal and perinatal complications may factor into the development of anorexia nervosa, such as maternal anemia,
Genetics: anorexia nervosa is believed to be highly heritable, with estimated inheritance rates ranging from 56% to 84%. Association studies have been performed, studying 128 different polymorphisms related to 43 genes including genes involved in regulation of eating behavior, motivation and reward mechanics, personality traits and emotion. Addiction to the chemicals released in the brain during starving and physical activity; people affected with anorexia often report getting some sort of high from not eating. The effect of food restriction and intense activity causes symptoms similar to anorexia in female rats, though it is not explained why this addiction affects only females (Uher R, Rutter M (2012).
Serotonin dysregulation; Alterations of these circuits may affect mood and impulse control as well as the motivating and hedonic aspects of feeding behavior. Starvation has been hypothesized to be a response to these effects, steroid hormone metabolism, which might reduce serotonin levels at these critical sites and ward off anxiety
Leptin and ghrelin; leptin is a hormone which has an inhibitory (anorexigenic) effect on appetite, by inducing a feeling of satiety. Ghrelin is an appetite inducing hormone produced in the stomach and the upper portion of the small intestine. Circulating levels of both hormones are an important factor in weight control.
Autoimmune system; Autoantibodies against neuropeptides such as melanocortin have been shown to affect personality traits associated with eating disorders such as those that influence appetite and stress responses. (Le Grange D, 2012)
Sociological:
Sociocultural studies have highlighted the role of cultural factors, such as the promotion of thinness as the ideal female form in Western industrialized nations, particularly through the media. There is a necessary connection between anorexia nervosa and culture; culture may be a cause, a trigger, or merely a kind of social address or which determines in which segments of society or in which cultures anorexia nervosa will appear. A moderate thesis is that a specific cultural factors trigger the illness, which is determined by many factors including family interactions, individual psychology, or biological predisposition. (Steinhausen HC (2002).
Anorexia And Bulimia Eating Disorder
Anorexia and Bulimia Anorexia and Bulimia are serious, functional eating disorders. There are many similarities with the two diseases, but the few differences differentiate the two. Mostly occurring in women, these disorders cause a person to look in the mirror and see themselves as 73. 6-80. 6 percent larger than they really are. These are terrible diseases that are almost purely mental and they ...
Anorexia nervosa is more likely to occur in a person’s pubertal years, especially for girls. Teenage girls concerned about their weight and who believe that slimness is more attractive among peers trend to weight-control behaviors. Teen girls are learning from each other to consume low-caloric, low-fat foods and diet pills. This results in lack of nutrition and a greater chance of developing anorexia nervosa.
There is also evidence to suggest that patients who have anorexia nervosa can be characterized by alexithymia and also a deficit in certain emotional functions. A research study showed that this was the case in both adult and adolescent anorexia nervosa patients. Early theories of the cause of anorexia linked it to sexual abuse or dysfunctional families. Some studies reported a high rate of reported child sexual abuse experiences in clinical groups of who have been diagnosed with anorexia. One found that women with a history of eating disorders were twice as likely to have reported childhood sexual abuse compared to women with no history of eating disorders.
Studies suggest that a genetic (inherited) component may play a more significant role in determining a person’s susceptibility to anorexia than was previously thought. Researchers are currently attempting to identify the particular gene or genes that might affect a person’s tendency to develop this disorder, and preliminary studies suggest that a gene located at chromosome 1p seems to be involved in determining a person’s susceptibility to anorexia nervosa. (Bowers WA, Andersen AE (1994).
Other evidence had pinpointed a dysfunction of hypothalamus (regulates metabolic processes), as contributing to the development of anorexia. Other studies have suggested that imbalances in neurotransmitter (brain chemicals involved in signaling and regulatory processes) levels in the brain may occur in people suffering from anorexia.
The Research paper on Treatment Of Eating Disorders Anorexia Patient
... the patient. Finally, a counseling schedule must be implemented with the family. Treatment of Eating 3 Definition of Anorexia Nervosa and Bulimia Eating disorders may ... notes that the second step to the treatment of eating disorders is individual therapy. This therapy helps the patient understand the decease process and its ...
Feeding problems as an infant, a general history of under-eating, and maternal depressive symptoms tend to be risk factors for developing anorexia. Other personal characteristics that can predispose an individual to the development of anorexia include a high level of negative feelings and perfectionism. For many individuals with anorexia, the destructive cycle begins with the pressure to be thin and attractive. A poor self-image compounds the problem. People who suffer from any eating disorder are more likely to have been the victim of childhood abuse. (Bravender T,2007).
Therapy & treatment
Since anorexia involves both mind and body, a team approach to treatment is often best. Those who may be involved in anorexia treatment include medical doctors, psychologists, counselors, and dieticians. The participation and support of family members also makes a big difference in treatment success. Having a team around you that you can trust and rely on will make recovery easier.
Treating anorexia involves three steps:
* Getting back to a healthy weight
* Starting to eat more food
* Changing how you think about yourself and food.
Counseling is crucial to anorexia treatment. Its goal is to identify the negative thoughts and feelings that fuel an eating disorder and replace them with healthier, less distorted beliefs. Another important goal of counseling is to teach how to deal with difficult emotions, relationship problems, and stress in a productive, rather than a self-destructive way.
Clinicians have to repeatedly decide which setting is optimal for the patient. The majority of referred AN patients are treated as inpatients at least once during the course of their eating disorder; e.g. this applies to 50 % of the patients in the United States. In both the United States and Australia, patients are generally admitted for short-term medical stabilization on a medical or pediatric ward. Inpatient treatment or day patient treatment should be considered for people with AN, whose disorder has not improved with appropriate outpatient treatment, or for whom there is a significant risk of suicide or severe self-harm, whose disorder is associated with high or moderate physical risk (Wilson GT, Grilo CM, Vitousek KM (2007).
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The typical duration of AN in an individual patient extends for many months ; obviously, even if a patient is admitted as an inpatient during the course of the disorder, they will be outside of a hospital for a substantial. This treatment included weekly individual therapy, family therapy, group therapy, dietary counseling
Each patient received 12 outpatient sessions which included to a variable extent individual and family therapy according to the needs of the respective patient. Outpatient group psychotherapy for patients and parents separately included ten outpatient meetings with the patients and ten group meetings for parents separately at monthly intervals. Additionally, dietary counseling and advice to promote a slow steady weight gain were offered on four occasions within the outpatient treatment packages (Meads C, Gold L, Burls A (2001)
Most people with AN should be treated on an outpatient basis with psychological treatment provided by a service that is competent in giving that treatment and assessing the physical risk of people with eating disorders; outpatient sessions include variable extent individual and family therapy according to the needs of the respective patient. The strongest recommendation of therapy refers to cognitive behavioral therapy and family-based therapy, because of evidence of its superiority to other psychological and drug treatments (Le Grange D, 2012).
Family-based treatment
Family therapy is based on the belief that the family is a unique social system with its own structure and patterns of communication. These patterns are determined by many things, including the parents’ beliefs and values, the personalities of all family members, and the influence of the extended family (grandparents, aunts, and uncles).
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As a result of these variables, each family develops its own unique personality, which is powerful and affects all of its members.
This is an outpatient therapy that generally involves 20 sessions over a 1 year period. In the first phase, sessions occur weekly and the focus is on parental control of weight restoration. The second phase involves gradually handing control back over to a patient, and meetings occur biweekly. In the final phase, meetings occur monthly and the focus is on a patient‘s developmental issues. Usually at the end of treatment, 96% no longer met criteria for Anorexia Nervosa. (Lock et al., 2006) Each phase lasts about 3–4 months. In the first phase, the focus is on correcting severe malnutrition associated with anorexia nervosa through parents taking charge of feeding their affected son or daughter. Therapy aims to establish and reinforce a strong parental alliance around refeeding their child while also attempting to align the patient with the sibling subsystem. This phase also includes a family meal that allows the therapist to observe familial interaction patterns around eating. The therapist stresses that parents did not cause the illness while also demonstrating how anorexia nervosa has changed their son’s or daughter’s behaviour dramatically. These observations highlight the differences between anorexic thinking and the patient’s former concerns allowing for separation of the disorder from the patient. When the patient accepts the demands of the parents and steady weight gain is evident, the second phase begins. This phase encourages parents to help their child to take more control over eating herself under their supervision. When this is accomplished and the patient’s weight has stabilized near to 95% of her ideal body weight without significant parental supervision, treatment can begin to focus on the impact anorexia nervosa has had upon establishing a healthy adolescent identity. This entails a review of central issues of adolescence (e.g. supporting increased personal autonomy for the adolescent, familial boundary management, and supporting parental focus on their life as a couple), (Lock et al., 2001).
Results indicated that 78% of participants (parents &adolescents) feel highly positive about family treatment.
Goal of therapy is to change patients’ thoughts or behavior to encourage them to eat in a healthier way. Families are seen as the necessary and most helpful tool for recovery. Family-based treatment (FBT) has been shown in randomized controlled trials to be more successful than individual therapy in most treatment trials, it focus on the whole family rather than on individual. The major goal of this therapy is to alter and improve the ongoing interactions among family members (Hockenbury&Hockenbury 2012).
Several components of family therapy for patients with AN are:
* the family is seen as a resource for the adolescent
* directives are provided to parents so that they may take charge of their child or adolescent’s eating routine
* a structured behavioral weight gain program is implemented
* after weight gain, control over eating is gradually returned to the child or adolescent
* as the child or adolescent begins to eat and gain weight, the therapeutic focus broadens to include family interaction problems, growth and autonomy issues and parent child conflicts.
Family interventions that directly address the eating disorder should be offered to children and adolescents. There are various forms of family-based treatment that have been proven to work in the treatment of adolescent AN including “conjoint family therapy” (CFT), in which the parents and child are seen together by the same therapist, “separated family therapy” (SFT) in which parents and child attend therapy separately with different therapists (Hartmann A. 2011).
Proponents of Family therapy for adolescents with AN assert that it is important to include parents in the adolescent’s treatment.
Cognitive behavioral therapy
Cognitive-behavioral therapy is used to treat the mental and emotional elements of an eating disorder. This type of therapy is done to change how you think and feel about food, eating, and body image. It is also done to help correct poor eating habits and prevent relapse.
Cognitive behavior therapy (CBT) is a type of psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence behaviors. Cognitive behavior therapy is generally short-term and focused on helping clients deal with a very specific problem.
During cognitive-behavioral therapy for eating disorders, patients learn:
* about their illness, its symptoms, and how to predict when symptoms will most likely recur.
* to keep a diary of eating episodes, binge eating, purging, and the events that may have triggered these episodes.
* to eat more regularly, with meals or snacks spaced no more than 3 or 4 hours apart.
* how to change the way they think about their symptoms. This reduces the power the symptoms have over them.
* how to change self-defeating thought patterns into patterns that are more helpful. This improves mood and their sense of mastery over theirs life. This helps them avoid future episodes.
* ways to handle daily problems differently
* how to identify and change destructive or disturbing thought patterns that have a negative influence on behavior.
The goal of cognitive behavior therapy is to teach patients that while they cannot control every aspect of the world around them, they can take control of how they interpret and deal with things in their environment (Bowers, WA, Andersen AE (1994).
Cognitive behavioral therapy (CBT) is an evidence-based approach, which in studies to date has shown to be useful in adolescents and adults with anorexia nervosa. The therapists use behavior modification, shaping, reinforcement, and modeling to teach problem solving and to change unhealthy behavior patterns. It is very effective treatment for children, adolescents, and adults, involves the use of mindfulness techniques which are meditation techniques, they target thoughts and behavior (Hockenbury&Hockenbury 2012).
Components of using CBT with adults and adolescents with anorexia nervosa have been outlined as:
* the therapist focuses on using cognitive restructuring to modify distorted beliefs and attitudes about the meaning of weight, shape and appearance
* specific behavioral techniques addressing the normalization of eating patterns and weight restorations, examples of this include the use of a food diary, meal plans, and weight gain
* cognitive techniques such as restructuring, problem solving, and identification and expression of affect
When using CBT with adolescents and children with AN, several professionals have expressed concerns about the minimum age and level of cognition necessary for implementing cognitive behavioral techniques. Modified versions and elements of CBT can be implemented with children and adolescents with AN. Such modifications may include the use of behavioral experiments to disconfirm distorted beliefs and absolutistic thinking in children and adolescents. Cognitive behavior therapy is often best-suited for clients who are comfortable with introspection. In order for CBT to be effective, the individual must be ready and willing to spend time and effort analyzing his or her thoughts and feelings. Such self-analysis can be difficult, but it is a great way to learn more about how internal states impact outward behavior. (Meads C, Gold L, Burls A (2001).
Cognitive behavior therapy is also well-suited for people looking for a short-term treatment option that does not necessarily involve pharmacological medication. One of the greatest benefits of cognitive-behavior therapy is that it helps clients develop coping skills that can be useful both now and in the future.
1. Journal article:
Family-Based Treatment for Adolescents With Anorexia Nervosa: A Dissemination Study.
Source: Eating Disorders. May/Jun2010, Vol. 18 Issue 3, p199-209. 11p. 4 Charts.
2. Journal article :
Is manualized family-based treatment for adolescent anorexia nervosa acceptable to patients? Patient satisfaction at the end of treatment
Source: Journal of Family Therapy. Feb2004, Vol. 26 Issue 1, p66-82. 17p.
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