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Anorexia Nervosa is a complex psychological disorder which affects the entire body including the reproductive tract.

What is Anorexia nervosa?
Anorexia Nervosa is a potentially life-threatening disorder in which a person does not take enough nutrition to maintain the minimum body weight necessary for a healthy body. The body weight is usually 15% or more below the normal weight for that age.

It is characterized by

  • Extreme dietary restrictions

  • An intense fear of gaining weight

  • A distorted body image.

People with this disorder may have an intense fear of weight gain, even when they are underweight. They may diet or exercise too much or use other ways to lose weight.

Food and weight gain becomes obsessions. Most people with anorexia nervosa develop strange eating habits. They like cooking large and elaborate meals for others which they themselves do not eat.

They refuse to eat in public and hide food when they do so. They cut their food into small particles and nibble at only a little of it while giving the impression of eating well.

Loss of weight is achieved mainly by eating only low calorie food like lettuce, spinach and popcorns and excessive exercising. The daily calorie intake may be less than 1000 calories.

Anorexia Nervosa
Anorexia Nervosa

This picture is that of a 40 year old woman whose only complaint was loss of periods for 1 year. She weighed only 30 kg. She looked alert and happy, insisting that she was eating normally and that her health was normal. She had to be admitted to the hospital when she had a fracture of the right femur which did not heal due to her severe ill-health and she died during treatment.

Persons especially at risk for developing Anorexia Nervosa:
It is commonly seen in young girls in their teens or in the early twenties. But it can affect men as well as older women.

  • Aspiring models
  • Film stars
  • Dancers,especially ballet dancers who need to keep a very slender figure.
  • TV personalities and athletes for whom being thin is an important necessity.
  • Young girls and boys, especially teenagers, who are under a lot of peer pressure to be thin, and who equate thinness with beauty, can also suffer from anorexia.
  • People having an anxiety disorder or eating problem during infancy or early childhood.
  • People with a negative self-image.
  • People who live in societies with certain social or cultural ideas about health and beauty

Causes of Anorexia Nervosa
The exact causes of anorexia are not known. Many factors may be involved. Genes and hormones may play a role. Social attitudes that promote very thin body types may also be involved. The cause is thought to be a mix of genetic, biochemical, psychological, and social factors.

Causes of Anorexia Nervosa
Causes of Anorexia Nervosa

  • Genetic - Studies suggest that anorexia may be partially inherited, as many people in the family have the same condition. Individuals with a first-degree relative that struggled with anorexia nervosa are more likely to develop it. Anorexia is also associated with certain genetic mutations that affect the metabolism of neurotransmitters (chemicals in the brain that help regulate mood and appetite).

  • Biological - Excessive dieting and staving can trigger anorexia nervosa. There is strong evidence that many of the symptoms of anorexia are actually symptoms of starvation. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite.

  • Psychological - Individuals with previous mental health diagnoses are more likely to develop eating disorders in general. Anorexia is commonly seen to co-occur with anxiety disorders as well as obsessive-compulsive disorders. Psychological traits such as perfectionism, low self-esteem, and difficulty expressing emotions can contribute to the development of anorexia.

  • Social - Social attitudes that promote very thin body types may be an important cause, especially in young girls who look up to models and film actresses as role models.
Types of Anorexia nervosa

There are two types of Anorexia Nervosa:

  • Restrictive type - In this type, there is restriction of food and the amountnof calories eaten. Low body weight is maintained by a very strict dietary regime and severe exercise.

  • Binging/Vomiting Type - In this type of Anorexia, the person eats adequately in front of other people, but immediately afterwards, vomits out the food before it can be digested. He/she may also misuse laxatives, diuretics or enemas to emove any digested food.

    Severity of Anorexia according to the BMI

    Body Mass Index (BMI) is commonly used to determine the severity of anorexia nervosa. But it is not the only criterion - other criteria such as behavioral, psychological and medical conditions should also be considered.

    The BMI or Body Mass Indicator indicates the weight status of an individual. It varies according to the severity of Anorexia nervosa:

  • Mild: BMI = 17 kg/ sq.m
  • Moderate: BMI 16-16.99 kg/sq.m
  • Severe: BMI 15-15.99 kg/sq.m
  • Extreme: BMI < 15 kg/sq.m
  • Symptoms of Anorexia Nervosa

    Anorexia Nervosa affects all the systems of the body, producing a number of symptoms.

    Symptoms of Anorexia Nervosa
    Symptoms of Anorexia Nervosa

  • Restricted eating.
  • Intense fear of gaining weight.
  • Distorted body image.
  • Sometimes purging and vomiting after every meal - a condition known as Bulimia.
  • Exercising to decrease weight.
  • Amenorrhea (loss of menstrual periods).
  • An innate belief that they are healthy.
  • Use of laxatives or diuretics to lose weight.
  • Sometimes the person may suffer from psychological conditions like depression, obsessive compulsive disorder or schizophrenia.
  • The person suffering from anorexia nervosa may complain of feeling cold due to a decrease in the core body temperature.
  • They may develop fine hair known as Lanugo all over the body. This hair, similar to that of a newborn, is an attempt by the body to conserve heat.
  • Nails and hair may become thin and brittle and the skin may become yellow and dry due to lack of nourishment.
  • The patient usually looks happy and alert, insisting that she has no problem other than lack of periods, and that she is eating normally.
  • Examination reveals an extremely thin and emaciated body. The skeletal frame juts out from under a thin sagging skin. Periods do not occur as the entire genital tract is atrophic with dormant ovaries.
  • The levels of circulating hormones in the blood are found to be abnormal. The levels of neurotransmitters like serotonin and norepinephrine, which are associated with feelings of happiness and satisfaction, are decreased in those with anorexia. Low levels of these chemicals are assoicated with depression.
  • People with Anorexia nervosa have high levels of hormones associated with stress like vasopressin.

    Complications of Anorexia Nervosa

    The severe lack of nutrition and calories causes a number of medical problems.

  • Low pulse and blood pressure.
  • Irregular heart beat and palpitations.
  • Osteoporosis due to low calcium intake. Fractures of bones are a common presentation.
  • Amenorrhea
  • Anemia
  • In severe cases, the person may starve himself or herself to death.

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    Treatment of Anorexia Nervosa

    Treatment of anorexia nervosa is very difficult. The main goals of treatment are (1) regain a healthy weight,(2) improve mental health and (3)reduce or eliminate symptoms of the disorder. The aim should be a weight gain of at least 1 to 3 pounds per week

    Fortunately, much of the medical complications like amenorrhea and heart palpitations revert back to normal with an improvement in the body weight.

    Treatment of anorexia nervosa usually involves a combination of approaches tailored to individual needs. Below are some common treatment options for anorexia nervosa.

    • Psychotherapy: This is often the first line of treatment for anorexia nervosa. Different types of psychotherapy can be used, such as Cognitive-behavioral therapy (CBT), DBT, and Family-Based therapy to help change negative thoughts and behaviours. Family based therapy is essential as it involves family members in the treatment process and has been shown to be more successful than individual therapy.

    • Medical Treatment: People with anorexia nervosa often require medical treatment to manage the physical complications of the condition. This may include refeeding or force feeding and monitoring of vital signs. Treatment of underlying medical conditions are also needed. Recent studies has shown medical marijuana can help stimulate appetite and decrease depression in these individuals.

      Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) may be prescribed to relieve symptoms of depression, anxiety and obsessive-compulsive disorder associated with anorexia nervosa.

    • Nutrition Advice: Diet is the most essential factor to work on in people with anorexia nervosa, and must be tailored to each person's needs. A dietician or nutritionist can work with patients to develop a healthy eating plan with foods that are higher in energy density and educate the family about nutritional needs.

    • Hospitalization: In some cases, people with anorexia nervosa require hospitalization to treat serious medical complications and ensure adequate nutrition. It is important to note that recovery from anorexia nervosa is a lengthy process, often involving multiple stages and relapses.
    The best approach to treatment is a multidisciplinary, team-based approach, which includes doctors, mental health professionals and dietitians, all with experience in eating disorders. Ongoing therapy and nutrition education are highly important to continued recovery.

    If anorexia nervosa is not treated, serious complications such as heart conditions and kidney failure can arise and eventually lead to death. The average number of years from onset to remission of Anorexia Nervosa is seven for women and three for men.

    Can anorexia nervosa be prevented?
    Preventing the development of anorexia nervosa can be difficult because the exact cause of the disorder is not fully understood. However, there are some steps that can be taken to reduce the risk of developing anorexia nervosa and to catch the disorder early when it is more treatable.

  • Early detection and intervention: Parents, teachers, and other adults who work with adolescents should be aware of the signs and symptoms of anorexia nervosa and that their child or teenager may be developing the disorder. Help should be given as soon as possible.

  • Coping with social and cultural pressures: One of the social and cultural factors that contribute to the development of anorexia is the unrealistic body image promoted in the media and the fashion world. Educating people, especially young people, about the dangers of these unrealistic images and encouraging body diversity and self-acceptance can help prevent the development of anorexia nervosa.

  • Promoting body image and self-esteem: Parents, teachers, and other role models can play an important role in helping young people develop healthy body image and self-esteem by being good role models themselves and encouraging self-confidence and self-acceptance.

  • Addressing maladaptive coping mechanisms: Childhood traumas and maladaptive developmental experiences should be addressed early on in life.

    Anorexia Nervosa is a complex psychological and behavioural disorder which needs empathy and understanding from family and medical practitioners. It is important to remember that it is treatable. An individual can struggle yet receive appropriate treatment and live a life free from food rules, dieting, and restrictions.

    Anorexia nervosa has the highest mortality rate of any psychological disorder. The mortality rate is 11 to 12 times greater than in the general population, and the suicide risk is 56 times higher. The mortality rate or the rate of death of Anorexia nervosa is quite high at 7 - 10%.

    Half of women with AN achieve a full recovery, while an additional 20-30% may partially recover. Not all people with anorexia recover completely: about 20% develop anorexia nervosa as a chronic disorder.

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