Overview : Anorexia Nervosa

INTRODUCTION

MENTAL DISORDERS :

• Mental disorder is a group of emotional , cognitive and behavioral symptoms that causes distress or disability .

EATING DISORDERS :

• Eating disorders are characterized by a severe disturbance in eating behavior .
• Eating disorders make you obsessed with food and distort your perception about ideal body size .

TYPES OF EATING DISORDERS :

Within the DSM there are two types of adult eating disorders :

• Anorexia Nervosa
• Bulimia Nervosa

ANOREXIA NERVOSA

MEANING :

• The term ' Anorexia Nervosa ' literally means " lack of appetite induced by nervousness " . But the real problem is not the lack of appetite . At the heart of anorexia nervosa is an intense fear of gaining weight or becoming fat , combined with a refusal to maintain even a minimally low body weight .

HISTORY :

• Descriptions of extreme fasting or ascetic food refusal that were probably signs of anorexia nervosa can be found in the early religious literature .
• The first known medical account of anorexia nervosa was published in 1689 by Richard Morton . Morton described two patients , an 18 year old girl and a 16 year old boy , who suffered from a " Nervosa consumption " that caused wasting body tissue . The female patient eventually died because she refused treatment . The disorder did not receive its current name until 1873 , when Charles Lasegue in Paris and Sir William Gull in London independently described the clinical syndrome . In his last publication on the condition , gull described a 14 year old girl who began " without apparent cause , to evince a repugnance to food ; and soon afterwards declined to take any whatever , except half a cup of tea or coffee " after being prescribed to eat light food every few hours , the patient made a good recovery .

DSM - IV - TR :

• Refusal to maintain a body weight that is normal for the persons age and height .
• Intense fear of gaining weight or becoming fat , even though underweight .
• Distorted perception of body shape and size .
• Absence of at least three consecutive menstrual periods .

Although the DSM criteria for anorexia nervosa require that post - menarcheal females stop menstruating in order to be diagnosed with the disorder , some have questioned the value of this diagnostic criteria . Studies have suggested that women who continue to menstruate but meet all the other diagnostic criteria for anorexia nervosa are just as ill as those who have amenorrhea . For men the equivalent of the menstruation criteria is diminished sexual appetite and lowered testosterone levels .

GENERAL CHARACTERISTICS :

• Patients suffering from anorexia nervosa deny having any problem .
• Patients may be quite proud of their weight loss .
• Patients conceal their thinness by wearing baggy clothes or sometimes carry hidden bulky objects to make themselves look heavier than they are .
• If they are being weighted , patients with anorexia nervosa may drink large amount of water to increase their body weight temporarily .

DIFFERENCE ( Between Binge - Eating / Purging Type Of Anorexia Nervosa And Bulimia Nervosa ) :

• The clinical picture of the binge - eating / purging type of anorexia has much in common with bulimia nervosa . Indeed some researchers have argued that the bulimic type of anorexia nervosa should really be considered other form of bulimia .
• The difference between a person with bulimia nervosa and a person with the binge - eating / purging type of anorexia nervosa is weight . By definition , the person with anorexia nervosa is severely underweight . This is not true of the person with bulimia nervosa . Consequently , if a person who binges or purges also meets for anorexia nervosa , the diagnosis is anorexia nervosa and not bulimia nervosa .
• It is important to understand that people with anorexia nevosa and bulimia nervosa share a common and overwhelming fear of becoming fat . However , unlike patients with anorexia nervosa , bulimic patients are typically of normal weight . Sometimes they may even be sightly overweight . The fear of becoming fat helps explain the development of bulimia nervosa .

TYPES OF ANOREXIA NERVOSA :

There are two types of anorexia nervosa :

• The Restricting Type
• The Binge - Eating / Purging Type

THE RESTRICTING TYPE :

• In the restricting type , every effort is made to limit how much food is taken , and caloric intake is tightly controlled . Patients avoid eating in presence of other people . When they are at the table , they may eat excessively slowly , cut their food into very small pieces , and dispose of food secretly .

THE BINGE - EATING / PURGING TYPE :

• Patients with binge - eating / purging type of anorexia nervosa differ from patients with restricting type of anorexia nervosa because they either binge , purge , or binge and purge .
• A binge involves the out - of - control eating of amount of food that are far greater than what most people would eat in the same amount of time and under the same circumstances .
• Binge can be followed by the efforts to purge , or remove the eaten food from their bodies . Methods of purging can be self induced vomiting , use of laxatives etc . Purging strategies do not prevent the absorption of all calories from food .

CASE STUDY :

• John , a 10 year old boy , is referred by a pediatrician who asked far an emergency evaluation because of a serious weight loss during the past year for which the pediatrician could find no medical cause . John is extremely concerned about his weight and weighs himself daily . He complains that he is too fat , and if he does not lose weight , he cuts back on food . He has lost 12 kg in the past year and still feels that he is too fat , though it is clear that he is underweight . In desperation , his parents have removed the scales from the house , as the result , john is keeping a record of the calories that he eats daily . He spends a lot of time on this , checking and rechecking that he has done it just right .

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