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Anorexia
Introduction:
Anorexia or anorexia nervosa is an eating disorder causes people to obsess about their weight and the food they eat characterized by markedly reduced appetite or total aversion to food. It's a serious psychological disorder,a condition that goes well beyond out-of-control dieting It's much more common in females than males. People with anorexia nervosa: 1. attempt to maintain a weight that's far below normal for their age and height (at least 15 per cent below what is expected for a person's age, sex and height) 2. It is self-induced weight loss caused by avoiding fattening foods and may involve taking excessive exercise, using laxatives or diuretics or enemas or self-induced vomiting or overuse of diet pills to induce loss of appetite often to a point close to starvation .

CAUSES:
There is no single cause for anorexia. Most experts have argued that the condition is caused by a combination of psychological, environmental and biological factors, which lead to a destructive cycle of behaviour.

Psychological factors:
Psychological characteristics that can make a person more likely to develop anorexia nervosa include:

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.* Low self-esteem

Feelings of ineffectiveness . a tendency towards depression and anxiety. excessive worrying and feeling scared or doubtful about the future inhibition where a person restrains or controls their behaviour and expression feelings of obsession and compulsion , an obsession is an unwanted thought, image or urge that repeatedly enters a persons mind. A compulsion is a repetitive behaviour or mental act that a person feels compelled to perform.

They may have an extreme drive for perfectionism , which means they may never think they're thin enough. Avoidance of conflict with others.

Environmental factors:
Most cases of anorexia develop during puberty , It may be that the combination of the hormonal changes during puberty and feelings of stress, anxiety and low self-esteem could trigger anorexia. Another important environmental factor is Western culture and society where wide range of different media which constantly reinforce the message that being thin is the only way to be beautiful, and that thinness should be pursued at all costs. a stressful life event, such as losing a job or a relationship pressures and stress at school, such as exams or bullying difficult family relationships physical or sexual abuse participation in an activity that demands slenderness ,such as ballet, gymnastics, or modeling. It also includes having parents who are overly controlling, put a lot of emphasis on looks, diet themselves, or criticize their childrens bodies and appearance

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Biological factors:
A genetic predisposition may be partially responsible for the development of anorexia. The genetic variant in serotonin receptors found in anorexics may predispose them to high levels of serotonin. At high levels, serotonin leads to anxiety. Serotonin levels decrease without access to food, so the selfstarvation associated with anorexia will leave the person feeling calmer and depression may set in. Once the person eats again, serotonin levels rise again, The increase in serotonin may retrigger anxiety symptoms.Over time, the anorexic subconsciously learns to avoid anxiety by avoiding food thereby maintaining low serotonin levels.

Signs and Symptoms:

Physical symptoms of anorexia:
Physical signs and symptoms of anorexia include:

Extreme weight loss Thin appearance Fatigue Abnormal blood counts Insomnia Dizziness or fainting A bluish discoloration of the fingers Brittle nails Hair that thins, breaks or falls out Absence of menstruation for women and girls. Constipation

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Irregular heart rhythms Low blood pressure Dehydration Osteoporosis Swelling of arms or legs Feeling cold, with a lower-than-normal body temperature.

Emotional and behavioral anorexia symptoms:

Emotional and behavioral characteristics associated with anorexia include: Refusal to eat Denial of hunger Excessive/ unhealthy exercise lack of emotion Social withdrawal Irritability Reduced interest in sex Self-harm ("cutting" or even suicide attempts). Using herbal products,diet pills, laxatives, or diuretics Throwing up after eating Obsession with calories, fat grams, and nutrition Body image distortion and excessive reliance on weight or shape for self-esteem Denial that youre too thin. Low self opinion/low self-esteem Exhibiting symptoms of depression Strange or secretive food rituals Refusing to eat around others or in public places. Eating in rigid, ritualistic ways (e.g. cutting food just so, chewing food and spitting it out,

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using a specific plate). Irrational (morbid) fear of fatness coupled with an intense drive for thinness.

Diagnosis:

Physical exams: This may include

1. Measuring your height and weight; 2. Calculate your body mass index (BMI). A normal BMI for adults is 20-25. People with anorexia generally have a BMI below 17.5. 3. Checking the vital signs, such as heart rate, blood pressure and temperature. 4. Checking the skin and nails for dryness or other problems.

Laboratory tests:.
1. Complete blood count (CBC), 2. More specialized blood tests to check electrolytes and protein as well as functioning of your liver, kidney and thyroid. 3. Urinalysis.

Psychological evaluation: A doctor or mental health provider can assess thoughts,

feelings and eating habits. Psychological self-assessments and questionnaires also are used.

Other studies:.
1. X-rays may be taken to check for broken bones, pneumonia or heart problems. 2. Electrocardiograms may be done to look for heart irregularities. 3. Bone density testing may be done to check your bone health. 4. Testing may also be done to determine how much energy your body uses, which can help in planning nutritional requirements.

Treatment:
Treatment for anorexia nervosa tries to address three main areas. 1) Restoring the person to a healthy weight; 2) Treating the psychological disorders related to the illness;

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3) Reducing or eliminating behaviours or thoughts that originally led to the disordered eating

Dietary:
Zinc :is beneficial in the treatment of anorexia even in patients not suffering from zinc deficiency, by helping to increase weight gain. Essential fatty acids:The omega-3 fatty acids docosahexaenoic acid and eicosapentaenoic acid have been shown to benefit various neuropsychiatric disorders of anorexia. Nutrition counseling

Medical Nutrition Therapy;

The first goal of treatment is getting back to a healthy weight and learning proper nutrition. A dietitian can offer guidance on a healthy diet, including providing specific meal plans and calorie requirements that will help you meet your weight goals.

also referred to as Nutrition Therapy is the development and provision of a nutritional treatment or therapy based on a detailed assessment of a person's medical history, psychosocial history, physical examination, and dietary history.

Medications:
There are no medications specifically designed to treat anorexia because they've shown limited benefit in treating this eating disorder. However, antidepressants, antipsychotics, and mood stabilizers may help some anorexic patients when given as part of a complete treatment program.

Antipsychotic Drugs:
Research supports their efficacy in inducing weight gain and helping lessen the frequency and intensity of intrusive anorexic thoughts. Weight restoration is undoubtedly a critical aspect of recovery, yet it is also, for many patients, the most difficult. During this weight restoration process, severe psychological distress and anxiety are not uncommon, as the often individual feels that she is losing control. Current research literature suggests that atypical antipsychotics, particularly olanzapine, can be effective in reducing agitation and distress obsessionality, including obsessional thoughts about food during this time. Olanzapine

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Antidepressants drugs:
Selective serotonin reuptake inhibitors -- These antidepressants are sometimes prescribed for people with anorexia. Fluoxetine has been studied in people with anorexia and depression, with mixed results. In some early studies, it appeared to increase weight and improve mood over several months. But in another, it helped relieve symptoms of depression, but did not affect the anorexia itself. Fluoxetine Depreban 20 mg caps Flutin 20 mg caps Prozac 20 mg caps

Recent studies indicate that the use of Prozac and other antidepressants may cause children and teenagers to have suicidal thoughts. Children who are taking these drugs must be monitored very carefully for signs of potential suicidal behavior.

Psychotherapy;
Individual, family-based and group therapy may all be beneficial.

Individual therapy:.

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.* This type of therapy can help you deal with the behavior and thoughts that contribute to

anorexia.
to identify the feelings and fears that caused you to stop eating, and develop a healthier attitude towards food and your body.

You can gain a healthier self-esteem and learn positive ways to cope with distress and other strong feelings.

A type of talk therapy called cognitive behavioral therapy (CBT) is commonly used
improve neurocognitive abilities such as attention, working memory, cognitive flexibility and planning, and executive functioning

A mental health provider can help assess the need for psychiatric hospitalization or day treatment programs.

Family-based therapy.:

Family therapy helps a person with anorexia see and understand the often-times dysfunctional role they play within the family

Family therapy is usually conducted with the person who has anorexia and their family. However, in some instances, a few family therapy sessions may involve therapy without the person who has anorexia present.

This may help the family understand the roles they are playing in supporting the disordered eating, and suggest ways the family can help the person with anorexia acknowledge the problem and seek out treatment.

Group therapy.:

This type of therapy gives you a way to connect to others facing eating disorders. careful with informal groups that aren't led by a mental health professional. For some people with anorexia, support groups might result in competitions to be the thinnest person there.

Hospitalization:

In cases of medical complications, psychiatric emergencies, severe malnutrition

(this person may need to be fed through a vein or stomach tube) or continued refusal to eat,distressed that you no longer want to live, hospitalization may be needed.

Hospitalization may be on a medical or psychiatric ward.

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.* Some clinics specialize in treating people with eating disorders. Some may offer day programs or residential programs, rather than full hospitalization. Specialized eating disorder programs may offer more intensive treatment over longer periods of time. Also, even after hospitalization ends, ongoing therapy and nutrition education are highly important to continued recovery.

Complications of anorexia:

Heart diseaseThe heart may develop dangerous rhythms, blood flow is reduced, blood pressure may drop and cholesterol levels tend to rise.

Electrolyte imbalanceThe dehydration and starvation of anorexia can reduce fluid and mineral levels, which can be life-threatening unless fluids and minerals are replaced.

Reproductive and hormonal abnormalitiesAnorexia causes low levels of reproductive hormones, changes in thyroid hormones, increased levels of the stress hormones and longterm irregular or absent menstruation, which may cause sterility and bone loss.

Blood problemsAnemia, pernicious anemia caused by severely low levels of vitamin B12. Neurological problemsAnorexics may suffer nerve damage and experience seizures, disordered thinking, loss of feeling and other nerve problems in the hands or feet.

Gastrointestinal problems: constipation Risk of death from starvation or suicide

References:
1. 2. 3. 4. 5. 6. 7. http://www.umm.edu/altmed/articles/anorexia-nervosa. http://www.nami.org/template http://www.nhs.uk/Conditions/Anorexia-nervosa http://www.mayoclinic.com/health/anorexia/ http://www.medicinenet.com/anorexia_nervosa/article. http://www.webmd.com/mental-health/anorexia-nervosa http://www.eatingdisordertreatment.com/about-eating-disorders/anorexia-nervosa-informationsymptoms-and-treament-of-anorexia 8. http://www.netdoctor.co.uk/

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*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

9. http://www.womenshealth.gov/ 10. http://www.helpguide.org/ 11. http://en.wikipedia.org/ 12. http://www.bupa.co.uk/individuals/health-information/directory/a/anorexia

Made by:Fatma Mounir Ahmed