Anorexia nervosa is an eating disorder that involves aggressive control of food intake in order to have a low body weight. Personal control of food consumption generally involves a combination of strict dieting, vomiting and extreme conditions of physical exercising. This eating disorder is caused by the psychological condition of anxiety with regards to one’s weight and body shape, which in turn, is derived from an extreme concern over gaining weight or from desperately wanting to be thin. Anorexia nervosa is also considered a psychological illness because the patients generally perceive themselves differently, and often at an exact opposite as to what other people see. Individuals with anorexia nervosa consider their loss of weight as a good indicator for a gain in self-confidence and self-respect (Sullivan, 1995). Their total control over weight gain provides them a sense of power over their lives.
PATHOPHYSIOLOGY OF ANOREXIA NERVOSA
Anorexia nervosa is a life-threatening medical condition because it may cause grave physical problems that are related to self-starvation (Hsu, 1996). Prolonged malnourishment may lead of severe loss of muscle and bones tissues, resulting in a massive decline in bodily strength. This eating disorder is often observed among females, both young and adult. Aside from loss of bone and muscle mass, females with anorexia nervosa usually miss their monthly menstruation, also as a result of the self-inflicted undernourishment. In cases wherein males are diagnosed with anorexia nervosa, these individuals commonly loss interest in sexual acts, or find themselves impotent. This eating disorder not only affects the individual himself, but also affects his relationship with his family and friends because patients often find it easier to withdraw from social interactions. The degree of severity of this psychological-physical illness if generally left unnoticed, resulting in a significant number of individuals with anorexia nervosa left undiagnosed (Zerbe, 1995).
This eating disorder may also affect children and young adults, presenting with the same characteristics in the psychological angle. However, these younger individuals might show an additional characteristic, which is being physically smaller than other individuals of the same age (Lock and LeGrange, 2005). Younger individuals with anorexia nervosa have also been observed to physiologically develop at a slow pace.
Anorexia nervosa generally affects not only the individual who controls his eating behavior, but also those individuals that are directly interacting with the affected individual. Healthcare practitioners have acting suggested that the concerned family member should seek help and support from related healthcare facilities or support groups. These groups may provide information that will help the family in understanding what is causing this eating disorder (LeGrange et al., 2005). These groups may also give methods on how to cope with such psychological illness. The most important action that must be initiated is for the family members to help the affected individual to accept the fact that he has an eating disorder. These members of the family should also know that they play a major role in facilitating the recovery of the patient (Lock et al., 2005).
Anorexia nervosa is recognized in two forms- the restricting type and the binge-eating/purging types (APA, 1994). The restricting type of anorexia nervosa involves the absolute inhibition of food consumption and does not accompany any purging or binge-eating actions. The binge-eating type of anorexia nervosa is commonly characterized by cycles of binge-eating and purging. The classic symptom of anorexia nervosa is subjecting one’s self to a starvation condition, with the main goal of preventing or avoiding gaining weight or sensing that any fat is deposited in the body. The psychological angle with anorexia nervosa is that the individual perceives himself as overweight yet actually, their weight is already below normal. The extreme condition of anorexia nervosa usually involves death due to severe malnutrition.
Anorexia nervosa involves self-limitation of food intake, resulting in an induced starvation, which directly denies the body of nutrients that are essential to the normal physiology of the body. This self-starvation causes a slowing down of most of the bodily processes, resulting in a conservation of energy. Such decrease in physiological processes is closely associated with slower heart rate, lower blood pressure, osteoporosis, muscle loss, extreme dehydration and hair loss. The muscle loss is strongly correlated with patient weakness and fatigue.
The family physician and any other healthcare professionals play a key role in helping the individual with anorexia nervosa to recognize that he is suffering from this eating disorder. Once the individual recognizes and accepts this psychological condition, treatment and care should be given to the patient. There are also numerous specialist clinics that provide treatment programs for individuals with eating disorders. A supportive and compassionate group of individuals will be helpful to a patient with anorexia nervosa, because most of the cases of this eating disorder involve psychological issues such as not being understood well by family and friends (Lock et al., 2001). There are some patients that can not accept the option of seeking consult with healthcare professionals and this may result in a significant worsening of the physical and mental well-being of the patient. There are also self-help support groups that can assist a patient in coping and solving this eating disorder. It is important that the patient be given sufficient information about anorexia nervosa and its associated treatment prior to subjecting one’s self to treatment.
Individuals with anorexia nervosa are often apprehensive about the active participation of family members because they will mean that these individuals may have access to any personal and confidential information about the patient. Such thought disturbed the peace of mind of the patient and they often feel that they have lost their privacy. Hence, there is a significant portion of individuals with anorexia nervosa that opt to take themselves to a healthcare professional for medical consultation and follow-ups because they are aware the medical professionals follow strict confidentiality rules with regards to their patient’s medical information. However, the patient should also know that any confidentiality clauses may be broken if the patient is found to be situated in a highly risky medical condition, hence the immediate family members should know of this particular situation, as well as what’s is causing this eating disorder (LeGrange and Lock, 2005).
The family physician is often the first individual that can clinically ascertain if someone has anorexia nervosa. The initial reaction of the patient upon diagnosis is generally very complicated, because the patient often denies that he has an eating disorder. There are several major symptoms that facilitate a physician to suspect when an individual suffers from anorexia nervosa. One major symptom is the significantly poor or low weight of the individual, in relation to the individual’s age and sex. Another sign strongly associated with anorexia nervosa is the extreme concern of the individual about his weight. In the case of females, anorexia nervosa may also result in physiological problems with the menstrual cycle. It is also essential that the physician conducts some blood tests to determine any other factors that may be causing such drastic and significant weight loss in the patient.
Individuals with eating disorders commonly find it hard and shameful to confess that they have an eating disorder. These people also feel that it is dishonorable to consult a healthcare professional for any health about this problem, because they will feel that they have lost control over their lives. These individuals also carry the fear of being criticized by the healthcare professional because they do not want to receive any unsolicited remarks from any other person. Some others may have received anecdotal stories about poor treatment of patients in a certain healthcare facility and they tend to generalize such story that all health clinics poorly treat patients with eating disorders. However, these patients should know that specialized clinics for eating disorders have been professionally trained to understand and be responsive to such psychological cases, that their fear of being mistreated should be taken away.
TREATMENT AND INTERVENTION
Patients diagnosed with anorexia nervosa are generally subjected to psychological treatment that consists of a sequence of meetings with a healthcare professional, as well as with a group of patients also having the same illness. In some cases, the meetings involve the patient and the members of his immediate family. There are currently several types of psychological treatments designed for patients diagnosed with anorexia nervosa.
Patients diagnosed with anorexia nervosa may also be treated with pharmaceutical drugs. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are generally prescribed to patients with anorexia nervosa (Meyer and Quenzer, 2004). Antidepressant drugs are the core for the treatment of depression, usually given together with supportive psychotherapy. However, evidence is accumulating that the combination of antidepressant treatment and some form of psychotherapy may be far better to either treatment alone, especially for more severe and recurrent depression. Over the past decade, tricyclic antidepressants such as imipramine or desipramine have been replaced by SSRI antidepressants as immediate medications, generally because of these are more tolerable and safer than the older drugs. Several theories have been proposed to explain the 6-week time lag for the onset of therapeutic effect of antidepressants on a patient. It is interesting to note the adverse effects appear first before the actual effects of the drugs are observed in a patient. The adverse effects generally arise as early synaptic effects of antidepressants, and the therapeutic effects gradually develop adaptive mechanisms such as desensitization and down-regulation of certain receptors.
Another psychoactive drug being used is monoamine oxidase inhibitor (MAO). MAO has been effective as anti-depressant, yet have been avoided because of the hypertensive side effects especially to those with tyramine diets (Pickel et al., 1977). MAOs have been effective in treating avoidance and reexperiencing symptoms however ineffective in hyperarousal situations. Anti-adrenergic agents are effective in pharmacotherapy since they are effective in lessening nightmares, hypervigilance and startled reactions to stimuli. One thing to consider in the use of this drug is the blood pressure of a patient because it has some side-effects in hypertension just like MAOs.
Mood stabilizers and anti-convulsants are becoming widely used in treating anorexia that is related to depression. Based on clinical studies, most patients responded well to the depression scale after taking this course of treatment. It was observed that these mood stabilizers and anti-convulsants such as Lamotrigine, treats the numbing sensations of patients and also their hyper-arousal and experiencing of nightmares.
Cognitive analytic therapy involves a psychotherapist interacting with the patient, in order to guide him a identifying and implementing positive modifications in his lifestyle. Such approach generally reassesses the patient’s current personal condition and attempts to rebuild the patient’s life through self-evaluation and self-assessment (Russell et al., 1987). This type of treatment results in the acknowledgment that there are some issues in the patient’s life that have stopped him from transforming events in the past, as well as augment the ways where the patient could manage personal problems. Cognitive analytic therapy is considered as an analytic approach because it involves exploration of unconscious impulses of the patient.
Cognitive behaviour therapy is a type of psychotherapy that is intended to assist the patient in creating connections between their thoughts, emotion and actions and their present or previous psychological symptoms. This therapy also involves a re-evalutation of personal perceptions, beliefs and reasoning regarding the patient’s symptoms. The therapy involves a combination of examination thoughts, feeling and behaviour as related to the eating disorder, being guided to employ several ways of coping with the illness-related symptoms and methods in reducing stress. Another type of psychological treatment is interpersonal psychotherapy, which is designed to guide patients in determining and addressing their present problems with personal interactions (Eisler et al., 1997). This treatment was initially aimed for the therapeutic interventions of patients diagnosed with depression, and now has been adapted for patients diagnosed with anorexia nervosa and bulimia nervosa. This treatment does not focus on changing the eating rituals of the patient, but instead, the treatment is based on the improvement of the patient’s social functioning. It is understood that once this personal area has been addressed and improved, the eating habits of the patient will subsequently improve.
Focal psychodynamic therapy is another psychological treatment that focuses on the main problem or difficulty that affects the patient. The impact of this problem is also included in the assessment. Family therapy is another psychological treatment regimen that involves meetings with the healthcare practitioner, as well as the immediate family of
the patient (Eisler et al., 2000). This type of treatment is routinely employed when the patient involved is a child or adolescent. The eating disorder is discussed during these sessions, as well as how such eating disorder affects the relationships within the patient’s family (LeGrange et al., 1992). The healthcare practitioner commonly encourages that the parents of the patient to take a major role behind the patient’s effort to return to a normal eating behaviour.
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