Eating Disorders - Anorexia nervosa
Click here to see Allison discuss Anorexia Nervosa on TV3's Ireland AM |
At the bWell Clinic we have seen the ravaging affects of eating disorders on young women and men. We hope to offer a practical light at the end of a very difficult tunnel to people suffering from the various types of eating disorders.
Building the clients awareness of the destructive nature of the disease and re-forming the self-concept and self and body image that is constructive to leading a healthy physical, emotional and Psychological state of being.
Eating Disorders are a very serious and prevalent problem in our society today affecting both genders from as young as seven to late adulthood. The manifestation of eating disorders is an outward expression of an individual experiencing immense internal emotional and psychological pain and confusion. For the sufferer it may appear that food and the controlling behaviours are the main concern for the individual but the serious and sometimes fatal behaviours has lead anorexia nervosa to be rated as the highest form of death and suicide in mental health problems.
‘Anorexia is thought to have the highest mortality rate of any psychiatric disorder, with approximately 10% of those who are diagnosed with the disorder eventually dying due to related causes. The suicide rate of people with anorexia is also higher than that of the general population and is thought to be the major cause of death for those with the condition.’
Birmingham CL, Su J, Hlynsky JA, Goldner EM, Gao M. (2005) The mortality rate from anorexia nervosa. International Journal of Eating Disorders, 38 (2), 143-6. |
| |
| |
| Anorexia nervosa |
| |
| Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder characterized by low body weight and body image distortion with an obsessive fear of gaining weight. Individuals with anorexia often control body weight by voluntary starvation, purging, vomiting, excessive exercise, or other weight control measures, such as diet pills and or laxatives. It primarily affects adolescent females, however approximately 10% of people with the diagnosis are male and this is a growing and worrying trend. Anorexia nervosa is a complex condition, involving psychological, neurobiological, and sociological components. |
| |
| |
| Diagnosis and clinical features of Anorexia Nervosa |
| |
The most commonly used criteria for diagnosing anorexia nervosa are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
To be diagnosed as having anorexia nervosa, according to the DSM-IV-TR, a person must display: |
| |
| 1. | Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected). |
|
| 2. | Intense fear of gaining weight or becoming obese. |
|
| 3. | Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. |
|
| 4. | In women who have had their first menstrual period but have not yet gone through menopause (post-menarcheal, premenopausal females), the absence of at least three consecutive menstrual cycles (amenorrhea). |
|
| 5. | Or other eating related disorders. |
|
| |
| |
| Furthermore, the DSM-IV-TR specifies two subtypes: |
| |
Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge eating or purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas)
|
| |
| Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating OR purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas). |
| |
| |
| Physical |
| |
| Anorexia nervosa can put a serious strain on many of the body's organs and physiological resources particularly on the: |
| |
 | Structure and function of the heart and cardiovascular system. |
|
| Typically there can be a disturbed electrolyte balance |
|
| Particularly low levels of phosphate, which has been linked to heart failure, muscle weakness, immune dysfunction, and ultimately death. |
|
| Those who develop anorexia pre-adulthood may suffer stunted growth and subsequent low levels of essential hormones (including sex hormones) and chronically increased cortisol levels. |
|
| Osteoporosis can also develop as a result of anorexia in 38-50% of cases |
|
| Poor nutrition leads to the retarded growth of essential bone structure and low bone mineral density. |
|
| Anorexia does not harm everyone in the same way. For example, evidence suggests that the results of the disease in adolescents may differ from those in adults. |
|
| Changes in brain structure and function are early signs of the condition. |
|
| Enlargement of the ventricles of the brain is thought to be associated with starvation, and is partially reversed when normal weight is regained. |
|
| |
| |
| Other effects may include the following: |
| |
| Extreme weight loss |
|
| Body mass index less than 17.5 in adults, or 85% of expected weight in children |
|
| Stunted growth |
|
| Endocrine disorder, leading to cessation of periods in girls |
|
| Decreased libido; impotence in males |
|
| Starvation symptoms, such as reduced metabolism, slow heart rate (bradycardia), hypotension, hypothermia and anemia |
|
| Abnormalities of mineral and electrolyte levels in the body |
|
| Thinning of the hair |
|
| Growth of lanugo hair over the body |
|
| Constantly feeling "cold" |
|
| Zinc deficiency |
|
| Reduction in white blood cell count |
|
| Reduced immune system function |
|
| Pallid complexion and sunken eyes |
|
| Creaking joints and bones |
|
| Collection of fluid in ankles during the day and around eyes during the night |
|
| Tooth decay |
|
| Constipation |
|
| Dry skin |
|
| Dry or chapped lips |
|
| Poor circulation, resulting in common attacks of 'pins and needles' and purple extremities |
|
| In cases of extreme weight loss, there can be nerve deterioration, leading to difficulty in moving the feet |
|
| Headaches |
|
| Brittle fingernails |
|
| Bruising easily |
|
| |
| |
| Psychological |
| |
| Distorted body image |
|
| Poor insight |
|
| Self-evaluation largely, or even exclusively, in terms of their shape and weight |
|
| Pre-occupation or obsessive thoughts about food and weight |
|
| Perfectionism |
|
| Obsessive compulsive disorder (OCD) |
|
| Belief that control over food/body is synonymous with being in control of one's life |
|
| Refusal to accept that one's weight is dangerously low even when it could be deadly |
|
| Refusal to accept that one's weight is normal, or healthy |
|
| |
| |
| Emotional |
| |
| Low self-esteem and self-efficacy |
|
| Intense fear about becoming overweight |
|
| Clinical depression or chronically low mood |
|
| Mood swings |
|
| |
| |
| Interpersonal and social |
| |
| Withdrawal from previous friendships and other peer-relationships |
|
| Deterioration in relationships with the family |
|
| Denial of basic needs, such as food and sleep |
|
| |
| |
| Behavioral |
| |
| Excessive exercise, food restriction |
|
| Secretive about eating or exercise behavior |
|
| Fainting |
|
| Self-harm, substance abuse or suicide attempts |
|
| Very sensitive to references about body weight |
|
| Aggressive when forced to eat "forbidden" foods |
|
| |
| |
Some signs and Symptoms to be aware of:
Anorexia |
| |
| 1. | Dramatic weight loss in a relatively short period of time. |
|
| 2. | Wearing big or baggy clothes to hide body shape |
|
| 3. | Obsession with weight and complaining of weight problems |
|
| 4. | Obsession with calories and fat content of foods |
|
| 5. | Obsession with continuous exercise |
|
| 6. | Frequent trips to the bathroom immediately following meals |
|
| 7. | Visible food restriction and self-starvation. |
|
| 8. | Visible bingeing and/or purging. |
|
| 9. | Use or hiding use of diet pills, laxatives, or enemas. |
|
| 10. | Isolation Fear of eating around and with others. |
|
| 11. | Shifting the food around on the plate |
|
| 12. | Hiding food in strange places |
|
| 13. | Flushing uneaten food down the toilet |
|
| 14. | Vague or secretive eating patterns |
|
| 15. | Keeping a "food diary" or lists food and/or excercise |
|
| 16. | Pre-occupied thoughts of food, weight and cooking |
|
| 17. | Visiting websites that promote unhealthy ways to lose weight |
|
| 18. | Reading books about weight loss and eating disorders |
|
| 19. | Self-defeating statements after food consumption |
|
| 20. | Hair loss. Pale or "grey" appearance to the skin |
|
| 21. | Dizziness and headaches |
|
| 22. | Frequent soar throats and/or swollen glands. |
|
| 23. | Low self-esteem. Feeling worthless |
|
| 24. | Need for acceptance and approval from others |
|
| 25. | Complaints of often feeling cold |
|
|
| 27. | Loss of menstrual cycle |
|
| 28. | Constipation or incontinence |
|
| 29. | Bruised or calluses knuckles |
|
| 30. | Bloodshot or bleeding in the eyes |
|
| 31. | Light bruising under the eyes and on the cheeks |
|
| 32. | Perfectionist personality |
|
| 33. | Loss of sexual desire or promiscuous relations |
|
| 34. | Mood swings. Depression. Fatigue |
|
| 35. | Insomnia. Poor sleeping habits |
|
| |
| |
| What can you do? |
| |
| It is up to the individual who is experiencing an Eating Disorder to take responsibility for their behaviour. |
|
| As a carer you can support but the change must come from the individual with the eating disorder. |
|
| Compassion. |
|
| Listen. |
|
| Understand that the eating disorder is communicating the pain help the person articulate how they feel in a healthier way. |
|
| Get professional therapeutic help. |
|
| |
| Media Articles |
| |
| |
Click here to watch Week 7 - Anorexia Nervosa
|
| |
| |
 |
