(Author)
Abstract
Anorexia nervosa is a psychological disorder in which the patient has somatic delusions resulting in their perception of distorted body image and being overweight. They start reducing their weight through restricting their diet and vomiting of meals, which are known as restricting type and bingeing/purging type of anorexia, respectively. Anorexia nervosa is different from healthy dieting in that a person on healthy diet loses weight in a healthy way, but an anorexic person can do anything to lose weight without considering his or her health. Anorexia can result in lack of energy and can change brain chemistry. Several social and genetic factors are involved in its development. It can be treated with the combined help of physicians, nutritionists, and psychologists. This paper deals with some important aspects of anorexia nervosa.
Introduction
Anorexia is a serious kind of disorder that is caused by the loss of appetite. In this case, the patient has the desire to lose weight. It can affect the men and women of any age, and can even pose the risk to life. Anorexia nervosa is a psychological disorder in which the patient may have somatic delusions (Hollander, Zohar, Sirovatka, & Regier, 2010) that he or she is too fat despite being emaciated. Anorexia nervosa can affect different aspects of life, and it can be treated with proper consideration.
In anorexia nervosa, there are three main characteristics:
- Denial to regulate a healthy weight of the body,
- Extensive feelings of increase in weight, and
- Disturbed image of the body.
Types of Anorexia
There are two types of anorexia; restricting type and bingeing/purging type (Siegfried et al., 2004). In the restricting type of anorexia, restriction of calories is the objective of the person to lose weight. This restriction of calories can be done with the help of diets, exercise, and fasting. On the other hand, purging type of anorexia involves vomiting or the use of diuretics and laxatives.
Psychology of anorexia
Although, anorexia is related to weight and food, it has some other problems at its core as, for example, patient may have depression, feelings of insecurity, loneliness, and/or pressure of becoming perfect. These things cannot actually be cured with any weight loss or dieting. A person may feel powerless, but control of diet may cause him to think that he or she has power to control his food. People may also feel that being hungry is a special talent that is usually not present in many people. They may also start dieting as a way of distracting themselves from difficult to control emotions, i.e. dieting may cause them to think about food, taking their thoughts away from problems in the life. However, any solution that a person may get from dieting or losing weight is short-lived, and the person may become anorexic with time. That’s why; anorexia needs special attention and cure in the form of satisfaction of emotional or psychological needs and not in the form of dieting or weight loss.
Causes and risk factors of anorexia
Anorexia is a complicated condition that arises as a result of combination of many different emotional, biological, and social factors. Culture’s appreciation of thinness is one of the most important causes of anorexia. Moreover, emotional difficulties, family environment, traumatic experiences of life, and low self-esteem are also considered as important causes of anorexia. Usually, people who feel helpless or worthless from the inside have more chances of developing anorexia. Family and social pressures of taking part in activities that require slenderness such as modeling can also result in anorexia. Stressful life events such as going away to school can be one of the causes of anorexia. Anorexia can also have genetic predisposition and may run in families. Higher levels of cortisol, a hormone related to stress, in the brain, and decreased levels of serotonin and norepinephrine, which are related to the feelings of well-being, are also among the causes of anorexia.
Signs and symptoms that are related to anorexia
Anorexic patient has the habit of constantly hiding his or her habits that is why it becomes difficult for the family and friends to spot the problem. With the development of anorexia, patient may start thinking about the weight and appearance as fear of gaining weight is one of the most important symptoms of anorexia.
Patients of anorexia may start controlling or restricting their food in the form of dieting. He or she may restrict food to only low-calorie foods, and may consider some foods, such as foods containing carbohydrates and fats, bad for health. In anorexia, patients may start giving extra consideration to food labels. They may keep a food diary and start reading the books on dieting. They may start lying about eating or they may pretend that they have eaten sufficient amount of food. They may think about food and cooking for others, but they eat very little. They may also start some strange and secretive food rituals such as the use of specific plate or taking some foods in a specific manner.
Medically and physically, there are some signs and symptoms that can be seen in the patients of anorexia as, for example, there could be a rapid and huge weight loss without any obvious medical problem. In anorexia, a person may start thinking of becoming overweight in spite of being in the underweight category. He or she may also feel too much fat in certain parts of the body such as hips, stomach, or thighs. Constant thinking and showing obsession about the weight and shape of the body, or size of clothes could also be a problem in anorexia. Patients may keep on weighing and may have concerns in case of even tiny fluctuations in the body weight. They may spend a lot of time in front of mirror and constantly find some problems in their bodies as, for example, they may always think that they are not sufficiently thin.
Patients of anorexia may also start using pills for reducing weight, appetite suppressants, laxatives, or diuretics. They may also vomit their food in bathrooms after eating meals and/or come with some form of mouthwash or smell of mints. Extensive level of exercise is also a major problem in the patients of anorexia. They may keep on exercising even in case of illness, injuries, or bad weather.
Effects of anorexia
Anorexia is related to severe calorie restriction that comes with serious types of physical and mental effects. Due to the absence of proper number of calories, body starts moving towards starvation in order to conserve energy. In this state, body may start using the remaining energy in the body. If the process of reduction in calories continues, more body fat would be consumed resulting in medical complications leading to harmful effects on the body and mind.
Effects on body
Some of the effects of anorexia on the body are as follows:
- Weakness and absence of energy,
- Low blood pressure, reduced heart rate, palpitations, and heart failure,
- Bloated feelings and constipation,
- Damage to the gums and tooth decay,
- Headaches,
- Dry and yellow coloration of skin due to the problem of anemia and other blood related disorders. Skin can easily be bruised,
- Brittle nails,
- Muscles become weak and joints become swollen that may result in fractures and osteoporosis,
- Stones may develop in the kidney and failure of kidney can also occur,
- Low levels of potassium, sodium, and magnesium in the body,
- Growth of fine hair all over the body and face. Moreover, hair may become thin and brittle,
- Development of emphysema-like conditions (Coxson et al., 2004),
- Troubles in pregnancy.
Effects on mind
Some of the effects of anorexia on the mind are as follows:
- Obsessive or pre-occupied thoughts about weight and food,
- Alterations in the brain chemistry,
- Serious forms of mood swings, clinical depression, sadness, and irritability,
- Aggression, when forced to eat certain types of food,
- Slowed or reduced thinking abilities,
- Poor form of memory,
- Fainting and dizziness,
- Substance abuse.
These effects may result in withdrawal of interpersonal relationships in order to achieve social isolation. The patient may also move away from relatives as they continuously warn the patient about the problem. It has also been found that nearly 40% of people with anorexia nervosa may develop the problem of bulimia nervosa, i.e. a disorder of eating with alternative periods of excessive eating and fasting or self-induced vomiting of food.
Therapeutic strategies for anorexia
One of the topmost treatment goals in almost all sessions of therapy is to remove the fear of gaining weight and distorted body image. Anorexia nervosa is one of the most important life threatening problems involving a lengthy course of treatment (d’Agincourt-Canning, Kunkel, & Dixon, 2014). Usually, therapeutic strategies for anorexia involve both mind and body. Patients of anorexia may have to visit physicians, psychologists, dieticians, and counselors. Moreover, support of family and friends can give a huge amount of help to the patients of anorexia. Researchers have found that family-based treatment is very efficient for younger patients (Starr & Kreipe, 2014).
Commonly, anorexia treatment involves three steps:
- Achieving the normal and healthy weight,
- Beginning to eat proper amount of food, i.e. required amount of food,
- Change of perception about the body and food.
Medical treatment for anorexia starts with proper inspection of any kind of serious health issues. In case of high levels of stress, malnourishment or weight problem, hospitalization is required.
Nutritional treatment of anorexia can be done with the help of a nutritionist or dietician. They can guide the patient about healthy eating and appropriate level of nutrition (Ekvall & Ekvall, 2005). They can also help in the development of meal plans and following them. Meal plans may include the use of sufficient amount of calories to achieve or regulate a normal and healthy weight of the body.
Counseling and providing support for anorexia can also be considered as one of the important therapeutic strategies. In counseling, basic aim is to find the negative thoughts and feelings that are resulting in some form of eating disorder, and replace those feelings with less distorted or healthier thoughts or beliefs. Counseling also helps in dealing with difficult emotions, stress, and relationship problems in a more productive way. It has to be considered that the more the counselors know the problem, the more they would be able to help the person living with anorexia. Talking with people, who have gone through this problem, and taking their help can also be one of the best strategies in overcoming the problem.
Concluding remarks
Anorexia nervosa most commonly affects the women in adolescence. It has some problematic symptoms such as restriction, resistance to proper treatment, and body image distortions. It is found to be related to the highest incidences of death from any psychiatric disorder. However, scientists are not sure about the cause of this disease that is also interfering with the development of better treatment of this disorder. Scientists are working on the neurobiology of this disorder (Kaye, 2008). Some combination of medical therapy and counseling could give an optimal cure but further investigations would help in exploring the cause of problem and curing it.
References
Coxson, H. O., Chan, I. H., Mayo, J. R., Hlynsky, J., Nakano, Y., & Birmingham, C. L. (2004). Early emphysema in patients with anorexia nervosa. American journal of respiratory and critical care medicine, 170(7), 748-752.
d’Agincourt-Canning, L., Kunkel, L., & Dixon, K. (2014). Patient and Family-Centred Care: Critical Partnerships when Treating Adolescent Anorexia Nervosa. In Paediatric Patient and Family-Centred Care: Ethical and Legal Issues (pp. 269-287). Springer New York.
Ekvall, S., & Ekvall, V. K. (2005). Pediatric Nutrition in Chronic Diseases and Developmental Disorders: Prevention, Assessment, and Treatment: Oxford University Press, USA.
Hollander, E., Zohar, J., Sirovatka, P. J., & Regier, D. A. (2010). Obsessive-Compulsive Spectrum Disorders: Refining the Research Agenda for DSM-V: American Psychiatric Publishing.
Kaye, W. (2008). Neurobiology of anorexia and bulimia nervosa. Physiology & Behavior, 94(1), 121-135.
Siegfried, Z., Kanyas, K., Latzer, Y., Karni, O., Bloch, M., Lerer, B., & Berry, E. M. (2004). Association study of cannabinoid receptor gene (CNR1) alleles and anorexia nervosa: differences between restricting and bingeing/purging subtypes. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 125(1), 126-130.
Starr, T. B., & Kreipe, R. E. (2014). Anorexia Nervosa and Bulimia Nervosa: Brains, Bones and Breeding. Current psychiatry reports, 16(5), 1-11.
