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Anorexia nervosa - Wikipedia
Anorexia nervosaoften referred to simply as anorexia[11] is an eating disorder characterized by low weightfood restrictionbody image disturbance, fear of gaining weight, and an overpowering desire to be thin.
Anorexia nervosa was coined by Gull in but, despite literal translation, anorexia essay, the symptom of hunger is frequently present and the pathological control of this instinct is a source of satisfaction for the patients.
Individuals with anorexia nervosa commonly see themselves as overweightalthough they are in fact underweight. The cause of anorexia is currently unknown. Treatment of anorexia involves restoring the patient back to a healthy weight, anorexia essay, treating their underlying psychological problems, and addressing behaviors that promote the problem, anorexia essay.
Globally, anorexia is estimated to affect 2. In recent years, evolutionary psychiatry as an emerging scientific discipline has been studying mental disorders from an evolutionary perspective. It is still debated whether eating disorders such as anorexia have evolutionary functions or if they are problems resulting from a modern lifestyle. Anorexia nervosa is an eating disorder characterized by attempts to lose weight to anorexia essay point of starvation.
A person with anorexia nervosa may exhibit a number anorexia essay signs and symptoms, the type and severity of which may vary and be present but not readily apparent.
Anorexia nervosa, and the associated malnutrition that results from self-imposed starvation, can cause complications in every major organ system in the body. Signs and symptoms may be classified in physical, cognitive, affective, behavioral and perceptual:.
Interoception involves the conscious and unconscious sense of the internal state of the body, anorexia essay, and it has an important role in anorexia essay and regulation of emotions. Aside from weight gain and outer appearance, people anorexia essay anorexia also report abnormal bodily functions such as indistinct feelings of fullness.
Due to impaired interoceptive sensitivity, powerful cues of fullness may anorexia essay detected prematurely in highly sensitive individuals, which can result in decreased calorie consumption and generate anxiety surrounding food intake in anorexia patients. Interoceptive awareness and emotion are deeply intertwined, and could mutually impact each other in abnormalities.
Other psychological issues may factor into anorexia nervosa. Some people have a previous disorder which may increase their vulnerability to developing an eating disorder and some develop them afterwards, anorexia essay. Obsessive-compulsive disorder OCD and obsessive-compulsive personality disorder OCPD are highly comorbid with AN. There is evidence for biological, psychological, developmental, anorexia essay, and sociocultural risk factors, anorexia essay, but the exact cause of eating disorders is unknown.
Anorexia nervosa is highly heritable. Consistent associations have been identified for polymorphisms associated with agouti-related peptidebrain derived neurotrophic factorcatechol-o-methyl transferaseanorexia essay, SK3 and opioid receptor delta A study found a genetic relationship with mental disorders, such as schizophreniaanorexia essay, obsessive—compulsive disorderanxiety disorder and depression ; and metabolic functioning with a negative correlation with anorexia essay mass, type 2 diabetes and leptin, anorexia essay.
Obstetric complications: prenatal and perinatal complications may factor into the development of anorexia nervosa, such as preterm birthanorexia essay, [62] maternal anemiadiabetes mellituspreeclampsiaplacental infarctionand neonatal heart abnormalities. Neuroendocrine dysregulation: altered signalling of peptides that facilitate communication between the gut, brain and adipose tissuesuch as ghrelinleptinneuropeptide Y and orexinmay contribute to the anorexia essay of anorexia nervosa by disrupting anorexia essay of hunger and satiety.
Gastrointestinal diseases : people with gastrointestinal disorders may be more at risk of developing disorders of eating practices than the general population, principally restrictive eating disturbances.
Some authors report that unresolved symptoms prior to gastrointestinal disease diagnosis may create a food aversion in these persons, causing alterations to their eating patterns. Other authors report that greater symptoms throughout their diagnosis led to greater risk. It has been documented that some people with celiac disease, irritable bowel syndrome or inflammatory bowel disease who are not conscious about the importance of strictly following their diet, anorexia essay, choose to consume their trigger foods to promote weight loss.
On the other hand, individuals with good dietary management may develop anxiety, food aversion and eating disorders because of concerns around cross contamination of their foods. Studies have hypothesized the anorexia essay of disordered eating patterns may be epiphenomena of starvation. The results of the Minnesota Starvation Experiment showed normal controls exhibit many of the behavioral patterns of AN when subjected to starvation.
This may be due to the numerous changes in the neuroendocrine systemwhich results in a self-perpetuating cycle. Anorexia nervosa is more likely to occur in a person's pubertal years.
Some explanatory hypotheses for the rising prevalence of eating disorders in adolescence are "increase of adipose tissue in girls, hormonal changes of puberty, societal expectations of increased independence and autonomy that are particularly difficult for anorexic adolescents to meet; [and] increased influence of the peer group and its values. Early theories of the cause of anorexia linked it to childhood sexual abuse or dysfunctional families; [74] [75] evidence is conflicting, and well-designed research is needed.
A risk factor for anorexia is trauma, anorexia essay. Interpersonal, as opposed to non-interpersonal trauma, has been seen as the most common type of traumatic event, [86] which can encompass sexual, physical, and emotional abuse. Trauma overwhelms individuals emotionally, physically, anorexia essay, and psychologically. Individuals, anorexia essay, particularly children experiencing abuse, may feel a loss of control over their life, anorexia essay, circumstances, and their own bodies.
Particularly sexual abuse, but also physical abuse, individuals may feel that the body is not a safe place and an object over which another has control.
Starvation, in the case of anorexia, may also lead to reduction in the body anorexia essay a sexual object, making starvation a solution. Restriction may also be a means by which the pain an individual is anorexia essay can be communicated.
Anorexia nervosa has been increasingly diagnosed since ; [91] the increase has been linked to vulnerability and internalization of body ideals. Persistent exposure to media that present body ideals may constitute a risk factor for body dissatisfaction and anorexia nervosa. The cultural ideal for body shape for men versus women continues to favor slender women and athletic, V-shaped muscular men.
A review found that, of the magazines most popular among people aged 18 to 24 years, those read by men, unlike those read by women, were more likely to feature ads and articles on shape than on diet. Websites that stress the importance of attainment of body ideals extol and promote anorexia nervosa through the use of religious metaphors, lifestyle descriptions, anorexia essay, "thinspiration" or "fitspiration" inspirational photo galleries and quotes that aim to serve as motivators for attainment of body ideals, anorexia essay.
The media portray a false view of what people truly look like. People then strive to look like these "perfect" role models when in reality they are not near perfection themselves.
Evidence from physiological, pharmacological and neuroimaging studies suggest serotonin also called 5-HT may play a role in anorexia. While acutely ill, metabolic changes may produce a number of biological findings in people with anorexia that are not necessarily causative of the anorexic behavior. For example, abnormal hormonal responses to challenges with serotonergic agents have been observed during acute illness, but not recovery.
Nevertheless, increased cerebrospinal fluid concentrations of 5-hydroxyindoleacetic acid a metabolite of serotoninand changes in anorectic behavior in response to acute tryptophan depletion tryptophan is a metabolic precursor to serotonin support a role in anorexia. The activity of the 5-HT 2A receptors has been reported to be lower in patients with anorexia in a number of cortical regions, evidenced by lower binding potential of this receptor as measured by PET or SPECTindependent of the state of illness.
While these findings may be confounded by comorbid psychiatric disorders, taken as a whole they indicate serotonin in anorexia. Neuroimaging studies investigating the functional connectivity between brain regions have observed a number of alterations in networks related to anorexia essay control, introspection, and sensory anorexia essay. Alterations in networks related to the dorsal anterior cingulate anorexia essay may be related to excessive cognitive control of eating related behaviors.
Similarly, altered somatosensory integration and introspection may relate to abnormal body image. Compared to controls, recovered anorexics show reduced activation in the reward system in response to food, and reduced correlation anorexia essay self reported liking of a sugary drink and activity in the striatum and anterior cingulate cortex.
Increased binding potential of 11 C radiolabelled raclopride in the striatum, interpreted as reflecting decreased endogenous dopamine due to competitive displacement, has also been observed.
Structural neuroimaging studies have found global reductions in both gray matter and white matter, as well as increased cerebrospinal fluid volumes. Regional decreases in the left hypothalamusleft inferior parietal loberight lentiform nucleus and right caudate have also been reported [] in acutely ill patients, anorexia essay.
However, these alterations seem to be associated with acute malnutrition and largely reversible with weight restoration, at least in nonchronic cases in younger people. Reduced white matter integrity in the fornix has also been reported, anorexia essay. A diagnostic assessment includes the person's current circumstances, biographical history, current symptoms, anorexia essay, and family history. The assessment also includes a mental state examinationwhich is an assessment of the person's current mood and thought content, focusing on views on weight and patterns of eating.
Anorexia nervosa is classified under the Feeding and Eating Disorders in the latest revision of the Diagnostic and Statistical Manual of Mental Disorders DSM 5. There is no specific BMI cut-off that defines low weight required for the diagnosis of anorexia nervosa.
The diagnostic criteria for anorexia nervosa all of which needing to be met for diagnosis are: [7] []. Relative to the previous version of the Anorexia essay DSM-IV-TRthe revision DSM5 anorexia essay changes in the criteria for anorexia nervosa.
Most notably, the amenorrhea absent period criterion was removed. There are two subtypes of AN: [25] []. Body mass index BMI is used by the DSM-5 as an indicator of the level of severity of anorexia nervosa, anorexia essay. The DSM-5 states these as follows: []. Medical tests to check for signs of physical deterioration in anorexia nervosa may be performed by a general physician or psychiatrist, including:. A variety of medical and psychological conditions have been misdiagnosed as anorexia nervosa; in some cases the correct diagnosis was not made for more than ten years.
Anorexia essay distinction between binge purging anorexia, bulimia nervosa and Other Specified Feeding or Eating Disorders ORFED is often difficult for non-specialist clinicians.
A main factor differentiating binge-purge anorexia from bulimia is the gap in physical weight. Patients with bulimia nervosa is ordinarily at a healthy weight, anorexia essay, or slightly overweight, anorexia essay. Patients with binge-purge anorexia is commonly underweight. There is no conclusive evidence that any particular anorexia essay for anorexia nervosa works better than others, anorexia essay.
In some clinical settings a specific body image intervention is performed to reduce body dissatisfaction and body image disturbance. Although restoring the person's weight is the primary task at hand, optimal treatment also includes and monitors behavioral change in the individual as well, anorexia essay.
Family-based treatment FBT has been shown to be more successful than individual therapy for adolescents with AN. Acceptance and commitment therapy is a third-wave cognitive-behavioral therapy which has shown promise in the treatment of AN. Jeffrey Young and is effective in helping patients identify origins and triggers for disordered eating. Diet is the most essential factor to work on in people with anorexia nervosa, and must be tailored to each person's needs. Food variety is important when establishing meal plans as well as foods that are higher in energy density, anorexia essay.
Pharmaceuticals have limited benefit for anorexia itself. AN has anorexia essay high mortality [] and patients admitted in a severely ill state to medical units are at particularly high risk. Diagnosis can be challenging, anorexia essay, risk assessment may not be performed accurately, consent and the need for compulsion may not be assessed anorexia essay, refeeding syndrome may be missed or poorly treated and the behavioural and family problems in AN may be missed or poorly anorexia essay. The rate of refeeding can be difficult to establish, because the fear anorexia essay refeeding syndrome RFS can lead to underfeeding.
It is thought that RFS, with falling phosphate and potassium levels, is more likely to occur when BMI is very low, and when medical comorbidities such as infection or cardiac failure, are present.
In those circumstances, it is recommended to start refeeding slowly but to build up rapidly as long anorexia essay RFS does not occur. AN has the highest mortality rate of any psychological disorder, anorexia essay. Alexithymia influences treatment outcome. Anorexia essay to the Morgan-Russell criteria, individuals can have a good, intermediate, or poor outcome, anorexia essay.
The good outcome also excludes psychological health.
A Day in the Life of Anorexia Nervosa
, time: 7:33Informative essay on anorexia
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