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Anorexia nervosa is a serious eating disorder that results from an individual's intense preoccupation with body weight. Individuals with anorexia have difficulty maintaining a normal body mass index score, and frequently make continued efforts to lose weight even if their weight is abnormally low. The psychological factors that precipitate anorexia can be quite complex, and as a result the diagnosis and treatment of the disorder often require thorough psychological assessment, differential diagnosis, and long-term therapy. This paper will explore current research on anorexia and investigate how medical and mental health professionals are using this research to inform their work with anorexic patients (Smith et. al, 2011).
According to the American Psychiatrics DSM-IV-TR (American Pyschiatric Association [APA], 1994) a diagnosis of anorexia requires the following criteria:
"Refusal to maintain body weight at or above a minimally normal weight for age and height, for example, 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.
Intense fear of gaining weight or becoming fat, even though underweight.
Disturbance in the way 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.
In postmenarcheal females, amenorrhea, i.e., the absence of at least 3 consecutive menstrual cycles. A woman having periods only while on hormone medication (e.g. estrogen) still qualifies as having amenorrhea.
Restricting Type: During the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (self-induced vomiting or misuse of laxatives, diuretics, or enemas).
Binge Eating/Purging Type: During the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior."
While the diagnostic criteria have been clearly outlined for mental health clinicians, many professionals note that it can be quite difficult to make a definitive diagnosis in patients due to factors such as resistance to treatment and denial of the disorder. According to Halse, Honey and Boughtwood (2008), many patients with anorexia will blame their lack of appetite and weight loss on stomach pains, or intolerance to certain foods. In addition, criterion such as amenorrhea require patient disclosure, and an individual who is struggling with the compulsion to lose weight many not be willing to disclose this information to a medical provider.
When a patient's physical symptoms lead medical professionals towards a diagnosis other than anorexia, such as a food allergy, the individual may ultimately use this misdiagnosis to justify her inadequate food consumption. In addition, patients with anorexia may engage in purging behaviors, such as excessive exercise that they explain as athletic training for s specific sport or event. For example, an anorexic patient may eat adequate calories, but if she engages in a running workout for excessive distance or time periods, she may burn far more calories than she consumes. Thus, patients can use seemingly reasonable explanations to prevent diagnosis, and this often occurs, as patients typically have a deep psychological need to control and reduce their weight. The potential resistance, evasive behaviors, and lack of proper diagnosis of anorexic individuals may also be complicated by their age. In the United States, patients who are over the age of 18 can make their own medical decisions, meaning that family members cannot compel them to seek a proper diagnosis or treatment. In some cases individuals may live with the disease for years and avoid any contact with mental health or medical professionals (Halse, Honey, & Boughtwood, 2008).
In addition to these diagnostic difficulties, many professionals note that the current DSM-IV criteria for Anorexia Nervosa (AN) have some significant classification problems that make a proper diagnosis very difficult. First, there is no reference provided for the weight criteria, so clinicians can have difficulty knowing if a patient's weight falls within the criterion. Secondly, the subtypes of anorexia are not particularly useful for the diagnosis of younger patients because these individuals typically exhibit resistricting behavior. As a result, many young patients are diagnosed with Eating Disorder Not Otherwise Specified (EDNOS) rather than AN, which often blocks proper treatment and research. Many clinicians have called for a revision of the diagnostic criteria in the DSM-V, which will be released in 2012 (Knoll, Bulik, & Hebebrand, 2010).
According to Keski-Rahkonen, et al., (2007), delays in diagnosis and misdiagnosis of anorexia can have serious consequences. A patient's weight may fall to a dangerously low level, and this may often result in electrolyte imbalances, heart irregularities, kidney damage, seizures, and extreme fatigue. The fatigue produced by the advancement of the disease can contribute to emotional issues such as depression and anxiety, and it may also result in neurological issues that are often irreversible.
A complete and accurate diagnosis of anorexia will often require the participation of family members or significant others, as a clinician attempts to gather personal information, and medical data regarding the patient. A variety of physical tests, such as BMI calculations and blood chemistry analysis in addition to many tests that may be required to make a differential diagnosis (Knoll, Bulik, & Hebebrand, 2010).
As previously noted, many individuals with anorexia make extensive efforts to hide or deny their condition. Frequently, they may blame their weight loss and poor diet on a variety of other health conditions. As such, a differential diagnosis is essential, and must be conducted with the utmost care (Halse, Honey, & Boughtwood, 2008).
The majority of patients who have an underlying medical condition will express concern about their weight loss, while individuals with anorexia may express a distorted body image, a desire to lose more weight, or a discomfort or resistance to discussing the topic of weight loss. Weight loss and a loss of appetite can be linked to a wide variety of medical illnesses, including diabetes, gastrointestinal disorders, endocrine disorders, chronic infections, malignancy, and even parasitic infections. A medical doctor must first rule out the presence of these conditions through diagnostic tests, such blood testing, ultrasound, stool testing, and even colonoscopy. A thorough physical exam is the first step towards and effective and error-free diagnosis, and physicians should be particularly aware of physical symptoms such as very dry skin, low body fat, abnormal heart rate, low blood pressure, and possibly hypothermia (Pritts & Susman, 2003).
In addition to physical illnesses, many psychiatric disorders can cause some symptoms of anorexia. Major Depressive Disorder and Generalized Anxiety Disorder can both result in loss of appetite, weight loss, fatigue, and obsessive-compulsive behaviors. An individual suffering from a major depressive event may experience a significant drop in body weight, and if she is not fully cognizant of her condition or is resistant to treatment she may underplay the severity of her depression. A number of psychiatric screening tools are available for the assessment and differential diagnosis of anorexia. One tool, the SCOFF questionnaire, has been widely used by clinicians for screening in the primary care setting. Research shows, however, that it is quite challenging to develop interview tools that will not elicit false positives or allow subjects to provide misleading answers (Pritts & Susman, 2003).
In addition to making a careful differential diagnosis, clinicians must consider the possible presence of comorbid psychiatric disorders. In a 2003 review of eating disorder diagnostics, Pritts and Susman noted that,
"Major depression is the most common comorbid condition among patients with anorexia, with a lifetime risk as high as 80%. Anxiety disorders, especially social phobia, also are common. Obsessive-compulsive disorder has a prevalence of 30% among patients with eating disorders. Substance abuse prevalence is estimated at 12 to 18% in patients with anorexia…"
Studies also show that personality disorders, especially borderline personality disorder, have a very high rate of comorbidity with anorexia. The complexity of both substance abuse and personality disorders can present major barriers in the proper diagnosis and assessment of anorexia because many individuals with these disorders may be resistant to treatment and avoidant or misleading with practitioners (Pritts & Susman, 2003)
Assessment and Etiology
Upon making a clear diagnosis of anorexia a clinical team must complete a thorough assessment of the severity and etiology of the disorder in order to design an effective treatment plan. Keel and McCormick (2010) suggest that should typically be conducted with the use of unstructured clinical interview questions, and clinicians should consider factors such as age, family history, medical history, and the possible presence of trauma when planning and conducting the assessment interview.
Assessment of the severity and nature of anorexia must be completed on a very individualized basis. A treatment team must careful assess factors such as body weight, overall physical condition, and the patient's attitude towards her weight. Factors such as the patient's self-concept, attitudes towards food, and any significant history of medical or psychiatric treatment should also be considered. In addition, a family assessment can help clinicians identify any relevant behavioral patterns or environmental stressors that made further inform the treatment…[continue]
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Anorexia Nervosa is a serious eating disorder that affects millions of people all over the globe. The purpose of this discussion is to examine this disorder. We will begin by defining and characterizing anorexia nervosa. We will then discuss the factors that contribute to the development of the disorder. Finally, our discourse will investigate the treatments associated with anorexia nervosa. Definition of Anorexia Nervosa The Gale Encyclopedia of Alternative Medicine defines Anorexia
nurture. This issue has been employed in questioning the role of genetics as well as environment in the analysis of behavior. Several researchers especially geneticists have attempted to interpret the behavior of a person on the basis of natural phenomena. The work of Strober et al. (1985,p.239) indicated that since the 19th century to date, researchers who are studying anorexia nervosa have explore several multiple causes of the illness.
People in professions where there is a particular social pressure to be thin (such as models and dancers) were much more likely to develop anorexia during the course of their career, and further research has suggested that those with anorexia have much higher contact with cultural sources that promote weight-loss. There is a high rate of reported child sexual abuse experiences in clinical groups of who have been diagnosed
Eating disorder, according to the National Association of Anorexia and Associated Disorders (ANAD) is "an unhealthy relationship with food and weight that interferes with many areas of a person's life" (ANAD). The topic of eating disorders has gained significance over the past owing to the ongoing healthy eating campaign. This text presents the causes, symptoms, and prevalence statistics of four common eating disorders among the American populace. Anorexia Nervosa Anorexia Nervosa is
These conditions include maternal anemia, maternal diabetes, and maternal high blood pressure during pregnancy, which increase the risk of anorexia in the child. After-birth complications in the newborn infant such as heart problems, low response to stimuli, early difficulties in eating, and below-normal birth weight have also been found to increase the risk of anorexia and bulimia (Ibid.) Genetic Reasons Some experts consider genetics to be the root cause of
In fact, males account for 5-10% of reported cases of anorexia nervosa (Hayes). Research suggest that males who develop anorexia nervosa and other eating disorders differ from females in three major areas of dieting behaviors: 1) while females diet because they feel fat, males diet because they have been overweight at some point in their lives; 2) males more often than females diet to attain certain goals in sports
(Hall, C.C. 1995). This fact is proven by studies of Asian women outside the United States. For instance, studies in Korea and China point out that a high rate of eating disorder cases are being recorded in these countries as a direct result of economic change and the influence of Western culture. (Park, E. 2000) in Japan as many as 1 in 500 women have shown signs of an eating