Anorexia nervosa , often referred to simply as anorexia , is a marked eating disorder with low weight, increased weight fear, and a strong desire to become lean, resulting in food restrictions. Many people with anorexia see themselves as overweight even though they are underweight. If asked usually they deny they have a problem with low weight. Often they weigh themselves often, eat only small amounts, and eat only certain foods. Some will exercise excessively, force themselves to vomit, or use laxatives to produce weight loss. Complications may include osteoporosis, infertility and heart damage, among others. Women will often stop experiencing menstrual periods.
The cause is unknown. There appears to be some genetic component with identical twins more often exposed than non-identical twins. Cultural factors also seem to play a role with people who assess the thinness of having a higher rate of illness. In addition, it occurs more frequently among those involved in activities that assess thinness such as high-level athletics, modeling, and dancing. Anorexia often begins to follow major changes or stressful events. Diagnosis requires very low body weight. The severity of the disease is based on body mass index (BMI) in adults with mild disease who have a BMI of more than 17, medium BMI 16-17, weight of BMI 15 to 16, and extreme BMI less than 15. In children, BMI for the percentile of age less than the 5th percentile is often used.
Anorexia treatment involves healthy weight recovery, treating underlying psychological problems, and addressing behaviors that promote problems. Although drugs do not help weight gain, they can be used to help anxiety or depression. A number of different types of therapy may be useful, such as cognitive behavioral therapy or the approach in which parents bear the responsibility to feed their child known as Maudsley family therapy. Sometimes people need to go to the hospital to recover their weight. The evidence for the benefits of nasogastric feeding, however, is unclear. Some people will only have one episode and recover while others may have many episodes over the years. Many complications improve or improve by regaining weight.
Globally, anorexia is thought to affect 2.9 million people by 2015. It is estimated that 0.9% to 4.3% of women and 0.2% to 0.3% of men in Western countries at some point in their lives. Approximately 0.4% of young women are affected in a given year and are estimated to occur ten times less often in men. Levels in most developing countries are unclear. Often it starts during adolescence or young adulthood. While anorexia became more commonly diagnosed during the 20th century it is unclear whether this is due to increased frequency or better diagnosis. In 2013 it directly resulted in about 600 deaths worldwide, up from 400 deaths in 1990. Eating disorders also increase the risk of a person's death from various other causes, including suicide. About 5% of people with anorexia die from complications over a ten-year period, almost 6 times increased risk. The term anorexia nervosa was first used in 1873 by William Gull to describe this condition.
Video Anorexia nervosa
Signs and symptoms
Anorexia nervosa is an eating disorder characterized by efforts to lose weight, to the point of starvation. A person with anorexia nervosa may exhibit a number of signs and symptoms, the type and severity may vary and may be present but not clearly visible.
Anorexia nervosa, and associated malnutrition resulting from self-starvation, can cause complications in every major organ system in the body. Hypokalemi, decreased levels of potassium in the blood, is a sign of anorexia nervosa. A significant decrease in potassium can lead to abnormal heart rhythms, constipation, fatigue, muscle damage and paralysis.
Symptoms may include:
- A low body mass index for a person's age and height.
- Amenorrhea, symptoms that occur after prolonged weight loss; causing menstruation to stop, hair becomes brittle, and skin becomes yellow and unhealthy.
- Fear even the slightest weight; take all precautions to avoid gaining weight or being "overweight".
- Fast, continuous weight loss.
- Lanugo: soft and smooth hair growing on face and body.
- An obsession for counting calories and monitoring the fat content of foods.
- Preoccupation with food, recipes, or cooking; can cook elaborate dinners for others, but do not eat their own food or consume very small portions.
- Food restriction in spite of underweight or healthy weight.
- Food rituals, such as cutting food into small pieces, refuse to eat around other people and hide or throw food away. Cleaning: Can use laxatives, diet pills, ipecac syrup, or water pills to flush foods from their system after meals or may engage in self-induced vomiting even though this is a more common bulimia symptom.
- Excessive exercise includes micro exercise, for example, making small and persistent fingers or toes movement.
- Self-perception as overweight, contrary to a less severe reality.
- Intolerance to cold complaints and often cold; body temperature can decrease (hypothermia) in an effort to conserve energy due to malnutrition.
- Orotostatic hypotension or hypotension.
- Bradycardia or tachycardia.
- Depression, anxiety disorders and insomnia.
- Loneliness: can avoid friends and family and become more attractive and closed.
- Abdominal distension.
- Halitosis (from vomiting or ketosis induced by hunger).
- Hair and dry skin, and thinning of hair.
- Chronic fatigue.
- Mood swings quickly.
- Having a change in the color of the foot causes the appearance of orange.
- Has severe muscle tension, aches and pains.
- Evidence/hurt yourself or hate yourself.
- Admire people who are thinner.
Interoceptive
Interception has an important role in homeostasis and setting emotions and motivation. Anorexia has been associated with interoception disorders. People with anorexia concentrate on the distorted perception of their body for fear of seeing overweight. Apart from outward appearance, they also report abnormal body functions such as unclear feelings. This gives an example of miscommunication between body and brain. Furthermore, people with anorexia experience intense cardiorespiratory sensations are remarkable, especially the breath, most common before they eat food. People with anorexia also report an inability to distinguish emotions from body sensations in general, called alexithymia. In addition to metacognition, people with anorexia also have difficulty with social cognition including interpreting the emotions of others, and showing empathy. Abnormal interoceptive awareness as these examples have been observed so frequently in anorexia that they have been a key characteristic of the disease.
Related matter
Other psychological problems may be anorexia nervosa factor; some meet the criteria for a separate Axis I diagnosis or personality disorder encoded by Axis II and thus be considered comorbid with a diagnosed eating disorder. Some people have previous disorders that can increase their susceptibility to developing eating disorders and some develop them thereafter. The presence of comorbid psychiatry Axis I or Axis II has been shown to affect the severity and type of anorexia nervosa symptoms in adolescents and adults.
Obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) are highly comorbid with AN, especially restrictive subtypes. Obsessive-compulsive personality disorder is associated with more severe symptoms and a worse prognosis. The causality between personality disorders and eating disorders has not been fully established. Other comorbid conditions include depression, alcoholism, borderline and other personality disorders, anxiety disorders, attention deficit hyperactivity disorder, and body dysmorphic disorder (BDD). Depression and anxiety are the most common comorbidities, and depression is associated with worse outcomes.
Autism spectrum disorders occur more commonly among people with eating disorders than in the general population. Zucker et al. (2007) proposed that conditions in the autism spectrum form the cognitive endophenotype underlying anorexia nervosa and requested increased interdisciplinary collaboration.
Maps Anorexia nervosa
Cause
There is evidence for biological, psychological, developmental, and sociocultural risk factors, but the exact cause of eating disorders is unknown.
Genetic
Anorexia nervosa is highly inherited. Twin studies have shown a level of heritability between 28 and 58%. The relative first degree of those with anorexia has about 12 times the risk of developing anorexia. Associate studies have been conducted, studying 128 different polymorphisms associated with 43 genes including genes involved in the regulation of feeding behavior, motivation and reward mechanics, personality traits and emotions. Consistent associations have been identified for polymorphisms associated with agouti-related peptides, brain-derived neurotrophic factors, catechol-o-methyl transferase, SK3 and delta-1 opioid receptors. Epigenetic modifications, such as DNA methylation, may contribute to the development or maintenance of anorexia nervosa, although clinical research in this area is still in its early stages.
Environment
Obstetric complications: prenatal and perinatal complications may be a factor in the development of anorexia nervosa, such as maternal anemia, diabetes mellitus, preeclampsia, placental infarction, and neonatal heart abnormalities. Neonatal complications may also have an effect on hazard avoidance, one of the personality traits associated with the development of AN.
Neuroendocrine is dysregulated: peptide signal changes that facilitate communication between the gut, brain and adipose tissue, such as ghrelin, leptin, neuropeptide Y and orexin, may contribute to the pathogenesis of anorexia nervosa by interfering with hunger and satiety regulation.
Gastrointestinal disease: people with gastrointestinal disorders may be at increased risk of developing eating disorders than the general population, especially restrictive eating disorders. Anorexia nervosa association with celiac disease has been found. The role played by gastrointestinal symptoms in the development of eating disorders seems rather complicated. Some authors report that unresolved symptoms before the diagnosis of gastrointestinal disease can create food reluctance in these people, causing a change in their diet. Other authors report that larger symptoms throughout the diagnosis lead to greater risk. It has been documented that some people with celiac disease, irritable bowel syndrome or inflammatory bowel disease are unaware of the strict importance of following their diet, choosing to consume their triggering foods to promote weight loss. On the other hand, individuals with good food management can develop anxiety, food aversion and eating disorders due to concerns about cross-contamination of their food. Some authors suggest that medical professionals should evaluate the presence of unrecognized celiac disease in all people with eating disorders, especially if they exhibit gastrointestinal symptoms (such as decreased appetite, abdominal pain, bloating, distension, vomiting, diarrhea or constipation), weight loss , or failure of growth; and also routinely ask celiac patients about weight or body shape problems, diet or vomiting to control weight, to evaluate the possibility of eating disorders, especially in women.
Studies have hypothesized the continuation of an irregular diet may be a famine epiphenomena. Results from the Minnesota Hunger Experiment showed normal controls showed many anorexia nervosa behavior patterns (AN) when starved. This may be due to many changes in the neuroendocrine system, which results in self-perpetuating cycles.
Another hypothesis is that anorexia nervosa is more likely in populations where obesity is more common, and the result of evolutionary impulses that are sexually selected to appear young in populations where size is the primary indicator of age.
Anorexia nervosa is more likely to occur during puberty of a person. Some explanatory hypotheses for increased prevalence of eating disorders during adolescence are "increased adipose tissue in girls, hormonal changes in puberty, social expectations of increasing independence and autonomy that are very difficult for anorexic teenagers to meet; [and] increasing peer group influence and value- its value. "
Psychological
The early theories of anorexia associated with childhood sexual abuse or dysfunctional families; conflicting evidence, and well-designed research is needed. Food fear is known as sitiophobia , cibophobia , or cytophobia and is part of the differential diagnosis. Other psychological causes of anorexia include low self-esteem, feeling like there is a lack of control, depression, anxiety, and loneliness.
Sociological
Anorexia nervosa has been increasingly diagnosed since 1950; this increase is associated with the vulnerability and internalization of the body's ideals. People in the profession where there are certain social pressures to be thin (like models and dancers) are more likely to develop anorexia, and those with anorexia have much higher contacts with cultural sources that encourage weight loss. This trend can also be observed for people who take part in certain sports, such as jockeys and wrestlers. There is a higher incidence and prevalence of anorexia nervosa in exercise with an emphasis on aesthetics, where low body fat is beneficial, and a sport where one has to make weight for competition. Family dynamics can play a major role in the cause of anorexia. When there is constant pressure from being thin, seductive, intimidation can lead to low self-esteem and other psychological symptoms.
Media effects
Constant exposure to the medium that presents the body's ideals can be a risk factor for body dissatisfaction and anorexia nervosa. The cultural ideals for body shape for men versus women continue to support lean and athletic women, muscular men V. The 2002 review found that, from the most popular magazines among people ages 18 to 24, read by men, unlike which are read by women, are more likely to show ads and articles about form than diet. Body dissatisfaction and internalization of body goals are risk factors for anorexia nervosa that threaten the health of male and female populations.
Websites that emphasize the importance of achieving the ideals of the body and enhancing anorexia nervosa through the use of religious metaphors, lifestyle descriptions, "inspiration" or "addictions" (inspiring photo galleries and quotes aimed at serving as motivators for the achievement of the ideal of the body). The pro-anorexia website reinforces the internalization of the ideals of the body and the importance of their attainment.
The media gives men and women the wrong view of what people look like. In magazines, movies, and even on billboards, most actors/models are photographed in various ways. People then try to look like this "perfect" role model when in fact they are not anywhere near perfection itself.
Mechanism
Evidence from physiological, pharmacological and neuroimaging studies suggests serotonin may play a role in anorexia. While acute pain, metabolic changes can produce a number of biological findings in people with anorexia that are not always the cause of anorexia behavior. For example, an abnormal hormonal response to a challenge with a serotonergic agent has been observed during acute illness, but not cured. Nevertheless, an increase in cerebrospinal fluid concentration of 5-Hydroxy indoleacetic acid (serotonin metabolite), and an anorectical behavioral change in response to thinning tryptophan (metabolic precursors to serotonin) support role in anorexia. The potential for binding of 5-HT receptors 2A and 5-HT recipes 1A has been reported to decrease and increase respectively in a number of cortical regions. While these findings may be confused by comorbid psychiatric disorders, overall they show serotonin in anorexia. This change in serotonin has been associated with characteristic features of anorexia such as obsessivity, anxiety, and appetite dysregulation.
Neuroimaging studies investigating functional connectivity between brain regions have observed a number of changes in tissue related to cognitive control, introspection, and sensory function. Changes in the tissues associated with the dorsal anterior cingulate cortex may be associated with excessive cognitive control of food-related behaviors. Similarly, somatosensory integration and introspection integration may be associated with abnormal body image. A study of functional neuroimaging studies reported reduced activation in the "bottom up" limbic area and increased activation in the "top down" cortical area that might play a role in restricting feeding.
Compared to control, recurrent anorexia indicates reduced activation in the reward system in response to food, and reduced the correlation between self-reported sweet loving drinks and activity in the striatum and ACC. The increased binding potential of raclopride [11C] in the striatum, interpreted as reflecting decreased endogenous dopamine due to competitive displacement, has also been observed.
Structural neuroimaging studies have found a global reduction in both gray matter and white matter, as well as an increase in cerebrospinal fluid volume. Decreased regions in the left hypothalamus, inferior parietal lobe, right lentiform nucleus and right caudatus have also been reported, in patients with acute pain. However, these changes appear to be associated with acute malnutrition and are highly reversible with weight recovery, at least in the noncronic cases in younger people. In contrast, some studies have reported an increase in the current orbitofrontal cortex volume of pain and in patients who recover, although the findings are inconsistent. The reduced white matter integrity in fornix has also been reported.
Diagnosis
Diagnostic assessment covers current state of affairs, biographical history, current symptoms, and family history. This assessment also involves the examination of mental states, which is the assessment of the mood and mind of a person today, focusing on the view of weight and diet.
DSM-5
Anorexia nervosa is classified under Eating Disorders and Eating in the latest revision of the Diagnostic and Statistical Manual of Mental Disorder (DSM 5).
In conjunction with an earlier version of DSM (DSM-IV-TR), the 2013 revision (DSM5) reflects changes in the criteria for anorexia nervosa, particularly from deleted amenorrhea criteria. Amenorrhea is omitted for several reasons: not applicable to men, does not apply to women before or after the age of menstruation or taking birth control pills, and some women who meet other criteria for AN still report some menstrual activity.
Subtype
There are two subtypes of AN:
- Types of eating/eating/cleaning: individuals use binge eating or display cleaning behavior as a means to lose weight. This differs from bulimia nervosa in terms of individual weight. A person with anorexia type of eating/cleansing can maintain a healthy or normal weight, but usually his weight is very thin. People with bulimia nervosa on the other hand can sometimes be overweight.
- This type of restriction: individuals use restricted food intake, fasting, diet pills, or exercise as a means to lose weight; they can exercise excessively to maintain weight or prevent weight gain, and some people just eat enough to stay alive.
Severity
Body mass index (BMI) is used by DSM-5 as an indicator of the severity of anorexia nervosa. DSM-5 states this as follows:
- Lightweight: BMI is greater than 17
- Medium: BMI 16-16.99
- Weight: BMI 15-15.99
- Extreme: BMI less than 15
Investigation
Medical tests to check for signs of physical damage to anorexia nervosa may be performed by a general practitioner or psychiatrist, including:
- Complete Blood Count (CBC): tests of white blood cells, red blood cells and platelets used to assess the presence of various disorders such as leukocytosis, leukopenia, thrombocytosis and anemia that can occur due to malnutrition./li>
- Urinalysis: various tests performed on urine used in the diagnosis of a medical disorder, to test substance abuse, and as a comprehensive health indicator
- Chem-20: Chem-20 is also known as SMA-20 group of 20 separate chemical tests performed on blood serum. Tests include cholesterol, protein and electrolytes such as potassium, chlorine and sodium and special tests for liver and kidney function.
- Glucose tolerance test: Oral glucose tolerance test (OGTT) is used to assess the body's ability to metabolize glucose. Can be useful in detecting various disorders such as diabetes, insulinoma, Cushing's syndrome, hypoglycemia and polycystic ovary syndrome.
- Serum cholinesterase test: liver enzyme test (acetylcholinesterase and pseudocolinesterase) is useful as a liver function test and to assess the effects of malnutrition.
- Liver Function Tests: A series of tests used to assess liver function tests are also used in the assessment of malnutrition, protein deficiency, renal function, bleeding disorders, and Crohn's disease.
- Lh responds to GnRH: Luteinizing hormone (Lh) response to the gonadotropin-releasing hormone (GnRH): Tests the pituitary gland response to GnRh, a hormone produced in the hypothalamus. Hypogonadism is often seen in cases of anorexia nervosa.
- Creatine Kinase Test (CK-Test): measures creatine kinase blood levels that spread the enzyme found in the heart (CK-MB), brain (CK-BB) and skeletal muscle (CK-MM).
- Blood urea nitrogen (BUN) test: urea nitrogen is a by-product of the first protein metabolism formed in the liver and then removed from the body by the kidneys. BUN test is mainly used to test kidney function. A low BUN rate may indicate the effects of malnutrition.
- BUN-to-creatinine ratio: BUN creatinine ratio is used to predict different conditions. High BUN/creatinine ratio can occur in severe hydration, acute renal failure, congestive heart failure, and intestinal bleeding. The low BUN/creatinine ratio may indicate a low protein diet, celiac disease, rhabdomyolysis, or liver cirrhosis.
- Electrocardiogram (ECG or ECG): measures the electrical activity of the heart. It can be used to detect various disorders such as hyperkalemia.
- Electroencephalogram (EEG): measures the electrical activity of the brain. It can be used to detect abnormalities such as those associated with pituitary tumors.
- Thyroid Screen TSH, t4, t3: test used to assess thyroid function by checking thyroid-stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3)
Differential diagnosis
Various medical and psychological conditions have been misdiagnosed as anorexia nervosa; in some cases the correct diagnosis is not done for more than ten years.
The difference between the diagnosis of anorexia nervosa, bulimia nervosa and unspecified eating disorder (EDNOS) is often difficult because there is a lot of overlap between people diagnosed with this condition. It seems that small changes in one's behavior or attitudes as a whole can change the diagnosis of anorexia: excessive eating type to bulimia nervosa. The main factor that distinguishes binge-purge anorexia from bulimia is a gap in physical weight. A person with bulimia nervosa is usually at a healthy weight, or slightly overweight. A person with binge-purge anorexia is generally less severe. People with LOT-COSTS subtypes may be underweight and usually do not overeat large amounts of food, but they clean up the small amount of food they eat. In contrast, those with bulimia nervosa tend to be of normal weight or overweight and binge eating in large quantities. It's not uncommon for a person with an eating disorder to "move through" diagnoses because their behaviors and beliefs change over time.
Treatment
There is no convincing evidence that any special treatment for anorexia nervosa works better than others; However, there is ample evidence to suggest that early intervention and treatment are more effective. Treatment for anorexia nervosa tries to overcome three main areas.
- Returns people to a healthy weight;
- Treating psychological disorders associated with disease;
- Reduce or eliminate behaviors or thoughts that initially cause an eating disorder.
Although restoring weight is a major task, optimal care also includes and monitors behavioral changes in individuals as well. There is some evidence that hospitalization can adversely affect long-term outcomes.
Psychotherapy for individuals with AN is challenging because they may consider skinny and may seek to maintain control and resist change. Several studies have shown that family-based therapy in adolescents with AN is superior to individual therapy.
Treatment for AN sufferers is difficult because they are afraid of gaining weight. Initially developing a desire for change may be important.
Diet
Diet is the most important factor for working in people with anorexia nervosa, and should be tailored to the needs of everyone. Food variety is important when setting food and food plans higher in energy density. People should consume enough calories, start slowly, and increase at a measured rate. The role evidence for zinc supplementation during refeeding is unclear.
Therapy
Family-based care (FBT) has proven to be more successful than individual therapy for adolescents with AN. Various forms of family-based treatment have been shown to work in adolescent AN treatment including convex family therapy (CFT), where parents and children are seen together by the same therapist, and separate family therapy (SFT) in which parents and children attend therapy separately with a different therapist. Proponents of family therapy for adolescents with AN confirm that it is important to include parents in adolescent care.
A four- to five-year follow-up study of Maudsley family therapy, an evidence-based manual model, showed full recovery at rates up to 90%. Although this model is recommended by NIMH, critics claim that this model has the potential to create power struggles in intimate relationships and can disrupt equal partnerships.
Cognitive behavioral therapy (CBT) is useful in adolescents and adults with anorexia nervosa; acceptance and commitment therapy is a type of CBT, which has been promising in the treatment of AN. Cognitive remediation therapy (CRT) is used in treating anorexia nervosa.
Medication
Pharmacy has limited benefits for the anorexia itself.
Login to hospital
AN has a high mortality and patients treated in severe illness to a very high risk medical unit. Diagnosis can be difficult, risk assessments may not be accurately assessed, consent and the need for coercion can not be appraised accurately, decompression syndromes can be missed or not handled properly and behavior and family issues in AN can be missed or not properly managed. The MARSIPAN Guidelines recommend that medical and psychiatric experts work together in managing people who are severely ill with AN.
Nutrition
Refeeding rates can be difficult to establish, as fear of refeeding syndrome (RFS) can cause underfeeding. It is estimated that RFS, with decreased levels of phosphate and potassium, is more likely to occur when BMI is very low, and when medical comorbidities such as infection or heart failure are present. In such circumstances, it is advisable to start refreshing slowly but to build quickly as long as the RFS does not occur. Recommendations on energy requirements vary from 5-10 kcal/kg/day in the most medically compromised patients, who appear to have the highest risk of RFS up to 1900 kcal/day
Prognosis
AN has the highest mortality rate from any psychological disorder. The mortality rate is 11 to 12 times greater than in the general population, and the risk of suicide is 56 times higher. Half of women with AN achieve full recovery, while an additional 20-30% can be partially recovered. Not everyone with anorexia is completely cured: about 20% develop anorexia nervosa as a chronic disorder. If anorexia nervosa is left untreated, serious complications such as heart conditions and renal failure can arise and eventually lead to death. The average number of years since the onset of AN remission is seven for women and three for men. After ten to fifteen years, 70% of people no longer meet diagnostic criteria, but many continue to experience feeding problems.
Alexithymia affects treatment outcomes. Recovery is also seen on the spectrum rather than black and white. According to Morgan-Russell criteria, individuals can have good, medium, or poor results. Even when a person is classified as having a "good" result, the weight should only be within 15% of the average, and normal menstruation should be present in women. Good results also do not include psychological health. Recovery for people with anorexia nervosa can not be denied positive, but recovery does not mean return to normal.
Complications
Anorexia nervosa can have serious implications if duration and severity are significant and if onset occurs before completion of growth, puberty maturation, or peak bone mass achievement. Specific complications for adolescents and children with anorexia nervosa may include the following: Growth retardation may occur, as increased height may slow down and may cease completely with severe weight loss or chronic malnutrition. In such cases, provided the growth potential is maintained, the high increase can be continued and reach its full potential once the normal intake is continued. High potency is usually preserved if the duration and severity of the disease is not significant or if the disease is accompanied by delayed bone age (especially before bone age of about 15 years), since hypogonadism can partially negate the effects of malnutrition at height by allowing for longer duration of growth compared with controls. Proper early care can maintain high potency, and may even help improve it in some post-anorexic subjects, due to factors such as long-term decrease in estrogen adipose tissue levels compared with premorbid levels. In some cases, especially where onset before puberty, complications such as dwarf growth and puberty delay are usually reversible.
Anorexia nervosa causes changes in the female reproductive system; significant weight loss, as well as psychological stress and intense exercise, usually result in menstrual cessation in women who pass through puberty. In patients with anorexia nervosa, there is a reduction of hormone secretion releasing gonadotropin in the central nervous system, preventing ovulation. Anorexia nervosa can also cause delay or arrest of puberty. Both the high increase and development of puberty depend on the release of growth hormone and gonadotropin (LH and FSH) from the pituitary gland. Gonadotropin suppression of anorexia nervosa patients has been documented. Typically, levels of growth hormone (GH) are high, but the level of IGF-1, the downstream hormone that must be released in response to low GH; this shows a state of "resistance" to GH due to chronic hunger. IGF-1 is required for bone formation, and decreased levels of anorexia nervosa contribute to the loss of bone density and potentially contribute to osteopenia or osteoporosis. Anorexia nervosa can also cause a decrease in peak bone mass. The largest accumulation of bone during adolescence, and if onset of anorexia nervosa occurs during this time and puberty stalls, low bone mass may be permanent.
Liver steatosis, or fatty infiltration of the liver, can also occur, and is an indicator of malnutrition in children. Neurological disorders that can occur as complications include seizures and tremors. Wernicke encephalopathy, resulting from vitamin B1 deficiency, has been reported in very undernourished patients; symptoms include confusion, problems with muscles responsible for eye movements and abnormalities in walking.
The most common gastrointestinal complications of anorexia nervosa are delayed abdominal emptying and constipation, but also include high liver function tests, diarrhea, acute pancreatitis, heartburn, difficulty swallowing, and, rarely, superior mesenteric artery syndrome. Pending abdominal discharges, or gastroparesis, often develop following diet restrictions and weight loss; the most common symptoms are bloated with gas and abdominal distension, and often occur after meals. Other symptoms of gastroparesis include full satiety, fullness, nausea, and vomiting. Symptoms may impede feeding and recovery efforts, but can be managed by restricting high-fiber foods, using liquid nutritional supplements, or using metoclopramide to increase emptying of food from the stomach. Gastroparesis generally disappears when weight returns.
Card Cardiac complications
Anorexia nervosa increases the risk of sudden cardiac death, although the exact cause is unknown. Cardiac complications include structural and functional changes in the heart. Some of these cardiovascular changes are mild and reversible with treatment, while others may be life-threatening. Cardiac complications may include arrhythmias, abnormally slow heartbeats, low blood pressure, decreased cardiac muscle size, reduced heart volume, mitral valve prolapse, myocardial fibrosis, and pericardial effusion.
Abnormal conduction and cardiac repolarization that can occur due to anorexia nervosa include QT prolongation, increased QT dispersion, conduction delay, and junctional rescue rhythm. Electrolyte abnormalities, especially hypokalemia and hypomagnesemia, can cause anomalies in the electrical activity of the heart, and lead to life-threatening arrhythmias. Hypokalemia most commonly results in anorexic patients when restricted with cleansing (induced vomiting or laxative use). Hypotension (low blood pressure) is common, and symptoms include fatigue and weakness. Orthostatic hypotension, a sharp drop in blood pressure when standing from the supine position, may also occur. Symptoms include mild headaches, weakness, and cognitive impairment, and may cause fainting or almost fainting. Orthostasis in anorexia nervosa may indicate deterioration of heart function and may indicate the need for hospitalization. Hypotension and orthostasis are generally lost after recovering to normal weight. Weight loss in anorexia nervosa also causes cardiac muscle atrophy. This results in reduced ability to pump blood, decreased ability to maintain exercise, decreased ability to increase blood pressure in response to exercise, and subjective feeling of fatigue.
Some individuals may also experience a decrease in cardiac contractility. Cardiac complications can be life-threatening, but the heart muscle generally improves with weight gain, and the heart normalizes its size for several weeks for months, with recovery. Cardiac muscle atrophy is a marker of disease severity, and while it is reversible with treatment and refeeding, it is possible that it may cause a permanent microscopic change in the heart muscle that increases the risk of sudden cardiac death. Individuals with anorexia nervosa may experience chest pain or palpitations; this could be the result of a mitral valve prolapse. Mitral valve prolapse occurs because the heart muscle size decreases while the mitral valve tissue remains the same size. Studies have shown a degree of mitral valve prolapse of about 20 percent in those with anorexia nervosa, while rates in the general population are estimated at 2-4 percent. It has been suggested that there is an association between mitral valve prolapse and sudden cardiac death, but has not been proven to be a cause, either in patients with anorexia nervosa or in the general population.
Relapse
Relapse occurs in about a third of people in the hospital, and the largest in the first six to eighteen months after being released from the institution.
Epidemiology
Anorexia is estimated to occur in 0.9% to 4.3% of women and 0.2% to 0.3% of men in Western countries at some point in their lives. Approximately 0.4% of young women are affected in a given year and are estimated to occur three to ten times less often in men. Levels in most developing countries are unclear. Often it starts during adolescence or young adulthood.
The lifetime rate of atypical anorexia nervosa, an ED-NOS form where not all diagnostic criteria for AN are met, much higher, at 5-12%.
While anorexia became more commonly diagnosed during the 20th century it is unclear whether this is due to increased frequency or better diagnosis. Most studies show that since at least 1970 the incidence of AN in adult women is fairly constant, while there are indications that the incidence may have increased for girls aged between 14 and 20 years.
Underrepresentation
Less eating disorders are reported in pre-industrial, non-westernized countries than in Western countries. In Africa, excluding South Africa, the only data that presents information about eating disorders occurs in case reports and isolated studies, not studies that investigate prevalence. The data show in the study that in westernized civilizations, ethnic minorities have very similar eating disorder levels, contrary to the belief that eating disorders primarily occur in Caucasians.
Men (and women) who may be diagnosed with anorexia may not meet the DSM IV criteria for BMIs because they have muscle weight, but have very little fat. Male and female athletes are often overlooked as anorexia sufferers. Research emphasizes the importance to pay attention to diet, weight and symptoms when diagnosing anorexia, not just looking at weight and BMI. For athletes, ritualized activities such as weight weighing emphasize weight, which can encourage the development of eating disorders among them. While women use diet pills, which are indicators of unhealthy behavior and eating disorders, men use steroids, which contextualize the ideals of beauty for gender. In a Canadian study, 4% of boys in grade nine used anabolic steroids. Anorexic men are sometimes referred to as manorexic .
History
The term
The earliest medical description of anorexia is commonly credited to the British physician Richard Morton in 1689. The case description of anorexia disease continued throughout the 17th, 18th and 19th centuries.
At the end of the nineteenth century anorexia nervosa became widely accepted by the medical profession as a recognized condition. In 1873, Sir William Gull, one of Queen Victoria's private physicians, published a seminal paper that coined the term anorexia nervosa and provided a number of detailed case and care descriptions. That same year, the French physician Ernest-Charles LasÃÆ'¨gue published the details of a number of cases in a paper entitled De l'Anorexie hysteria .
Awareness of the condition was largely confined to the medical profession until the latter part of the twentieth century, when German-American psychoanalyst Hilde Bruch published The Golden Cage: Anorexia Nervosa Enigma in 1978. Despite major advances. in neuroscience, Bruch's theory tends to dominate popular thought. The next important event was the death of famous singer and drummer Karen Carpenter in 1983, which prompted widespread media coverage of eating disorders.
Etymology
This term is derived from the Greek: an - (?? -, prefix denoting negation) and orexis (??????, "lust"), literally to the loss of a nervous appetite.
See also
- List of people with anorexia nervosa
- Eat recovery
- National Association of Anorexia Nervosa and Related Disorders
- Orthorexia nervosa
- Pro-ana
- Inedia
References
External links
- Bailey AP, Parker AG, Colautti LA, Hart LM, Liu P, Hetrick SE (2014). "Memetakan bukti untuk pencegahan dan pengobatan gangguan makan pada orang muda". J Eat Disord . 2 (1): 5. doi: 10.1186/2050-2974-2-5. PMC 4081733 . PMID 24999427.
- Coelho GM, Gomes AI, Ribeiro BG, Soares Ede A (2014). "Pencegahan gangguan makan pada atlet wanita". Buka Akses J Med Olahraga . 5 : 105-13. doi: 10.2147/OAJSM.S36528. PMCÂ 4026548 . PMID 24891817.
- Luca A, Luca M, Calandra C (2015). "Makan Gangguan di Akhir Kehidupan". Aging Dis . 6 (1): 48-55. doi: 10.14336/AD.2014.0124. PMCÂ 4306473 . PMID 25657852.
- Asosiasi Nasional Anorexia Nervosa dan Gangguan Terkait
- Masyarakat Psikologi Klinis - Anorexia
Source of the article : Wikipedia
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