Presentation on theme: "Anorexia Nervosa. What is Anorexia Nervosa What is anorexia? Eating disorder with psychological aetiology More common in females Weight loss leads: abnormalities."— Presentation transcript:
What is Anorexia Nervosa What is anorexia? Eating disorder with psychological aetiology More common in females Weight loss leads: abnormalities of heart rhythm abdominal symptoms anaemia hormonal and electrolyte imbalances Poorly understood, no universally accepted treatment One of a spectrum of eating disorders Beyond, out of control dieting Weight loss becomes an indication of mastery and control Primary drive.. to control one’s body and overcome fears Compulsive behaviour, Obsessive personality (similar to addiction) Usually presents in adolescence but sometimes in younger children
Cause No known cause May be genetic predisposition Demands of society and peer group Demands of parents re perfection Poor self image ?? Family dysfunction: Members interdependent on each other Cannot achieve an identity as an individual They are not individuals, only a member of a family Fear of growing up (perhaps of independence) Maturational process affected by diet Some limited evidence for hypothalamic dysfunction (reduction in serotonin)
Predisposing factors low self esteem, trying to change the way s/he is; feelings of ineffectiveness / perfectionism (changing my body will make me a more effective person). Search for perfectionism. I ought to be perfect; Feeling it is necessary to maintain control over their body and lives. A focus on something that can be controlled. Leads to an extreme fear of increasing weight; Fear of maturation (adolescence). Lack of ways to deal with physical changes, dieting.. a coping mechanism; Weight obsession in society, obesity intolerable, thinness is perfect. Overweight people seen as.. slow, lazy, sloppy.
Warning signs of an eating disorder A preoccupation with food and weight (i.e. counting calories, excessive dieting, weighing oneself several times per day); Claims of "feeling fat" when weight is normal or even low; individual experiences "body distortion" (they perceive their shape to be something other than it is); Guilt and shame about eating, not wanting to eat in front of other people; Evidence of binge-eating, hoarding of food, use of laxatives, diuretics, purgatives, and emetics; Excessive exercise; exercising to lose weight not to get fit; Emotional changes: moodiness, depression, irritability, social withdrawal; Extreme concern about appearance; An over-sensitivity to criticism of any kind; A need for perfection, an inflexibility; thinking in extremes (i.e. If I'm not thin, I'll be obese).
Characteristics Sometimes difficult to diagnose Patient tries to hide condition Denial and secrecy Do not seek help themselves By presentation, lack insight, provide unreliable information
Four criteria 1.Refusal to maintain weight at min. desirable level 2.Intense fear of gaining weight, becoming fat, although underweight; 3.Gross distortion of self perception, weight loss not seen; 4.In post menarche.. amenorrhoea. Two subtypes: Binge-eating / purging type (vomiting, laxatives etc.) Restricting type (just dieting).
Specific Signs of Anorexia Nervosa: Significant weight loss in the absence of related illness; Significant reduction in eating, coupled with a denial of hunger; Dieting when not "over" weight; Signs of starvation; Amenorrhoea in women; Unusual eating habits: preference for foods of a certain texture or colour, compulsively arranging food, unusual mixtures of food.
Bulimia Nervosa Evidence of binge-eating: actual observation, verbal reports, large amounts of food missing, Frequent weight fluctuations; Evidence of purging: vomiting, laxative/diuretic abuse, emetics, frequent fasting, excessive exercise; Swelling of parotid glands under the jaw (caused by frequent vomiting); Frequent, unusual dental problems.
The Physical Effects of Starvation lowered heart rate and body temperature bradycardia, hypotension, cardiomyopathy overall lowering of body metabolism (the rate at which the body burns calories) anaemia irregular menstruation or loss of menses growth of fine downy body hair on the face, back, arms and legs; loss of hair from scalp brittle nails dry, pasty skin (yellow colour) fatigue swelling and puffiness in fingers, ankles, and face amenorrhoea, hormonal imbalance long term renal and liver damage
The Physical Effects of Bingeing and Purging Strenuous over exercise dangerous Electrolyte imbalance and protein loss: hypokalaemia Irritability Depression Muscle weakness Dysrhythmias Convulsions Heart, renal failure Gastrointestinal, bloating, constipation, oesophagitis fluid and electrolyte loss, cramp Weakness Rebound oedema after fluid loss Nutritional deficiencies Dental, loss of enamel (vomiting), Ipecac contains a muscle poison ‘emetine’
Complications Death Cardiac disease and electrolyte imbalance Depression, social withdrawal Sleep problems Reduced attention and concentration
Diagnosis of Eating Disorders Listen in a non-judgmental and caring manner; Diagnose eating disorders by the appearance of specific symptoms, not the exclusion of "real" physical illnesses. Eating disorders are invariable characterised by a drive for thinness, an excessive fear of becoming fat, and harmful attitudes towards the body, self, and food; Eating disorders also occur in males, and the symptomatology in males is fairly similar to that seen in females. Eating disorders occur in individuals of all ages, backgrounds, and weights.
Treatment and Support Priority to: (a) identify early; (b) treat by trained therapists; and (c) supplemented by support groups for individuals with eating disorders, family and friends; Eating disorders have biological, psychological, familial, and sociocultural components. Consequently, effective treatment of eating disorders should involve a collaboration among health professionals; Goal: (a) restore and maintain a normal weight; (b) develop normal eating patterns; (c) overcome unhealthy attitudes about the body, the self, and relationships; (d) uncover and resolve experiences of trauma and abuse; (e) strengthen coping skills; and (f) help family and friends assist the person in the process of overcoming the eating disorder;
Further reading Bakker, R., B. van Meijel, et al. (2011). "Recovery of Normal Body Weight in Adolescents with Anorexia Nervosa: The Nurses' Perspective on Effective Interventions." Journal of Child & Adolescent Psychiatric Nursing 24(1): 16-22. Brewerton, T. D. and C. Costin (2011). "Long-term Outcome of Residential Treatment for Anorexia Nervosa and Bulimia Nervosa." Eating Disorders 19(2): 132-144. Hambrook, D., A. Oldershaw, et al. (2011). "Emotional expression, self-silencing, and distress tolerance in anorexia nervosa and chronic fatigue syndrome." British Journal of Clinical Psychology 50(3): 310-325. Matzkin, V., N. Slobodianik, et al. (2007). "Risk factors for cardiovascular disease in patients with anorexia nervosa." International Journal of Psychiatric Nursing Research 13(1): 1531-1545. Mitchison, D., P. Hay, et al. (2013). "Self-reported history of anorexia nervosa and current quality of life: findings from a community-based study." Quality of Life Research 22(2): 273-281. Nilsson, K. and B. Hägglöf (2006). "Patient perspectives of recovery in adolescent onset anorexia nervosa." Eating Disorders 14(4): 305-311. Paulson-Karlsson, G., I. Engström, et al. (2009). "A pilot study of a family-based treatment for adolescent anorexia nervosa: 18- and 36-month follow-ups." Eating Disorders 17(1): 72-88. Ross, J. A. and C. Green (2011). "Inside the experience of anorexia nervosa: A narrative thematic analysis." Counselling & Psychotherapy Research 11(2): 112-119. Wentz, E., I. Gillberg, et al. (2012). "Somatic problems and self-injurious behaviour 18 years after teenage-onset anorexia nervosa." European Child & Adolescent Psychiatry 21(8): 421-432. Westwood, L. M. and S. E. Kendal (2012). "Adolescent client views towards the treatment of anorexia nervosa: a review of the literature." Journal of Psychiatric & Mental Health Nursing 19(6): 500-508. Williams, S. and M. Reid (2010). "Understanding the experience of ambivalence in anorexia nervosa: the maintainer's perspective." Psychology & Health 25(5): 551-567. Williams, S. and M. Reid (2012). "‘It's like there are two people in my head’: A phenomenological exploration of anorexia nervosa and its relationship to the self." Psychology & Health 27(7): 798-815. Zugai, J., J. Stein-Parbury, et al. (2013). "Effective nursing care of adolescents with anorexia nervosa: a consumer perspective." Journal of Clinical Nursing 22(13/14): 2020-2029.