Citizendia
Your Ad Here

For other uses, see Anorexia.
Anorexia Nervosa
Classification and external resources
An anti-anorexia nervosa billboard featuring recovering anorexic actress Isabelle Caro
ICD-10 F50.0-F50.1
ICD-9 307.1
OMIM 606788
DiseasesDB 749
eMedicine emerg/34  med/144

Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder characterized by low body weight and body image distortion with an obsessive fear of gaining weight. Isabelle Caro is a French woman from Marseilles, France. Isabelle became well-known by making headlines after appearing in a highly controversial ad campaign The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The 2007 version of the ICD is available online at http//wwwwho The 2007 version of the ICD is available online at http//wwwwho The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Psychiatry is a medical specialty which exists to study, prevent, and treat Mental disorders in Humans Psychiatric Diagnosis is the identification by Process of elimination, of the nature of anything An eating disorder is a compulsion to eat or avoid eating that negatively affects both one's physical and mental health Although many people prefer the less-ambiguous term body mass, the term body weight is overwhelmingly used in daily English speech and in biological and medical science contexts Body image is a term which may refer to the Perceptions of a human's own Physical appearance, or the internal sense of having a body which is interpreted by the brain Individuals with anorexia are known to commonly control body weight through the means of voluntary starvation, purging, vomiting, excessive exercise, or other weight control measures, such as diet pills or diuretic drugs. Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Anti-obesity drugs or weight loss drugs refer to all pharmacological agents that reduce or control weight. A diuretic is any Drug that elevates the rate of urination ( Diuresis) It primarily affects adolescent females, however approximately 10% of people with the diagnosis are male. Anorexia nervosa is a complex condition, involving neurobiological, psychological, and sociological components. Neurobiology is the study of cells of the Nervous system and the organization of these cells into functional circuits that process information and mediate behavior Psychology (from Greek grc ψῡχή psȳkhē, "breath life soul" and grc -λογία -logia) is an Academic and Sociology (from Latin: socius "companion" and the suffix -ology "the study of" from Greek λόγος lógos "knowledge" [1]

The term anorexia is of Greek origin: a (α, prefix of negation), n (ν, link between two vowels) and orexis (ορεξις, appetite) thus meaning a lack of desire to eat. [2] A person who is diagnosed with anorexia nervosa is most commonly referred to with the adjectival form anorexic. The noun form, "anorectic" is generally not used in this context and usually refers to drugs that suppress appetite. Note "Anorectic" is also a term for an anorexic person a person suffering from Anorexia nervosa Anorectics, anorexigenics A drug, broadly speaking is any chemical substance that when absorbed into the body

"Anorexia nervosa" is frequently shortened to "anorexia" in both the popular media and television reports. This is technically incorrect, as the term "anorexia" used separately refers to the medical symptom of reduced appetite (which therefore is distinguishable from anorexia nervosa in being non-psychiatric). Anorexia (deriving from the Greek "α(ν-" ( a(n-, a prefix that denotes absence + "όρεξη (orexe = appetite is the decreased sensation

Contents

Diagnosis and clinical features

The most commonly used criteria for diagnosing anorexia are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD). The American Psychiatric Association (APA is the main Professional organization of Psychiatrists and trainee psychiatrists in the United States, and the The Diagnostic and Statistical Manual of Mental Disorders' ( DSM) is published by the American Psychiatric Association The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases

Although biological tests can aid the diagnosis of anorexia, the diagnosis is based on a combination of behavior, reported beliefs and experiences, and physical characteristics of the patient. Anorexia is typically diagnosed by a clinical psychologist, psychiatrist or other suitably qualified clinician. Clinical psychology includes the scientific study and application of Psychology for the purpose of understanding preventing A psychiatrist (also archaically called an alienist) is a Physician who specializes in Psychiatry and is certified in treating Mental disorders Notably, diagnostic criteria are intended to assist clinicians, and are not intended to be representative of what an individual sufferer feels or experiences in living with the illness.

The full ICD-10 diagnostic criteria for anorexia nervosa can be found here, and the DSM-IV-TR criteria can be found here. The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The Diagnostic and Statistical Manual of Mental Disorders' ( DSM) is published by the American Psychiatric Association

To be diagnosed as having anorexia nervosa, according to the DSM-IV-TR, a person must display:

  1. Refusal to maintain body weight at or above a minimally normal weight for age and height (e. g. , 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). Weight loss, in the context of Medicine or Health or Physical fitness, is a reduction of the total Body weight, due to a mean loss of fluid
  2. Intense fear of gaining weight or becoming obese. Overweight is generally defined as having more body fat (adipose tissue than is optimally Healthy Being overweight is a common condition especially where
  3. Disturbance in the way in which 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.
  4. The absence of at least three consecutive menstrual cycles (amenorrhea), in women who have had their first menstrual period but have not yet gone through menopause (postmenarcheal, premenopausal females). Amenorrhoea ( BE) amenorrhea ( AmE) or amenorrhœa, is the absence of a Menstrual period in a woman of reproductive age Menopause is the permanent shutting down of the female Reproductive system, a considerable length of time before the end of the lifespan
  5. Or other eating related disorders.

Furthermore, the DSM-IV-TR specifies two subtypes:

The ICD-10 criteria are similar, but in addition, specifically mention

  1. The ways that individuals might induce weight-loss or maintain low body weight (avoiding fattening foods, self-induced vomiting, self-induced purging, excessive exercise, excessive use of appetite suppressants or diuretics). The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases
  2. Certain physiological features, including "widespread endocrine disorder involving hypothalamic-pituitary-gonadal axis is manifest in women as amenorrhoea and in men as loss of sexual interest and potency. The endocrine system is an integrated system of small organs that involve the release of extracellular signaling molecules known as Hormones The endocrine system is instrumental The hypothalamus links the Nervous system to the Endocrine system via the Pituitary gland (hypophysis The pituitary gland, or hypophysis, is an Endocrine gland about the size of a Pea. The gonad is the organ that makes Gametes The gonads in males are the Testes and the gonads in Females are the Ovaries. Amenorrhoea ( BE) amenorrhea ( AmE) or amenorrhœa, is the absence of a Menstrual period in a woman of reproductive age There may also be elevated levels of growth hormones, raised cortisol levels, changes in the peripheral metabolism of thyroid hormone and abnormalities of insulin secretion". Growth hormone ( GH) is a Peptide hormone that stimulates growth and cell reproduction in humans and other animals Cortisol is a Corticosteroid Hormone produced by the Adrenal gland (in the Zona fasciculata of the Adrenal cortex) Metabolism is the set of Chemical reactions that occur in living Organisms in order to maintain Life. The thyroid is one of the largest Endocrine glands in the body
  3. If onset is before puberty, that development is delayed or arrested.

Presentation

There are a number of features, that although not necessarily diagnostic of anorexia, have been found to be commonly (but not exclusively) present in those with this eating disorder. [3][1]

Physical

Anorexia nervosa can put a serious strain on many of the body's organs and physiological resources,[4][5][6] particularly on the structure and function of the heart and cardiovascular system, with slow heart rate (bradycardia) and elongation of the QT interval seen early on. Physiology (from Greek grc φύσις physis, "nature origin" and grc -λογία -logia) is the study of the mechanical physical The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic This is an article about the rock music band "Circulatory System" Bradycardia, as applied to adult medicine is defined as a resting Heart rate of under 60 beats per minute though it is seldom symptomatic until the rate drops below 50 beat/min In medicine specifically Cardiology, the QT interval is a measure of the time between the start of the Q wave and the end of the T wave in the heart's People with anorexia typically have a disturbed electrolyte balance, particularly low levels of phosphate, which has been linked to heart failure, muscle weakness, immune dysfunction, and ultimately death. An electrolyte is any substance containing free Ions that behaves as an electrically conductive medium A phosphate, an Inorganic chemical, is a salt of Phosphoric acid. An immune system is a collection of mechanisms within an Organism that protects against Disease by identifying and killing Pathogens and Tumor Those who develop anorexia before adulthood may suffer stunted growth and subsequent low levels of essential hormones (including sex hormones) and chronically increased cortisol levels. Hormones (from Greek ὁρμή - "impetus" are chemicals released by cells that affect cells in other parts of the body Cortisol is a Corticosteroid Hormone produced by the Adrenal gland (in the Zona fasciculata of the Adrenal cortex) Osteoporosis can also develop as a result of anorexia in 38-50% of cases,[7] as poor nutrition leads to the retarded growth of essential bone structure and low bone mineral density. Osteoporosis is a Disease of Bone that leads to an increased risk of fracture. Anorexia does not harm everyone in the same way. For example, evidence suggests that the results of the disease in adolescents may differ from those in adults. [4]

Changes in brain structure and function are early signs of the condition. Enlargement of the ventricles of the brain is thought to be associated with starvation, and is partially reversed when normal weight is regained. The ventricular system is a set of structures in the Brain continuous with the Central canal of the Spinal cord. Starvation (also called inanition) is a severe reduction in Vitamin, Nutrient, and Energy intake and is the most extreme form of [8] Anorexia is also linked to reduced blood flow in the temporal lobes, although since this finding does not correlate with current weight, it is possible that it is a risk trait rather than an effect of starvation. The temporal lobes are parts of the cerebrum that are involved in speech, Memory, and Hearing. [9]

Other effects may include the following:

Psychological

Emotional

Interpersonal and social

Behavioral

Diagnostic issues and controversies

The distinction between the diagnoses of anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified (EDNOS) is often difficult to make in practice and there is considerable overlap between patients diagnosed with these conditions. The endocrine system is an integrated system of small organs that involve the release of extracellular signaling molecules known as Hormones The endocrine system is instrumental Amenorrhoea ( BE) amenorrhea ( AmE) or amenorrhœa, is the absence of a Menstrual period in a woman of reproductive age Libido in its common usage means Sexual desire however more technical definitions such as those found in the work of Carl Jung, are more general referring to libido Metabolism is the set of Chemical reactions that occur in living Organisms in order to maintain Life. Bradycardia, as applied to adult medicine is defined as a resting Heart rate of under 60 beats per minute though it is seldom symptomatic until the rate drops below 50 beat/min In Physiology and Medicine, hypotension refers to an abnormally low Blood pressure. Hypothermia is a condition in which an organism's temperature drops below that required for normal Metabolism and bodily functions Anemia ( AmE) or anæmia/anaemia ( BrE) (from the Ancient Greek grc-Latn anaîmia, meaning “without blood” is defined as a qualitative An electrolyte is any substance containing free Ions that behaves as an electrically conductive medium Lanugo is fine downy Hair; it is a type of Pelage. In humans Fetal development Zinc (ˈzɪŋk from Zink is a Metallic Chemical element with the symbol Zn and Atomic number 30 An immune system is a collection of mechanisms within an Organism that protects against Disease by identifying and killing Pathogens and Tumor Complexion refers to the natural color texture and appearance of the Skin, especially that of the face Dental caries is a disease that damages Tooth structures resulting in what is commonly called tooth decay or cavities which are holes in the teeth Constipation, costiveness, or irregularity, is a condition of the Digestive system in which a person (or animal experiences hard Feces that Weight loss, in the context of Medicine or Health or Physical fitness, is a reduction of the total Body weight, due to a mean loss of fluid A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted Body image is a term which may refer to the Perceptions of a human's own Physical appearance, or the internal sense of having a body which is interpreted by the brain Perfectionism, in Psychology, is a belief that perfection can and should be attained Obsessive-compulsive disorder (OCD is a Chronic Anxiety disorder most commonly characterized by obsessive Distressing Intrusive thoughts In Psychology, self-esteem reflects a Person 's overall evaluation or appraisal of her or his own worth Self-efficacy is the belief that one is capable of performing in a certain manner to attain certain goals Overweight is generally defined as having more body fat (adipose tissue than is optimally Healthy Being overweight is a common condition especially where Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression A mood is a relatively long lasting affective or emotional state A mood swing is an extreme or rapid change in mood. They are commonly associated with Mood disorders of which the classic example is Bipolar disorder (also Self-injury ( SI) or self-harm ( SH) is deliberate Injury inflicted by a person upon their own body without suicidal intent Substance abuse is the overindulgence in and dependence of a Drug or other chemical leading to effects that are detrimental to the individual's physical and mental health Bulimia nervosa is an Eating disorder characterized by recurrent Binge eating, followed by compensatory behaviors referred to as "purging" Eating disorder not otherwise specified (EDNOS involves disordered eating patterns Furthermore, seemingly minor changes in a patient's overall behavior or attitude (such as reported feeling of 'control' over any bingeing behavior) can change a diagnosis from 'anorexia: binge-eating type' to bulimia nervosa. It is not unusual for a person with an eating disorder to 'move through' various diagnoses as his or her behavior and beliefs change over time. [3]

Additionally, it is important to note that an individual may still suffer from a health- or life-threatening eating disorder (e. g. , sub-clinical anorexia nervosa or EDNOS) even if one diagnostic sign or symptom is still present. Eating disorder not otherwise specified (EDNOS involves disordered eating patterns For example, a substantial number of patients diagnosed with EDNOS meet all criteria for diagnosis of anorexia nervosa, but lack the three consecutive missed menstrual cycles needed for a diagnosis of anorexia. [1]

Feminist writers such as Susie Orbach and Naomi Wolf have criticized the medicalisation of extreme dieting and weight-loss as locating the problem within the affected women, rather than in a society that imposes concepts of unreasonable and unhealthy thinness as a measure of female beauty. Feminism is a discourse that involves various movements theories, and Philosophies which are concerned with the issue of Gender difference, advocate Susie Orbach is a Feminist Psychologist and writer on women's psychology Naomi Wolf (born 12 November 1962 is an American author political consultant and public intellectual Medicalization (or medicalisation) is the process by which health or behavior conditions come to be defined and treated as medical issues

Causes and contributory factors

It is clear that there is no single cause for anorexia and that it stems from a mixture of biological, social, and psychological factors. Current research is commonly focused on explaining existing factors and uncovering new causes. However, there is considerable debate over how much each of the known causes contributes to the development of anorexia. In particular, the contribution of perceived media pressure on women to be thin has been especially contentious. [10]

Physiological factors

Genetic factors

Family and twin studies have suggested that genetic factors contribute to about 50% of the variance for the development of an eating disorder[11] and that anorexia shares a genetic risk with clinical depression. Twin studies are one of a family of designs in Behavior genetics which aid the study of individual differences by highlighting the role of environmental and genetic In Probability theory and Statistics, the variance of a Random variable, Probability distribution, or sample is one measure of Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression [12] This evidence suggests that genes influencing both eating regulation, and personality and emotion, may be important contributing factors. In one study, variations in the norepinephrine transporter gene promoter were associated with restrictive anorexia nervosa, but not binge-purge anorexia (though the latter may have been due to small sample size). The Norepinephrine transporter or NET (or noradrenaline transporter (NAT is a Monoamine transporter that transports the Neurotransmitter In Biology, a promoter is a region of DNA that facilitates the transcription of a particular Gene. [13]

Several rodent models of anorexia have been developed which largely involve subjecting the animals to various environmental stressors or using gene knockout mice to test hypotheses about the effects of certain genes. Rodentia is an order of Mammals also known as rodents, characterised by two continuously-growing incisors in the upper and lower jaws which must A gene knockout is a genetic technique in which an organism is engineered to carry genes that have been made inoperative (have been "knocked out" of the organism [14] These models have suggested that the hypothalamic-pituitary-adrenal axis may be a contributory factor, although the models have been criticised as food is being limited by the experimenter and not the animal, and these models cannot take into account the complex cultural factors known to affect the development of anorexia nervosa. The hypothalamic-pituitary-adrenal axis ( HPA or HTPA axis) also known as the Limbic -hypothalamic-pituitary-adrenal axis (LHPA axis is a complex set of direct influences

Neurobiological factors

There are strong correlations between the neurotransmitter serotonin and various psychological symptoms such as mood, sleep, emesis (vomiting), sexuality and appetite. Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons A recent review of the scientific literature has suggested that anorexia is linked to a disturbed serotonin system,[15] particularly to high levels at areas in the brain with the 5HT1A receptor - a system particularly linked to anxiety, mood and impulse control. In the field of Neurochemistry, 5-HT receptors are receptors for the Neurotransmitter and peripheral signal mediator Serotonin, also Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components Deferred gratification or delayed gratification is the ability to wait in order to obtain something that one wants Starvation has been hypothesised to be a response to these effects, as it is known to lower tryptophan and steroid hormone metabolism, which, in turn, might reduce serotonin levels at these critical sites and, hence, ward off anxiety. Tryptophan (abbreviated as Trp or W) is one of the 20 standard amino acids, as well as an Essential amino acid in the Human diet Steroid hormones are Steroids which act as Hormones Mammalian steroid hormones can be grouped into five groups by the receptors to which they bind In contrast, studies of the 5HT2A serotonin receptor (linked to regulation of feeding, mood, and anxiety), suggest that serotonin activity is decreased at these sites. One difficulty with this work, however, is that it is sometimes difficult to separate cause and effect, in that these disturbances to brain neurochemistry may be as much the result of starvation, than continuously existing traits that might predispose someone to develop anorexia. There is evidence, however, that both personality characteristics (such as anxiety and perfectionism) and disturbances to the serotonin system are still apparent after patients have recovered from anorexia,[16] suggesting that these disturbances are likely to be causal risk factors.

Recent studies also suggest anorexia may be linked to an autoimmune response to melanocortin peptides which influence appetite and stress responses. Melanocortins are a group of Pituitary Peptide hormones that include adrenocorticotropin ( ACTH) and the alpha beta and gamma Melanocyte-stimulating Peptides (from the Greek πεπτίδια, "small digestibles" are short Polymers formed from the linking in a defined order of α- Amino [17] Additional factors appear to be involved in the development of anorexia nervosa in elderly patients. All neurotransmitters associated with appetite decline with age. In addition there is a decline in levels of Substance P and Neuropeptide Y. Substance P is the transmitter that carries complex taste information from the taste-buds to the brain. Neuropeptidee Y regulates carbohydrate cravings< ref>Giannini AJ, Telew N. Anorexia nervosa in geriatric patients. Geriatric Medicine Today. 1987;6:75-78. </ref>

Nutritional factors

Zinc deficiency causes a decrease in appetite that can degenerate in anorexia nervosa (AN), appetite disorders and, notably, inadequate zinc nutriture. Zinc (ˈzɪŋk from Zink is a Metallic Chemical element with the symbol Zn and Atomic number 30 Zinc (ˈzɪŋk from Zink is a Metallic Chemical element with the symbol Zn and Atomic number 30 The use of zinc in the treatment of anorexia nervosa has been advocated since 1979 by Bakan. At least five trials showed that zinc improved weight gain in anorexia. A 1994 randomized, double-blind, placebo-controlled trial showed that zinc (14 mg per day) doubled the rate of body mass increase in the treatment of AN. [18] Deficiency of other nutrients such as tyrosine and tryptophan (precursors of the monoamine neurotransmitters norepinephrine and serotonin, respectively), as well as vitamin B1 (thiamine) could contribute to this phenomenon of malnutrition-induced malnutrition. A nutrient is food or chemicals that an organism needs to live and grow or a substance used in an organism's metabolism which must be taken in from its environment Tyrosine (abbreviated as Tyr or Y) or 4-hydroxyphenylalanine, is one of the 20 Amino acids that are used by cells to synthesize Tryptophan (abbreviated as Trp or W) is one of the 20 standard amino acids, as well as an Essential amino acid in the Human diet Monoamine neurotransmitters are Neurotransmitters and Neuromodulators that contain one Amino group that is connected to an aromatic ring by a See Chemical synapse for an introduction to concepts and terminology used in this article Norepinephrine ( INN) (abbreviated norepi or NE) or noradrenaline ( BAN) (abbreviated NA or NAd) is a Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons For the similarly spelled pyrimidine see Thymine Thiamin or thiamine, also known as Vitamin B1 [18]

Psychological factors

There has been a significant amount of work into psychological factors that suggests how biases in thinking and perception help maintain or contribute to the risk of developing anorexia.

Anorexic eating behavior is thought to originate from feelings of fatness and unattractiveness[19] and is maintained by various cognitive biases that alter how the affected individual evaluates and thinks about their body, food and eating. For an article about the conceptual problems of the mind see Cognitive closure (philosophy.

One of the most well-known findings is that people with anorexia tend to over-estimate the size or fatness of their own bodies. A recent review of research in this area suggests that this is not a perceptual problem, but one of how the perceptual information is evaluated by the affected person. In Psychology and the Cognitive sciences perception is the process of attaining awareness or understanding of sensory Information. [20] Recent research suggests people with anorexia nervosa may lack a type of overconfidence bias in which the majority of people feel themselves more attractive than others would rate them. The overconfidence effect is a bias in which people are correct in their judgements far less often than they think they are In contrast, people with anorexia nervosa seem to more accurately judge their own attractiveness compared to unaffected people, meaning that they potentially lack this self-esteem boosting bias. [21]

People with anorexia have been found to have certain personality traits that are thought to predispose them to develop eating disorders. High levels of obsession (being subject to intrusive thoughts about food and weight-related issues), restraint (being able to fight temptation), and clinical levels of perfectionism (the pathological pursuit of personal high-standards and the need for control) have been cited as commonly reported factors in research studies. Perfectionism, in Psychology, is a belief that perfection can and should be attained [22]

It is often the case that other psychological difficulties and mental illnesses exist alongside anorexia nervosa in the sufferer. Mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as Clinical depression, obsessive compulsive disorder, substance abuse and one or more personality disorders are the most likely conditions to be comorbid with anorexia, and high-levels of anxiety and depression are likely to be present regardless of whether they fulfill diagnostic criteria for a specific syndrome. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Obsessive-compulsive disorder (OCD is a Chronic Anxiety disorder most commonly characterized by obsessive Distressing Intrusive thoughts Substance abuse is the overindulgence in and dependence of a Drug or other chemical leading to effects that are detrimental to the individual's physical and mental health Personality disorder, formerly referred to as a Character Disorder is a class of mental disorders characterized by rigid and on-going patterns of feeling thinking and behavior In Medicine, comorbidity (literally "additional Morbidity " is either * The presence of one or more disorders (or diseases in addition to [23]

Research into the neuropsychology of anorexia has indicated that many of the findings are inconsistent across studies and that it is hard to differentiate the effects of starvation on the brain from any long-standing characteristics. Neuropsychology is the applied scientific discipline that studies the structure and function of the Brain related to specific psychological processes and overt behaviors Nevertheless, one reasonably reliable finding is that those with anorexia have poor cognitive flexibility[24] (the ability to change past patterns of thinking, particularly linked to the function of the frontal lobes and executive system). The frontal lobe is an area in the Brain of Mammals It is located at the front of each Cerebral hemisphere and positioned anterior to (in front of the

Other studies have suggested that there are some attention and memory biases that may maintain anorexia. Attention is the Cognitive process of selectively concentrating on one aspect of the environment while ignoring other things In Psychology, memory is an organism's ability to store retain and subsequently retrieve information [25] Attentional biases seem to focus particularly on body and body-shape related concepts, making them more salient for those affected by the condition, and some limited studies have found that those with anorexia may be more likely to recall related material than unrelated material.

Fairburn and colleagues psychological model of anorexia
Fairburn and colleagues psychological model of anorexia

Although there has been quite a lot of research into psychological factors, there are relatively few hypotheses which attempt to explain the condition as a whole.

Professor Chris Fairburn, of the University of Oxford and his colleagues have created a 'transdiagnostic' model,[26] in which they aim to explain how anorexia, as well as related disorders such as bulimia nervosa and ED-NOS, are maintained. The University of Oxford (informally "Oxford University" or simply "Oxford" located in the city of Oxford, Oxfordshire, England is the Their model is developed with psychological therapies, particularly cognitive behavioral therapy, in mind, and so suggests areas where clinicians could provide psychological treatment. See also Cognitive Therapy Cognitive Behavioral Therapy ( CBT) is an umbrella-term for psychotherapeutic systems that deal with cognitions interpretations

Their model is based on the idea that all major eating disorders (with the exception of obesity) share some core types of psychopathology which help maintain the eating disorder behavior. Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected Psychopathology is a term which refers to either the study of Mental illness or mental distress or the manifestation of behaviours and experiences which may be indicative This includes clinical perfectionism, chronic low self-esteem, mood intolerance (inability to cope appropriately with certain emotional states) and interpersonal difficulties. Perfectionism, in Psychology, is a belief that perfection can and should be attained In Psychology, self-esteem reflects a Person 's overall evaluation or appraisal of her or his own worth

Social and environmental factors

Sociocultural studies have highlighted the role of cultural factors, such as the promotion of thinness as the ideal female form in Western industrialised nations, particularly through the media. While there is significant variation in anatomical proportions between people there are many references to body proportions that are intended to be canonical either in A recent epidemiological study of 989,871 Swedish residents indicated that gender, ethnicity and socio-economic status were large influences on the chance of developing anorexia, with those with non-European parents among the least likely to be diagnosed with the condition, and those in wealthy, white families being most at risk. Gender comprises a range of differences between men and women extending from the biological to the social In Sociology or Anthropology, social status is the honor or prestige attached to one's position in Society (one's Social position) [27] A classic study by Garner and Garfinkel demonstrated that those 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,[28] and further research has suggested that those with anorexia have much higher contact with cultural sources that promote weight-loss. A model is a person who is posed or displayed for the purpose of Art, Fashion, or other products and Advertising. Dance (from French danser, perhaps from Frankish) is an Art form that generally refers to movement of the body usually rhythmic [29]

Although anorexia nervosa is usually associated with Western cultures, exposure to Western media is thought to have led to an increase in cases in non-Western countries. However, it is notable that other cultures may not display the same 'fat phobic' worries about becoming fat as those with the condition in the West, and instead may present with low appetite with the other common features. [30]

There is a high rate of reported child sexual abuse experiences in clinical groups of who have been diagnosed with anorexia (up to 50% in those admitted to inpatient wards, with a lesser prevalence among people treated in the community). Although prior sexual abuse is not thought to be a specific risk factor for anorexia, those who have experienced such abuse are more likely to have more serious and chronic symptoms. [31]

The Internet has enabled anorexics and bulimics to contact and communicate with each other outside of a treatment environment, with much lower risks of rejection by mainstream society. The Internet is a global system of interconnected Computer networks A variety of websites exist, some run by sufferers, some by former sufferers, and some by professionals. The majority of such sites support a medical view of anorexia as a disorder to be cured, although some people affected by anorexia have formed online pro-ana communities that reject the medical view and argue that anorexia is a 'lifestyle choice', using the internet for mutual support, and to swap weight-loss tips. Pro-ana refers to the rejection of the idea that Anorexia nervosa is an Eating disorder. [32] Such websites were the subject of significant media interest, largely focusing on concerns that these communities could encourage young women to develop or maintain eating disorders, and many were taken offline as a result. [33]

Prognosis

Anorexia is thought to have the highest mortality rate of any psychiatric disorder, with approximately 6% of those who are diagnosed with the disorder eventually dying due to related causes. [34] The suicide rate of people with anorexia is also higher than that of the general population and is thought to be the major cause of death for those with the condition. [35]

Incidence, prevalence and demographics

The majority of research into the incidence and prevalence of anorexia has been done in Western industrialized countries, so results are generally not applicable outside these areas. Incidence is a measure of the risk of developing some new condition within a specified period of time In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given However, recent reviews[36][37] of studies on the epidemiology of anorexia have suggested an incidence of between 8 and 13 cases per 100,000 persons per year and an average prevalence of 0. Epidemiology is the study of factors affecting the Health and Illness of populations and serves as the foundation and Logic of interventions made in the 3% using strict criteria for diagnosis. These studies also confirm the view that the condition largely affects young adolescent females, with females between 15 and 19 years old making up 40% of all cases. Furthermore, the majority of cases are unlikely to be in contact with mental health services. As a whole, about 10% of people with anorexia are male and about 90% of people with anorexia are female. [1] Anorexia, however, is not exclusively limited to any age or demographic. In March 2008, a British senior university lecturer with PhD in psychology and a professional background in health, Rosemary Pope, died from anorexia. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located "PhD" redirects here for other uses see PhD (disambiguation. [38]

Treatment

The first line treatment for anorexia is usually focused on immediate weight gain, especially with those who have particularly serious conditions that require hospitalization. A first-line treatment or first-line therapy is a Medical therapy recommended for the initial treatment of a Disease, sign or Symptom A hospital is an institution for Health care providing treatment by specialised staff and equipment and often but not always providing for In particularly serious cases, this may be done as an involuntary hospital treatment under mental health law, where such legislation exists. Involuntary commitment is the practice of using legal means or forms as part of a Mental health law to commit a person to a Mental hospital, Insane asylum Mental health law is the area of the law that is applied specifically to persons with a diagnosis or possible diagnosis of mental illness and to the people involved in managing or treating In the majority of cases, however, people with anorexia are treated as outpatients, with input from physicians, psychiatrists, clinical psychologists and other mental health professionals. A patient is any person who receives medical attention care or treatment. A physician, medical practitioner or medical doctor who practices Medicine, and is concerned with maintaining or restoring human Health A psychiatrist (also archaically called an alienist) is a Physician who specializes in Psychiatry and is certified in treating Mental disorders Clinical psychology includes the scientific study and application of Psychology for the purpose of understanding preventing

A recent clinical review has suggested that psychotherapy is an effective form of treatment and can lead to restoration of weight, return of menses among female patients, and improved psychological and social functioning when compared to simple support or education programmes. Psychotherapy is an Interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living The menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive-age Females Overt menstruation (where there is blood flow from the [39] However, this review also noted that there are only a small number of randomised controlled trials on which to base this recommendation, and no specific type of psychotherapy seems to show any overall advantage when compared to other types. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare Family therapy has also been found to be an effective treatment for adolescents with anorexia[40] and in particular, a method developed at the Maudsley Hospital is widely used and found to maintain improvement over time. Family therapy, also referred to as couple and family therapy and family systems therapy, is a branch of Psychotherapy that works with families The Maudsley Hospital in Denmark Hill, Camberwell, South London is unique as a Psychiatric hospital in that it was always intended to be a centre [41]

Drug treatments, such as SSRI or other antidepressant medication, have not been found to be generally effective for either treating anorexia,[42] or preventing relapse[43] although it has also been noted that there is a lack of adequate research in this area. Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression It is common, however, for antidepressants to be prescribed, often with the intent of trying to treat the associated anxiety and depression.

Supplementation with 14mg/day of zinc is recommended as routine treatment for anorexia nervosa due to a study showing a doubling of weight regain after treatment with zinc was begun. The mechanism of action is hypothesized to be an increased effectiveness of neurotransmission in various parts of the brain, including the amygdala, after adequate zinc intake begins resulting in increased appetite. The la amygdalae ( Latin, also la corpus amygdaloideum, singular la amygdala, from Greek el αμυγδαλή grc-Latn amygdalē, 'almond' [44]

There are various non-profit and community groups that offer support and advice to people who suffer from anorexia or who care for someone who does.

See also

References

  1. ^ a b c d Lask B, and Bryant-Waugh, R (eds) (2000) Anorexia Nervosa and Related Eating Disorders in Childhood and Adolescence. The history of Anorexia nervosa begins with the first recognition and description of anorexia as a disease in the late 19th century Adi Barkan is an Israeli Fashion photographer and model agent who has campaigned for legislation banning the use of anorexic models Anorexia (deriving from the Greek "α(ν-" ( a(n-, a prefix that denotes absence + "όρεξη (orexe = appetite is the decreased sensation Anorexia mirabilis literally means "miraculous lack of appetite" Body dysmorphic disorder ( BDD) (previously known as Dysmorphophobia and sometimes referred to as Body dysmorphia) is a psychiatric disorder Body image is a term which may refer to the Perceptions of a human's own Physical appearance, or the internal sense of having a body which is interpreted by the brain Bulimia nervosa is an Eating disorder characterized by recurrent Binge eating, followed by compensatory behaviors referred to as "purging" Binge eating disorder ( BED) is a Psychiatric disorder in which a subject shows the following symptoms Periodically does not exercise control over consumption Cachexia (kəˈkɛksiə is loss of weight, Muscle atrophy, fatigue weakness and significant loss of appetite in someone who is not actively trying to Calorie restriction, or caloric restriction (CR aims to improve health and slow the aging process by limiting dietary energy intake Defensive vomiting is a symptom of Anorexia nervosa and Bulimia nervosa in which a person who has drastically over-eaten (generally in reaction to previous extreme An eating disorder is a compulsion to eat or avoid eating that negatively affects both one's physical and mental health Eating disorder not otherwise specified (EDNOS involves disordered eating patterns Fasting girls is a Victorian term for young females usually preadolescent who it was claimed were capable of surviving over indefinitely long periods of time without consuming Female body shape has a bearing on a wide range of human activities and there are and have been widely different ideals of it in different cultures over history Malnutrition is a general term for a medical condition caused by an improper or insufficient diet. Muscle dysmorphia is a disorder in which a person becomes obsessed with the idea that he or she is not Muscular enough Orthorexia, or orthorexia nervosa is a term coined by Steven Bratman, a Colorado MD to denote an Eating disorder characterized by excessive Pro-ana refers to the rejection of the idea that Anorexia nervosa is an Eating disorder. Purging disorder is an Eating disorder characterized by recurrent purging (self-induced Vomiting, misuse of Laxatives Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished Wannarexia, or anorexic yearning,is a label applied to someone who claims to have Anorexia nervosa, or wishes they did Hove: Psychology Press. ISBN 0-86377-804-6.
  2. ^ Costin, Carolyn. ~ (1999) The Eating Disorder Sourcebook. Linconwood: Lowell House. 6.
  3. ^ a b Gowers S, Bryant-Waugh R. (2004) Management of child and adolescent eating disorders: the current evidence base and future directions. J Child Psychol Psychiatry, 45 (1), 63-83. PMID 14959803
  4. ^ a b Katzman DK. (2005) Medical complications in adolescents with anorexia nervosa: a review of the literature. International Journal of Eating Disorders, 37 Suppl, S52-9. PMID 15852321.
  5. ^ Anorexia Vs Obesity in North America, retrieved May 25th 2007.
  6. ^ Birmingham CL, Su J, Hlynsky JA, Goldner EM, Gao M. (2005) The mortality rate from anorexia nervosa. International Journal of Eating Disorders, 38 (2), 143-6. PMID 16134111.
  7. ^ Legroux-Gerot I, Vignau J, Collier F, Cortet B. (2005) Bone loss associated with anorexia nervosa. Joint Bone Spine, 72 (6), 489-95. PMID 16242373.
  8. ^ Palazidou E, Robinson P, Lishman WA. (1990) Neuroradiological and neuropsychological assessment in anorexia nervosa. Psychol Med, 20 (3), 521-7. PMID 2236361.
  9. ^ Lask B, Gordon I, Christie D, Frampton I, Chowdhury U, Watkins B. (2005) Functional neuroimaging in early-onset anorexia nervosa. Int J Eat Disord, 37 Suppl, S49-51. PMID 15852320.
  10. ^ Tiggemann M and Pickering AS. (1996) Role of television in adolescent women's body dissatisfaction and drive for thinness Int J Eat Disord, Sep;20(2):199-203.
  11. ^ Klump KL, Kaye WH, Strober M (2001) The evolving genetic foundations of eating disorders. Psychiatr Clin North Am, 24 (2), 215-25. PMID 11416922.
  12. ^ Wade TD, Bulik CM, Neale M, Kendler KS. (2000) Anorexia nervosa and major depression: shared genetic and environmental risk factors. Am J Psychiatry, 157 (3), 469-71. PMID 10698830.
  13. ^ Urwin, R. E. , Bennetts, B. , Wilcken, B. et al. (2002). "Anorexia nervosa (restrictive subtype) is associated with a polymorphism in the novel norepinephrine transporter gene promoter polymorphic region," Molecular Psychiatry, 7(6), 652–657.
  14. ^ Siegfried Z, Berry EM, Hao S, Avraham Y. (2003) Animal models in the investigation of anorexia. Physiol Behav, 79 (1), 39-45. PMID 12818708.
  15. ^ Kaye WH, Frank GK, Bailer UF, Henry SE, Meltzer CC, Price JC, Mathis CA, Wagner A. (2005) Serotonin alterations in anorexia and bulimia nervosa: new insights from imaging studies. Physiol Behav, 85 (1), 73-81. PMID 15869768.
  16. ^ Kaye WH, Bailer UF, Frank GK, Wagner A, Henry SE. (2005) Brain imaging of serotonin after recovery from anorexia and bulimia nervosa. Physiol Behav, 86(1-2), 15-7. PMID 16102788.
  17. ^ Fetissov SO, Harro J, Jaanisk M, Jarv A, Podar I, Allik J, Nilsson I, Sakthivel P, Lefvert AK, Hokfelt T. (2005) Autoantibodies against neuropeptides are associated with psychological traits in eating disorders. Tomas Hökfelt (born 29 June 1940) is a former professor in Histology at the Karolinska Institutet from 1979 until 2006 when he got his emeritate Proc Natl Acad Sci U S A, 102 (41), 14865-70. PMID 16195379.
  18. ^ a b Neurobiology of Zinc-Influenced Eating Behavior | [1]
  19. ^ Rosen JC, Reiter J, Orosan P. (1995) Assessment of body image in eating disorders with the body dysmorphic disorder examination. Behav Res Ther, 1, 77-84. PMID 7872941.
  20. ^ Skrzypek S, Wehmeier PM, Remschmidt H. (2001) Body image assessment using body size estimation in recent studies on anorexia nervosa. A brief review. Eur Child Adolesc Psychiatry, 10 (4), 215-21. PMID 11794546.
  21. ^ Jansen A, Smeets T, Martijn C, Nederkoorn C. (2006) I see what you see: the lack of a self-serving body-image bias in eating disorders. Br J Clin Psychol, 45 (1), 123-35. PMID 16480571.
  22. ^ Wonderlich SA, Lilenfeld LR, Riso LP, Engel S, Mitchell JE. (2005) Personality and anorexia nervosa. Int J Eat Disord, 37 Suppl, S68-71. PMID 15852324.
  23. ^ O'Brien KM, Vincent NK. (2003) Psychiatric comorbidity in anorexia and bulimia nervosa: nature, prevalence, and causal relationships. Clin Psychol Rev, 23 (1), 57-74. PMID 12559994
  24. ^ Tchanturia K, Campbell IC, Morris R, Treasure J. (2005) Neuropsychological studies in anorexia nervosa. Int J Eat Disord, 37 Suppl, S72-6. PMID 15852325.
  25. ^ Cooper MJ (2005) Cognitive theory in anorexia nervosa and bulimia nervosa: progress, development and future directions. Clin Psychol Rev, 25 (4), 511-31. PMID 15914267.
  26. ^ Fairburn CG, Cooper Z, Shafran R. (2003) Cognitive behavior therapy for eating disorders: a "transdiagnostic" theory and treatment. Behav Res Ther, 41 (5), 509-28. PMID 12711261.
  27. ^ Lindberg L, Hjern A. (2003) Risk factors for anorexia nervosa: a national cohort study. International Journal of Eating Disorders, 34 (4), 397-408. PMID 14566927
  28. ^ Garner DM, Garfinkel PE. (1980) Socio-cultural factors in the development of anorexia nervosa. Psychol Med, 10 (4), 647-56. PMID 7208724.
  29. ^ Toro J, Salamero M, Martinez E. (1994) Assessment of sociocultural influences on the aesthetic body shape model in anorexia nervosa. Acta Psychiatrica Scandinavica, 89 (3), 147-51. The Acta Psychiatrica Scandinavica is a Scandinavian Peer reviewed Scientific journal containing Original research, Systematic PMID 8178671.
  30. ^ Simpson KJ. (2002) Anorexia Nervosa and culture. J Psychiatr Ment Health Nurs, 9 (1), 65-71. PMID 11896858.
  31. ^ Carter JC, Bewell C, Blackmore E, Woodside DB. (2006) The impact of childhood sexual abuse in anorexia nervosa. Child Abuse Negl, 30 (3), 257-69. PMID 16524628.
  32. ^ Norris ML, Boydell KM, Pinhas L, Katzman DK. (2006) Ana and the internet: A review of pro-anorexia websites. International Journal of Eating Disorders, 39(6):443-7. PMID 16721839.
  33. ^ Reaves, J. (2001). Anorexia goes high tech. Time (July). Retrieved on April 16, 2007. Events 1178 BC - A Solar eclipse may have marked the return of Odysseus, legendary King of Ithaca, to his kingdom Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century.
  34. ^ Herzog, David B; Greenwood, Dara N; Dorer, David J; Flores, Andrea T; Ekeblad, Elizabeth R; Richards, Ana; Blais, Mark A & Keller, Martin B (2000), “Mortality in eating disorders: A descriptive study”, International Journal of Eating Disorders 28 (1): 20-26 
  35. ^ Pompili, M; Mancinelli, I; Girardi, P; Ruberto, A & Tatarelli, R (2004), “Suicide in anorexia nervosa: A meta-analysis”, International Journal of Eating Disorders (John Wiley) 36 (1): 99-103 
  36. ^ Bulik CM, Reba L, Siega-Riz AM, Reichborn-Kjennerud T. (2005) Anorexia nervosa: definition, epidemiology, and cycle of risk. Int J Eat Disord, 37 Suppl, S2-9. PMID 15852310.
  37. ^ Hoek HW. (2006) Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Curr Opin Psychiatry. , 19 (4), 389-94. PMID 16721169.
  38. ^ "Professor, 49, died from anorexia", BBC, 2008-04-22. 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common Events 1500 - Portuguese Navigator Pedro Álvares Cabral becomes the first European to sight Brazil. Retrieved on 2008-04-23. 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common Events 215 BC - A temple is built on the Capitoline Hill dedicated to Venus Erycina to commemorate the Roman defeat at  
  39. ^ Hay P, Bacaltchuk J, Claudino A, Ben-Tovim D, Yong PY. (2003) Individual psychotherapy in the outpatient treatment of adults with anorexia nervosa. Cochrane Database Syst Rev, 4, CD003909. PMID 14583998.
  40. ^ Lock J, Le Grange D. (2005) Family-based treatment of eating disorders. Int J Eat Disord, 37 Suppl, S64-7. PMID 15852323.
  41. ^ Le Grange D. (2005) The Maudsley family-based treatment for adolescent anorexia nervosa. World Psychiatry, 4 (3), 142-6. PMID 16633532.
  42. ^ Claudino AM, Hay P, Lima MS, Bacaltchuk J, Schmidt U, Treasure J. (2006) Antidepressants for anorexia nervosa. Cochrane Database Syst Rev, 1, CD004365. PMID 16437485.
  43. ^ Walsh BT, Kaplan AS, Attia E, Olmsted M, Parides M, Carter JC, Pike KM, Devlin MJ, Woodside B, Roberto CA, Rockert W. (2006) Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. JAMA, 295(22), 2605-12. PMID 16772623.
  44. ^ Birmingham CL, Gritzner S (2006) How does zinc supplementation benefit anorexia nervosa? Eating and Weight Disorders, 11 (4), e109-111. Zinc (ˈzɪŋk from Zink is a Metallic Chemical element with the symbol Zn and Atomic number 30 PMID 17272939

External links

Support organizations and information

Media stories and reports

Dictionary

anorexia nervosa

-noun

  1. An eating disorder characterized by self starvation due to a fear of gaining weight.
© 2009 citizendia.org; parts available under the terms of GNU Free Documentation License, from http://en.wikipedia.org
 Dapyx Software network: MP3 Explorer | Ebook Manager | Zenithic