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Anorexia Nervosa

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trisha sarode

on 20 May 2014

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Transcript of Anorexia Nervosa

Anorexia Nervosa
Physical Symptoms





Intense Fear

Low Self-Esteem

Slow rigid thinking


Environmental Causes
Western Culture and the Media
create idolized stereotypes which influence how individuals perceive their bodies.

Family Conflicts and Traumatic Events
have emotional impacts which can influnce the development Anorexia Nervosa
Signs and Symptoms



Introduction to Anorexia Nervosa
Anorexia Nervosa is a psychiatric feeding and eating disorder characterized by a distorted view of ones physical appearance.
(Mandsen, Bohon , Feusner. 2013)
Psychological Causes
Anxiety and Depression
(DSM - V)

Clinical Perfectionism
(Shaffran, Cooper, Fairburn. 2002)

Stress and Developmental Fears
(Andrew J. Hill)
-> Anorexia nervosa in young women is 0.3% to 0.5%
(Hoek and van Hoeken, 2003).

-> 8 cases per 100,000 population.

->Incidence rates are highest in 15- to 19-year-old girls
(Lucas et al., 1999).

-> Evidence suggests that in the younger age group of ages 7-14 years, up to 25% of cases are boys
(C. Stark, 2000).

Three Essential Features of Anorexia Nervosa
from the DSM-V (American Psychiatric Association, 2013)
1. Persistent energy intake restriction

2. Intense fear of gaining weight

3. Disturbance in self-perceived weight or shape
Biological Causes
Increased Risk among First degree biological relatives

Brain Abnormalities


Increased release of Dopamine
(Zandian, Ioakimidis, Bergh, Sodersten, 2007)
->The absence of a menstrual period in a woman of reproductive age for more than 3 months
( Parulekar, Day, Ottaway, Sheppard, Trundeau, Bramwell, Levine, Pritchard, 2005)

In approximately 50%, the amenorrhea occurs at about the same time as the weight loss;
The other 50% occurs either after or before the substantial weight loss. (Katzman & Golden)

->Hypotension and Hypothermia as low as 35 degress celcius
(Katzman & Golden)
-> Lanugo- fine body hairs
-> Yellowing of the skin (Hypercarotenemia)
Behavioural Symptoms
35% of patients with Anorexia also have OCD
(Zandian, Ioakimidis, Bergh, Sodersten, 2007)

Serious Dieting Behaviour

Anti-Social Behaviours



Medical Treatment

Counselling and Therapy


-> restricting certain foods
->counting calories, skipping meals
->obsessive rules, rigid thinking
-> excessive exercise.

->loss of control
->self-induced vomiting
->misusing laxatives
Difficulties in Treatment
Medical Treatment
Counselling and Therapy
-> Physical symptoms can be life threatening and
individuals lack motivation to seek treatment. (Duvvuri, Kaye, 2009)

-> 35% of the patients dropped out of treatment, and then 50% of the patients dropped out of the study upon follow-up 1 year later (Bachar, Eytan, Yael, Shulamit, Berry, 1999)

-> Diagnosis is an essential step in the treatment of
Anorexia Nervosa.

-> Hospitilisation - A weight gain of approximately 1kg per week
is optimal (Katzman & Golden, 2005).

-> There are no medications specifically designed to treat
anorexia (Zandian, et al., 2007; Katzman & Golden, 2005)

-> Once there is improvement in the physiological symptoms of starvation, psychological treatment can begin.
-> Family-based treatment has been found to be effective in the adolescent agegroup (Le Grange, Lock, Dymek 2003).

-> Cognitive behavioural therapy reduced the rate of
relapse from 53% to 22% in adults(Pike, Walsh, Vitousek, Wilson, Bauer, 2003).

-> Nutritional counselling reteaches patients how to eat
properly and maintain a healthy diet (Zandian, et al., 2007; Katzman & Golden, 2005).
American Psychiatric Association (1994). Diagnostic and Statistical Manual for Mental Disorders, 4th ed.

Bachar ET, Eytan B, Yael L, Shulamit K, Berry EM (1999). Empirical comparison of two psychological therapies. Self psychology and cognitive orientation in the treatment of anorexia and bulimia. J Psychother Pract Res;8:115–28.

Duvvuri, V., Kaye, W.H. (2009) Anorexia Nervosa; The Journal of Life Long Learning in Psychiatry. Volume 8, No. 4, 455-462

Fairbun, C.G., Cooper, Z., Doll, H.A., Welch, S.L. (1999). Risk Factors for Anorexia Nervosa-Three Integrated Case-Control Comparisons, Arch Gen Psychiatry. Volume 56, 460-476.

Hill A.J (1993), Causes and consequences of dieting and anorexia, Proceedings of Nutrition Society, 52(1), 211-218 DOI: http://dx.doi.org/10.1079/PNS19930053

Hoek H.W, Hoeken D.V (2003), Review of the Prevalence and incidence of eating disorders, International Journal of eating disorders, 34(4), 383-396 DOI: 10.1002/eat.10222

Hsu, G.L.K. (1996). Epidemiology of the Eating Disorders. Psychiatric Clinics of North America, 19(4), 681-697.

Katzman, D.K., & Golden, N.H. (2005). Anorexia Nervosa and Bulimia Nervosa.

Lucas A.R, Crowson C.S, O’Fallon W.M, Melton L.J (1999), The ups and downs of anorexia nervosa, International journal of eating disorder, 26(4), 397-405 DOI: 10.1002/(SICI)1098-108X(199912)26:4<397::AID-EAT5>3.0.CO;2-0

Le Grange D, Lock J, Dymek M. Family-based therapy for adolescents with bulimia nervosa. Am J Psychother 2003;57:237.

Madsen. S.K, Bohon. C, Feusner J.D (2013), Visual processing in Anorexia Nervosa and body dysmorphic disorder: similarities, differences, and future research directions, Journal of psychiatric research, 47, 1483-1491 DOI: http://dx.doi.org/10.1016/j.jpsychires.2013.06.003

National Eating Disorders Association (2005). Anorexia Nervosa, www.NationalEatingDisorders.org

National Eating Disorders Collaboration (2011). Fact Sheet, Anorexia Nervosa, www.nedc.com.au

Pike KM, Walsh BT, Vitousek K, Wilson GT, Bauer J. (2003). Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa. Am J Psychiatry;160:2046–9.

Stark, C. (2000). All about Anorexia Nervosa: A Booklet for Those Wanting to Know More about Anorexia Nervosa. Mental Health Foundation.
Steinhausen, H.C. (2002). The Outcome of Anorexia Nervosa in the 20th Century, Am J Psychiatry; 159:1284–1293

The mental Health Foundation, All about Anorexia, 1997, accessed 15/05/14, < https://attachment.fbsbx.com/file_download.php?id=676782582395145&eid=ASsdZShRFwzmTkjcoyExnyywnOMzOus_UNWaEptCly5AaoA-kJmBPJsRjtpL3V6mzd8&inline=1&ext=1400503543&hash=ASsuG0CpBj9MOMFN>

Zandian, M., Ioakimidis, I., Bergh, C., Södersten, P. (2007).Cause and Treatment of Anorexia Nervosa, Physiology & Behavior . 92, 283–290

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