Anorexia Nervosa DSM-IV Criteria for Anorexia Nervosa A) Refusal to maintain body weight at or above a minimally normal weight for age and height. Weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make weight gain during period of growth leading to body weight less than 85% of that expected. B) Intense fear of gaining weight or becoming fat even though under -weight. C) Disturbance in the way one’s body weight or shape is experienced undue influence of body weight on self -evaluation or denial of the seriousness of the current low body weight. DSM-IV) The Diagnostic and Statistical Manual contains 3 eating disorders Anorexia Nervosa Bulimia Nervosa and Eating Disorder Not Otherwise Specified. Although Anorexia Nervosa (AN) will be the focus of this report it is worth noting the 3 disorders are very similar and in fact Eating Disorder Not Otherwise Specified is the name given to the disorder when only 1 criterion for AN is missing for example if a patients weight loss is still in the normal range despite significant weight loss or if a patient still menstruates.
Bulimia Nervosa is when the patient excessively over-eats and purges but does not experience significant weight loss. (Franco 2012) Main Symptoms The main symptom is extreme thinness that has no medical cause and usually a pre-occupation with food. AN seems like a physical illness when in fact it is a psychological one. Heart-rhythm disturbances digestive abnormalities bone density loss anemia and hormonal and electrolyte imbalances are the most common physical symptoms and in severe cases organ failure can lead to death.
The patient will very rarely present to the Doctor for treatment alone due to denial of having a problem being an intrinsic part of the illness. Young patients will often be taken to the Doctor by a concerned parent with the usual symptoms being a sudden withdrawal from family or friends and a lack of interest in formerly enjoyed activities as well as significant weight loss. (Phillips 2010)Bulimia and AN go hand in hand with many overlapping symptoms such as disordered thinking. Up to 50% of patients with AN develop bulimia and a smaller percentage of patients who are initially bulimic develop AN. ” (Franco) AN sufferers have an extremely distorted perception of themselves. Where others may see a once beautiful girl wasting away the patient may perceive that she is succeeding at looking after herself and has enormous self -control that others lack. (Watters 2010) Men or boys who have AN tend to have other psychological problems while women and girls are more likely to be perfectionist and displeased with their bodies. Dryden-Edwards 2012) Bio-Psycho-Social Factors AN is the most obvious physically but attempting to treat just the biological symptoms will have little long term effect. Studies suggest social factors are what cause AN and indeed AN is little known in non-industrialised countries that do not subscribe to a Hollywood ideal of beauty which is easy to see is unattainable by the average person due to the unrealness of it. Not even the celebrities look like their on-screen personas in real life thanks to photo shopping and professional make-up artists.
It’s good to see Australian teen magazines are helping their target audience develop a healthy body image by having something called “a reality check alert”. If the magazine is sent a celeb picture that has already been re-touched they will print a little disclaimer next to it reminding their readers it’s not natural. A healthy body image is the first step to preventing AN and Bulimia. Edward Shorter a medical historian working today believes that illnesses like AN “are a culturally agreed-upon expression of internal distress’.
Richard Gordon writes in Eating Disorders-Anatomy of a Social Epidemic “Individuals with pre-existing mood or anxiety disorders or a whole host of under-lying psychopathologies or developmental vulnerabilities histories of sexual abuse or familial concerns with weight control may be pre-disposed to adopting such culturally sanctioned behaviours as modes of managing unbearable levels of distress. ” (Watters 2010) This means that social factors are probably the most important aspect of why this particular illness developed but the propensity to develop a culturally specific disorder came from psychological issues.
This does not make the illness any less real or deserving of medical care just that practitioners need to develop a care plan based on a holistic approach and recognise that the starvation is secondary to psychological issues. The quotes are not meant to downplay the role body image has in the illness but there may be more at stake than poor body image that the sufferer has poorly defined feelings of inadequacy that find a culturally recognised home in AN. AN has the highest incidence of suicide than any other mental illness and sufferers are 32 more times likely than average to commit suicide. Butterfly Foundation) Past Treatment Anorexia-type symptoms began presenting to doctors in adolescent girls during the 1850’s at the height of the Hysteria epidemic. At first it was a strange manifestation of the well -known women’s illness (well known at the time-it has disappeared from the medical canon today) but by 1860 it was becoming common for young women to starve themselves. In 1873 the model for AN that we would recognise today became well known but with the name Hysterical Anorexia.
Treatment was usually hospitalisation with Doctors reporting being perplexed that their patients did not seem to want to get well. Treatments in the 1970’s tended to conform to the medical model with enforced hospitalisation and force feeding. (Watters 2010) Today’s Treatment Today individual and family counselling is just as important as nutrition education. Many sufferers display perfectionist tendancies so Cognitive Behavioral Therapy seems to be the most effective treatment in helping sufferers understand their irrational thought patterns.
The average patient suffers from AN for 7 years and while 5% of the population may have AN at any time the illness has a 15%-20% mortality rate (Butterfly Foundation) which makes it the highest mortality rate of any mental illness so early detection and treatment is essential for a positive prognosis. Significant Behaviours One of the hardest behaviours for family and friends of sufferers to understand or come to terms with is the patients preoccupation with food but refusal to eat it.
The sufferer shows signs of being compulsive when it comes to food working out how many calories each portion of food contains and devising a diet and slavishly sticking to it and punishing themselves if they eat too much for example an unplanned piece of birthday cake. AN sufferers are often addicted to exercise and will exercise up to 6 hours a day. AN sufferes necessarily have to lie to family and friends about their behaviour and this can create another level of strain on the patient as they are often high achievers and “good girls” and in fact sufferers redominately come from the middle and upper socio-economic classes and more often than not have high levels of academic success. (Dryden-Edwards 2012) Personal Qualities and Professional Skills As a case worker one needs to be prepared to work with family and friends of your client in a way that you may feel conflicts with confidentiality issues. The important thing is keeping your client alive while helping her find a psychiatrist or psychologist who can help her get to the bottom of the underlying issues.
A lot of patience will be required on a personal level and if you feel the impulse to grab your client and shake her and cry “why won’t you eat dammit” perhaps a little research won’t go astray. The otherside to that is not to become too emotionally involved. Hopefully her family and friends are a strong support but otherwise find out about support groups for your client but beware the “pro-ana” groups’ that are trying to turn an illness that claims many beautiful young people and turn it into a lifestyle choice. 1225 words References and Bibliography “Mum Please Help” Phillips Karen Webster Irina MD.
Clearview Books 2010. “Crazy like us- The Globalization of the American Psyche” Watters Ethan. Free Press 2010 “Case Studies in Abnormal Psychology” Oltmanns Thomas F. Neale John M. Davison Gerald C. John Wiley & Sons 2003 “Anorexia Nervosa” Dryden Edwards Roxanne MD http:www. medicinet. com Retrieved 10/11/2012 “Eating Disorders” Franco Kathleen N. http: www. clevelandclinicmeded. com Retrieved 10/11/2012 “DSM-IV Diagnostic Criteria for Anorexia Nervosa” Taken from DSM-IV http: www. medicalcriteria. com Created 3/7/2005 Retrieved 10/11/2012 www. butterfly foundation. com Site dedicated to education about Anorexia
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