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Anorexia Nervosa
Anorexia Nervosa
Diagnosis and the Road to Recovery
Amy Jones
Lifespan Nutrition, T/R 11:00
Prof. Dunn-Frederick
November 10, 2013
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Anorexia Nervosa
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Anorexia nervosa is one of the most devastating and misunderstood
psychiatric disorders that affect “1/200 Americans in their lives (three-quarters of
them female)” (Miller, 2009). Although so profound in the American population, the
majority of people struggle to understand how an eating disorder such as Anorexia
can affect not only the individual, but the individual’s family and relationships with
others as well. It is very difficult to treat anorexia and complete full recovery, and
typically affects individuals for the majority or rest of their lives due to its lifeconsuming nature. According to the Agency for Healthcare Research and Quality
(AHRQ), the prevalence and severity of Anorexia in current populations has risen
substantially in the population since 2000, accounting for approximately 37% of
hospitalizations from 2005-2006 (Miller, 2009). The purpose of this paper is to
explain the major components, health problems and treatments currently available in
the following subset order:
1) Diagnosis and Explanation of the Disorder
2) The impact on the individual’s life and health
3) The treatments currently available to those with the disorder.
The reader will then be able to identify the symptoms of Anorexia, and understand
the many physical and psychological components of the disorder. Common
misunderstandings will be explained; focusing on the severity of the disease and the
painful road that is recovery.
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Diagnosis and Explanation of Anorexia Nervosa
Anorexia Nervosa is a psychological eating disorder categorized by extremely
restrictive patterns often until the point of starvation in order to achieve or maintain
and body weight that is considered thin to the individual. There are two subtypes of
Anorexia: 1) the Restrictive subtype, which refers to the strict caloric intake and strict
diets that the individual follows characterized by an extremely low BMI to the point of
emaciation; and 2) the Binging and Purging subtype, where a person with Anorexia
also binges and purges (eats a very large amount at one time and then attempts to rid
the body of the calories through vomiting or laxative drugs). This is similar to the
Bulimia nervosa (another eating disorder), but whereas Bulimics fall within the
normal to high BMI range a Subset 2 Anorexic has the very low BMI associated with
Anorexia and the binging and purging of Bulimia (Feingold, 174). The form that most
people associate with Anorexia is subset 1, yet each is equally devastating.
The diagnosis for Anorexia Nervosa is from the Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition (DSM-IV), published by the American
Psychiatric Association in 1994 (Feingold, 174) as follows:
1) Refusal to maintain a body weight at or above a minimally normal weight for
age and height. This is called the ‘relentless pursuit of thinness.’
2) Intense fear of gaining weight. This is called ‘fear of fatness.’
3) Disturbance in the way one’s body weight or shape is experienced.
This is called ‘body image distortion’ and some researchers consider this to be the
underlying disorder in all eating disorders. Body image distortion is a mental
disorder.
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4) In menarchal females, absence of menstrual periods for three consecutive
menstrual cycles, unrelated to hormonal pharmaceuticals.
Individuals may have all diagnosis characteristics are just some of the characteristics
in order to be diagnosed with the disease.
The majority of diagnoses occur after age 8, with many cases developing
between the ages of 15-18 (Miller, 2009). This is due to a variety of factors, including
family environment, social influences, genetic predispositions, and perfectionist or
obsessive-compulsive tendencies (Harvard Medical School). A strong research
emphasis is being put on the American societal ideal of “thinness” projected upon
teen girls and women through countless media sources on a daily basis. “These
external cues may lead a susceptible individual to lose weight, which in turn sets in
motion an escalating obsession with restrictive eating and body size” (Miller, 2009).
The Impact of Anorexia on the Individual’s Health
Due to the starvation that occurs as a result of such restrictive caloric intake,
many health problems result from Anorexia, including death. These problems include
but are not limited to:
The development of life-threatening complications, such as cardiac
arrhythmias, kidney failure, and liver failure. This is one reason that
anorexia nervosa is one of the most deadly psychiatric disorders, killing
5.6% of patients for every decade that they remain ill. Treatment is
challenging because starvation not only severely damages the body, but
also harms the brain—causing changes in thinking, emotions, and
behaviors that may be difficult to reverse (Miller, 2009).
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The strict eating patterns and extremely low caloric intake amongst restrictive
anorexics has a direct impact on bone health due to the lack of nutrition to support
the body and muscles. According to Halverson et. al., of the Regional Dept. of Eating
Disorders in Norway, “adolescence is a crucial period for the acquisition of bone mass.
Most bone mineral is accumulated during the teenage years, and additional gain in
bone mass declines rapidly by late puberty. Thus AN [Anorexia Nervosa] during
adolescence is particularly harmful for future bone health and strength, and many
young patients with AN will never reach their expected bone mass” (2012). In a study
by Halverson et. al. in 2012, the bone mineral density (BMD) in the hip and spine of
recovered anorexics was significantly lower in correlation with low body weight (BMI
<19; 31% of study participants) even with long-term recovery from the disorder. The
study also found that 33% of participants had osteopenia of the hip/spine, and 8%
had early osteoporosis as well as significantly low BMD in the hip and spine.
Not only does the disorder emaciate and destroy the body, but the brain and
psyche as well. Starvation completely changes the way the brain is wired according to
scientists who recently have compared the brain scans of anorexic women with the
brain of someone with adequate nutrition (Rosen, 2013). Now, a major question has
arisen whether a certain brain wiring causes a predisposition to develop the disease
or whether starvation permanently changes the brain wiring:
Using brain imaging tools and other methods to explore what's going on
in patients' minds, researchers have scraped together clues that suggest
anorexics are wired differently than healthy people. The mental brakes
people use to curb impulsive instincts, for example, might get jammed
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in people with anorexia. Some studies suggest that just a taste of sugar
can send parts of the brain barreling into overdrive. Other brain areas
appear numb to tastes -- and even sensations such as pain. For people
with anorexia, a sharp pang of hunger might register instead as a dull
thud (Rosen, 2013).
This is profound insight into the way anorexia changes the thought processes of the
brain may have an extremely beneficial impact on therapy for individuals suffering
from the disease.
Researchers and therapists have come to realize that people who develop
anorexia had a history of perfectionist behaviors and rigid practice regimens
throughout their lives. "It's very rare for me to see a person with anorexia in my office
who isn't a straight-A student," Lock says. Even at an early age, people who later
develop the eating disorder tend to exert an almost superhuman ability to practice,
focus or study. "They will work and work and work," says Lock. "The problem is they
don't know when to stop" (Rosen, 2013). Another key factor researchers consider is
the possibility of the reward center of the brain becoming re-wired through the
process of developing the disorder. The natural brain connections between food and
pleasure become replaced, rerouting the connection between food and pleasure,
while connecting the thought of skipping meals to the pleasure center of the brain
(Rosen, 2013). In fact, anorexics may register the mood-boosting chemical dopamine
entirely differently than healthy people. In a research situation, psychiatrist and
neuroimaging researcher Ursula Bailer discovered that when given to normal healthy
people, dopamine created intensely pleasurable feelings in the brain. In contrast,
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when given to anorexics, dopamine caused an intense amount of anxiety. The
connection between anxiety and dopamine-inducing appetitive foods may be able to
explain the extreme discomfort and anxiety felt by anorexics presented with a certain
“bad” food (Rosen, 2013).
Treatment Currently Available to those with Anorexia
Although brain wiring may contribute a lot to the development and
permanence of the anorexia in individuals, it is not impossible for people to undergo
treatment and recover. However, it is an extremely hard road to travel, and takes a lot
of work for both the anorexic and his/her family. One major stumbling block to
families coping with a member’s ED is the stigma associated with the disorder. In a
study by Sims & Matthews published in the Journal of Child and Family Studies (2013)
found that compared to the family functioning and understanding of girls with
anorexia nervosa in comparison to girls with type 1 diabetes, mothers viewed
anorexia as less understandable, less chronic, and less controllable than the mothers
with diabetic children. The stigma associated with an eating disorder, specifically
anorexia, is that the individual can simply stop starving themselves, and that they
simply wish to be thin. It is not viewed as a “real” disorder by the general public,
despite the fact that anorexia nervosa is the most deadly of psychiatric disorders
(Miller, 2009). The stigma is so harsh in today’s society that “patients and parents
may feel to blame for the condition, an added burden presumably not carried by
patients with a medical condition” (Sims & Matthews, 2012). "’One of the biggest
problems is that people do not take this disease seriously,’ says James Lock, an eating
disorders researcher at Stanford University who co-wrote the book on family-based
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treatment. ‘No one gets upset at a child who has cancer,’ he says. ‘If the treatment is
hard, parents still do it because they know they need to do it to make their child well’"
(Rosen, 2013). Therefore, if the family cannot perform a functional and positive role
in the recovery form anorexia, the chances of recovery for that child are very low.
One treatment in particular does not work if the individual wishes to recover
completely. Treatment can be in the form of outpatient care or hospitalization
depending on the severity of the case (Miller, 2009). According to Miller of the
Harvard Medical School, when “an adult loses 15% of his/her ideal body weight
he/she will require inpatient treatment or a highly structured outpatient program.
Because children and adolescents are at risk for suffering irreversible developmental
damage if they are malnourished, inpatient care may be necessary even before they
reach the 15% weight-loss threshold” (2009).
Due to the changed psyche that results from the ED, many sufferers of anorexia
may refuse treatment due to an intense fear of gaining weight. In this case, one of the
most effective treatments involves the entire family and the patient her/himself.
“Clinicians often combine positive reinforcement—such as praising weight gain and
linking privileges to target weights—with close monitoring such as having someone
sit with the patient to ensure that he/she eats, and weighing her regularly. A major
challenge is carrying out this phase of treatment in a sympathetic, rather than
punitive, manner” (Miller, 2009). Although hospitalization does lead to weight gain
for most individuals, upon returning home the majority of anorexics lose the weight
again since the mental components of the disease remain (Rosen, 2013).
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Family based treatment is considered the most effective treatment for
adolescent anorexics. The program developed by Walter Kaye, called Family-BasedTreatment (FBT) teaches anorexics and their families how to deal with and treat the
disease (Rosen, 2013). FBT is considered very successful: “A year after therapy, about
half the patients treated with FBT recover” (Rosen, 2013). 50% is a grim statistic
considering that it is the best-case scenario for recovery. However, since AN is a
psychiatric disease, it is extremely hard to fully recover from. Some medications are
prescribed to deal with anxiety and depression amongst anorexics, but these do not
fix the problem or the behaviors. Antipsychotics and psychotherapy are sometimes
used to avoid relapse (Miller, 2009), but no medication is currently available to
successfully treat the disorder.
The hope for finding a cure to anorexia lies in furthering research amongst
adolescents with eating disorders and their families. Society’s standards and the
media certainly bombard children on a daily basis of what “perfection” looks like,
setting up adolescents to fail in regards to self-esteem and body image. Until society
can change and the stigma associated with anorexia nervosa is diminished, the future
prospect of a full recovery for sufferers will remain low and grim. Until then,
programs such as FBT will serve to treat the disorder. However, nothing will change
until anorexia nervosa is taken seriously for what it is: an extremely dangerous and
deathly psychiatric disorder that quietly destroys the lives of those who suffer from it.
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References
Feingold, E. 2005. Treating people with eating disorders with homeopathy. American Journal
of Homeopathic Medicine, 98, 3, 174-178.
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Hall, L. & Ostroff, M. 1998. Anorexia Nervosa: A guide to recovery. Eating Disorders Research
Catalog, Gurze Books. 2013.
Halvorsen, I., Platou, D., & Hoiseth, A. 2012. Bone mass eight years after treatment for
adolescent-onset anorexia nervosa. European Eating Disorders Review, 20, 5, 386-392.
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Miller, M., MD (Ed.). 2009. Harvard Medical School. Treating Anorexia Nervosa. Harvard
Mental Health Letter, 26.
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Rosen, M. 2013. The Anorexic brain: Neuroimaging improves understanding of eating
disorder. Science News, 184, 3, 20-24.
http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=89468706&site=e
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Sim, L., & Matthews, A. 2013. The role of maternal illness perception in family functioning in
adolescent girls with Anorexia. Journal of Child and Family Studies, 22, 4, 541-550.
http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=86879443&site=e
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