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     Volume 5 Issue 84 | March 3, 2006 |

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Anorexia Nervosa

Anorexia nervosa (anorexia) is an eating disorder with both physical and emotional traits. A person with anorexia is very underweight, yet the person severely limits the amount of food he or she eats, has a distorted body image, cannot maintain a healthy body weight, and is intensely afraid of gaining weight. Long-term or severe anorexia can lead to starvation, serious health problems, and even death.

Anorexia can become a lifelong illness, although it is possible to fully recover with proper treatment. It may develop from a combination of biological, psychological, and social triggers.

Recent studies have shown an increased risk for developing anorexia if a biological parent, sister, or brother has the condition. However, a genetic link may be only part of the cause. Other factors include certain personality traits and cultural and social pressures. Stressful life events, such as moving, divorce, or death of a loved one, may also trigger anorexia.

Common feelings and actions linked to anorexia nervosa include:
- Intense fear of gaining weight.
- Restricting food or types of food, such as food containing any kind of fat.
- Weighing less than 85% of expected body weight. (In a child or teen, losing or not gaining weight during a growth spurt is a concern.)
- Seeing your body as overweight, in spite of being underweight (this is called a distorted body image).
- Over-exercising.
- Secrecy around food and not seeing or wanting to talk about a problem with eating or weight loss.

Anorexia often begins with an intent to diet normally to lose a few pounds but escalates when the person becomes obsessed with the diet and limits food more than is healthy. As time goes on, the person restricts the amount and types of food eaten. Food restriction is usually not just about dieting but about the need to control something in life; the person feels a sense of power when controlling thirst and hunger.

People who have anorexia also become socially withdrawn and lose interest in the outside world.
As the illness advances, irrational behaviours begin, such as:
- Making rules about food--for example, eliminating dairy products or meat, because they are perceived as "high-calorie."
- Creating rituals about how food should be eaten--chewing food a certain number of times.
- Developing a fear of foodfearing a weight gain if any food is eaten at all.
- Losing the ability to feel hunger.
- Exercising too much, to the point of injury.
- Taking laxatives or water pills (diuretics), or inducing vomiting from fear of gaining weight.
A person at risk for anorexia may have:
- A history of eating disorders in a first-degree biological relative, such as a mother, sister, or especially a twin.
- Certain personality traits, such as perfectionism and low self-esteem.
- Certain cultural and social pressures, particularly family conflict.
- A history of sexual or physical abuse (although not all abuse victims develop eating disorders).
A parent may have cause for concern if:
- A child expresses concerns about weight at a very young age.
- An adolescent girl who is overweight receives compliments as she begins to lose weight.
Call a doctor if someone you love:
- Shows signs of anorexia, including rapid weight loss, refusal to eat, being overly concerned about weight, inducing vomiting, or abusing laxatives or diuretics.
- Sees himself or herself as fat and continues to diet in spite of being considered too thin by other people.
- Has lost a lot of weight and cannot stop losing weight.
- Is female and is not having menstrual periods.
- Exercises so much that injury is occurring and yet does not stop exercising.
- Is very afraid of gaining even a small amount of weight, and this interferes with eating healthy meals.
- Has been diagnosed with anorexia and feels dizzy, has trouble sleeping, or has symptoms of depression or anxiety.

Treatment Overview:
All people with anorexia need treatment. The goals of treatment are to restore a healthy weight and eating behaviours and to eliminate the physical and mental problems associated with malnutrition, such as osteoporosis or depression. Correcting abnormal thoughts, attitudes, and behaviours related to the eating disorder is also part of the extended treatment.

Ideally, treatment is provided by a team including a mental health professional, a doctor, and a nutritionist. Depending on the severity of the condition, initial treatment usually includes:
- Restoring a healthy weight. Achieving a more healthy weight often lessens or eliminates eating disorder symptoms, such as hoarding food or obsessive-compulsive behaviours. Professional counselling, to help a person see that he or she has a problem, help improve body image, and focus on relationship problems, usually through individual counselling and family therapy.
- Nutritional counselling, to help establish healthy eating patterns and a better understanding of good nutrition.
- Treatment of other conditions that frequently occur along with anorexia, such as depression or heart problems. Having another disease or disorder along with anorexia complicates treatment and may extend the duration and intensity of treatment.

There is no known way to prevent anorexia. Early treatment may be the best way to prevent the disorder from progressing. Knowing the early signs and seeking immediate treatment can help prevent complications of anorexia nervosa.

Recent research indicates that the medication fluoxetine (such as Prozac) may help reduce relapse of this disorder. Seeking early diagnosis and treatment can play a significant role in preventing the illness from progressing to a more serious condition.

While there is no way to prevent anorexia, there are many ways adults can help children and teens develop a healthy view of themselves and learn to approach food and exercise with a positive attitude. Doing this may prevent some children and teens from developing anorexia.

Continuing good care at home will aid in recovery from anorexia. Individual goals will be set by the person's doctor, mental health professional, and nutritionist. Some of the goals include:
- Learning new eating behaviours.
- Emotional self-care.
- Developing trust in people who are trying to help you.
- Family members will also need to support the person's mental and physical goals for healing. Learning about the disorder will be helpful for family members as well as the person with the disorder.

Professional counselling is a very important part of recovery from anorexia. Individual counselling is frequently required for up to a year and may take as many as five to six years to fully provide relief from the psychological characteristics of the condition.Seven Professional counseling usually is not started until after the person is out of a nutritional crisis since the person may temporarily lack the skills of reasoning or understanding. Types of professional counseling that are effective in treating anorexia include:

Psychological counselling. Cognitive-behavioural therapy (CBT) may be used to treat anorexia. CBT teaches how to change attitudes and behaviors about eating, weight gain, and recovery. While it is proven effective in treating other eating disorders (such as bulimia nervosa), research is ongoing to confirm its effectiveness in treating anorexia. Usual CBT treatment consists of 20 counseling sessions over several months, although with anorexia, the need for treatment may continue for years rather than months.

Group counselling. Working with other people who have anorexia can be very helpful. People with the disorder can share triumphs and setbacks, offer encouragement, and make meaningful comments that might be helpful. However, it is important for the person to continue individual professional counseling in addition to attending group counselling.

Family therapy. Sometimes family members unknowingly interfere with recovery from anorexia. Family therapy educates the entire family about anorexia and can be quite effective in treating this disorder. Initially, it can help the person with anorexia regain weight. Eventually, family therapy focuses on dealing with other family issues.

It is very important for people who have anorexia to receive nutritional counselling. A registered dietician helps design a diet plan. The dietician tries to shift the focus from counting calories to eating foods the person likes, in a relaxed and enjoyable setting. People with this illness need to gain weight each week until they reach a healthy weight for their height. Then it is important for them to stay at a comfortable weight. To help with weight gain, liquid food supplements may be used.



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