ByEID MANSY

What is anorexia nervosa? One type of eating and psychological disorder.

a condition that goes beyond out-of-control dieting. The weight loss becomes a sign of mastery and control. The drive to become thinner is actually secondary to concerns about control and/or fears relating to one's body. The individual continues the endless cycle of restrictive eating often to a point close to starvation in order to feel a sense of control over the body. This cycle becomes an obsession and is similar to any type of drug or substance addiction.

Who is at risk for anorexia?95% of those affected by anorexia are female,It typically begins to manifest during early

adolescence, but also seen in young children and adults.

In the U.S. about one out of every 100 adolescent girls has the disorder.

Caucasians are more often affected than people of other racial backgrounds,

more common in middle and upper socioeconomic groups.

According to the U.S. National Institute of Mental Health (NIMH), an estimated 0.5% to 3.7% of women will suffer from this disorder at some point in their lives.

Who is at risk for anorexia?

Many experts consider people for whom thinness is especially desirable, or a professional requirement (such as athletes, models, dancers, and actors), to be at risk for eating disorders such as anorexia nervosa.

ALLEGRA-VERSACE a famous model with anorexia A poor self-image compounds the problem.

What causes anorexia?

At this time, no definite cause of anorexia nervosa has been determined. However, research within the medical and psychological fields continues to explore possible causes, e.g.:demands from society and families, For many individuals, the destructive

cycle begins with the pressure to be thin and attractive.

A poor self-image compounds the problem.

What causes anorexia? (cont.)Some studies suggest that a genetic

(inherited) component may play a role in determining susceptibility to anorexia. Researchers are currently attempting to identify the particular gene or genes involved.

Although no organic cause for anorexia has been identified, some evidence points to a dysfunction in the part of the brain (hypothalamus) which regulates certain metabolic processes. Other studies have suggested that imbalances in neurotransmitter levels in the brain may occur in people suffering from anorexia

How is anorexia diagnosed? Anorexia nervosa is a complicated disorder to

diagnose.

Individuals with anorexia often attempt to hide the disorder.

Denial and secrecy frequently accompany other C/O.

The individual typically does not accept that she or he has a problem (denial).

In many cases, the actual diagnosis is not made until there are other medical complications.

How is anorexia diagnosed? (Cont.)family members seek medical help only

after a marked weight loss has occurred.

Anorexics often lack insight into their problem despite being severely malnourished and may be unreliable in providing accurate information.

(So, it is often necessary to obtain

information from parents or other family members in order to evaluate the degree of weight loss and extent of the disorder.)

There are four basic criteria for the diagnosis of anorexia nervosa that are characteristic:

1)The refusal to maintain body weight at or above a minimally normal weight for age and height. Body weight less than 85% of the expected weight is considered minimal.

2)An intense fear of gaining weight or becoming fat, even though the person is underweight.

3)Self-perception that is grossly distorted and weight loss that is not acknowledged.

4)In women who have already begun their menstrual cycle, at least three consecutive periods are missed (amenorrhea), or menstrual periods occur only after a hormone is administered.

Two subtypes of anorexia nervosa:

In the binge-eating/purging type, the individual regularly engages in binge eating or purging behavior which involves self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode of anorexia (Bulimia).

In the restricting type, the individual severely restricts food intake but does not engage in the behaviors seen in the binge eating type.

What are anorexia symptoms and signs (psychological and behavioral)?

Anorexia can have dangerous psychological and behavioral effects on all aspects of an individual's life and can affect other family members as well.

The individual can become seriously under-weight, which can lead to depression and social withdrawal.

Irritability and easy upset, difficulty interacting with others.

disrupted sleep and fatigue during the day.

Most individuals with anorexia become obsessed with food and thoughts of food (think about it constantly and become compulsive about eating rituals).

Additionally, they may exhibit other obsessions or compulsions related to food, weight, or body shape that meet the diagnostic criteria for an obsessive compulsive disorder.

Other psychiatric problems are also common in people with anorexia nervosa, including affective (mood) disorders, anxiety disorders, and personality disorders.

Generally, individuals with anorexia are compliant. Sometimes, they are overly compliant, to the extent that they lack adequate self-perception.

They usually do well in school and may often overextend themselves in a variety of activities.

The families of anorexics often appear to be "perfect." Physical appearances are important to them. Performance in other areas is stressed as well, and they are often high achievers.

All of these features can negatively affect daily activities. Diminished interest in previously preferred activities can result.

Some individuals also have symptoms that meet the diagnostic criteria for a major depressive disorder.

For some Anorexics, weight loss is so severe that there is a loss of menstruation.

Medical complications for individuals with Anorexia Nervosa can be severe and even life threatening (emaciation, bradycardia, hypotension, hypothermia, impaired renal functioning and gastrointestinal problems).

If Anorexia Nervosa is left untreated, it can be fatal.

What are anorexia symptoms and signs (physical)?

Most of the medical complications of anorexia nervosa result from starvation. Few organs are spared the progressive deterioration.

Heart and circulatory system: Although not life-threatening, an abnormally slow heart rate (bradycardia) and low blood pressure (hypotension) are frequent manifestations of starvation and are commonly associated with anorexia.

Of greater significance are disturbances in the heart rhythm (arrhythmia) as prolonged QT interval.

A reduction in the work capacity of the heart is associated with severe weight loss and starvation.

Gastrointestinal complications:

Constipation and abdominal pain are the commonest symptoms.

Slow rate of food absorption. Starvation and overuse of laxatives can

seriously disrupt the body's normal functions involved in the elimination process.

Liver damage

The glandular (endocrine) system in the body is profoundly affected by anorexia with serious consequences.

Disturbances in the menstrual cycle are frequent and can affect not only fertility but also bone density, which is very important to a woman's health as she ages.

Continual restrictive eating can trick the thyroid into thinking that the body is starving, causing it to slow down in an attempt to preserve calories.

Kidney (renal) function may appear normal.

However, potassium deficiency, increased or decreased urination may occur.

Anorexics who use a large quantity of laxatives or who frequently vomit are at great risk for electrolyte imbalance, which may be life-threatening.

Anemia is frequently found in anorexic patients. Suppressed immunity and a high risk for infection are suspected, but not clinically proven.

Physical symptoms: dry, flaky skin that takes on a yellow

tinge. Fine, downy hair grows on the face, back, arms, and legs.

Despite this new hair growth, loss of hair on the head is not uncommon.

Nails can become brittle. Frequent vomiting can erode dental

enamel and eventually lead to tooth loss.

How is anorexia treated?

Anorexia may be treated in an outpatient setting, or hospitalization may be necessary.

For an individual with severe weight loss that has impaired organ function, hospital treatment must initially focus on correction of malnutrition, and intravenous feeding may be required.

A gain of between one to three pounds per

week is a safe goal when malnutrition must be corrected.

Different kinds of psychological therapy have been employed to treat people with anorexia. Individual therapy, cognitive behavior therapy, group therapy, and family therapy have all been successful in treatment of anorexia.

Those with anorexia can be treated by a medical doctor, a clinical psychologist, or both.

While no medications have been identified that can definitively reduce the compulsion to starve themselves, some of the selective serotonin reuptake inhibitor (SSRI) antidepressant drugs have been shown to be helpful in weight maintenance after weight has been gained, and in controlling mood and anxiety symptoms that may be associated with the condition.

What is the prognosis (outcome) of anorexia?

Anorexia is among the psychiatric conditions with the highest mortality rate, (6% of anorexia victims dying from complications). The most common causes of death in theses people are medical complications of the condition including cardiac arrest and electrolyte imbalances. Suicide is also a cause of death.

Early diagnosis and treatment can improve the overall prognosis. With appropriate treatment, about half of those affected will make a full recovery. Some people experience a fluctuating pattern of weight gain followed by a relapse, while others experience progressively deterioration over many years and still others never fully recover. It is estimated that about 20% of people with anorexia remain chronically ill from the condition.

As with many other addictions, it takes a day-to-day effort to control the urge to relapse. Many individuals will require ongoing treatment for anorexia over several years, and some may require treatment over their entire lifetime.

The anorexic girl, aged 19, was admitted to hospital & placed under treatment Two months later, she had returned to her normal body weight & had established good eating habits

PEARLS for AnesthetistsWhile anesthetizing Anorexic patients, we have to

pay attention to:1- Hypotension, bradycardia and arrhythmias.2- Hypokalemia, hypomagnesaemia, hypocalcaemia

and acidosis with other electrolyte disturbances and their subsequent effects.

3- dehydration and hypoglycemia.4-hypoalbuminaemia.5- complications and end organ damage as:

starvation ketosis, anemic heart failure , renal and liver failure.

To summarize!Anorexia nervosa is an eating disorder and a psychological

disorder. The cause of anorexia has not been definitively established, but

self-esteem and self-image issues, family dynamics, societal pressures, and even genetic factors may each play a role.

Anorexia affects females far more often than males and is most common in adolescent females.

The disorder affects about 1% of adolescent girls in the U.S. People with anorexia tend to show compulsive behaviors and

may become obsessed with food. The extreme dieting and weight loss can lead to a potentially

fatal degree of malnutrition. Other possible consequences of anorexia include heart-rhythm

disturbances, digestive abnormalities, anemia, and hormonal and electrolyte imbalances.

The treatment of anorexia must focus on more than just weight gain.

The prognosis of anorexia is variable, with some people making a full recovery. Others experience a fluctuating pattern of weight gain followed by a relapse, or a progressively deteriorating course.

As with many other addictions, it takes a day-to-day effort to control the urge to relapse, and long-term treatment may be needed.

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