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Anorexia or anorexia nervosa is characterized by abnormal concepts of body image that cause changes in eating behavior and results in significant physical and psychological impairment. Hence it is a component of the eating disorders that afflict women predominantly. The concern associated with anorexia stems from the fact that besides comorbid psychiatric conditions, it has an impact on the health status if the individual afflicted with the disorder, resulting in long-term health consequences like heart disease, kidney failure and the increased risk of an early death. Knowledge of anorexia assists in understanding the disease and the means to the evolving of effective treatment strategies to combat this disease.
Overview of Anorexia Nervosa
Knowledge of the existence of the disorder goes back to the 1600s, when it was described as a nervous condition that caused sadness and anxious cares. The term anorexia nervosa was given to the disease in 1873, when it considered a perversion of the ego. Levey, Williams-Wilson, and Curfman, 2006, currently define anorexia nervosa as “characterized by the individual’s refusal to maintain minimally normal body weight, an intense fear of gaining weight, and significant disturbance in the perception of the shape or size of the body. Additionally, postmenarchal females with this disorder are amenorrheic (ie, exhibit the absence of at least 3 consecutive menstrual cycles)”.
The DSM –IV characterizes anorexia nervosa as a refusal of the individual to maintain body weight at or above minimal normal weight for age and height. This has led to the general practice of considering an individual to have anorexia nervosa on the basis of individual weight basis, when weight drops to less than eighty-five percent of the ideal body weight based on height and age. Body image distortion, wherein the individual has an inaccurate perception of body shape and size is considered to be the cause of the intense fear of gaining weight or becoming fat witnessed in individuals with anorexia nervosa. Anorexia is subdivided into two types. The first is the restrictive type, wherein intake of food is severely limited. The second type is the binge-eating or purging type that is characterized by on a regular basis indulge in gorging on food or binge-eating followed purging behaviors through self-induced vomiting, abuse of laxatives, diuretics or enemas.
Anorexia is not a very common disorder with between five to ten cases per hundred thousand people being the incidence rate. However in present times this incidence is found to be increasing. Females account for more than ninety percent if the incidence of anorexia, and hence anorexia has been essentially considered a disease of females. In the United States of America one out every one hundred to two hundred females in late adolescence or early childhood are found to be affected by with anorexia. Generally anorexia is seen to start in early adolescence or teenage and in early adulthood, but this does not rule out an earlier or later occurrence. The mortality rate associated with anorexia is quite high ranging between six to twenty percent of individuals afflicted with it. The usual causes of death in due to anorexia nervosa are starvation or suicide. Additional causes of death include electrolytic issues or infections arising from the vulnerability of the weakened body of the individual afflicted with anorexia. With anorexia essentially a disease associated with females, it is the female population that suffers mostly from the consequences of anorexia nervosa.
Females and Anorexia Nervosa
With anorexia nervosa founded in distorted body image perception, it is natural that women are more prone to anorexia than men. The importance of physical appearances goes back to ancient times, wherein beauty, size and muscularity were considered elements of health and fertility in the culture of ancient societies. In those times beauty in women was not restricted to being slim, but rather a more ample physical appearance. This was due to the requirements of manual labor being a part of the daily routine of a woman, and the need to produce many children. To the ancient Greeks the perception of an ideal lay in small chin, delicate jaws, full lips, a small nose, large and widely spaced and a waist-to-hip ratio of 0.7.
From that has evolved the moral worth that has been assigned physical appearance in societies around the world. Individuals with good looks are believed to be able more easily to get married, be hired, get better wages or salaries, and get promoted earlier. Pretty women find it easier to get help, when in distress, and are less likely to be reported, caught, accused, or punished for minor and major crimes.
Current western cultures have placed great emphasis on the value of women’s bodies and appearance above any other attributes of a woman. Slimness in body shape is the attribute of value for females in modern society. This emphasis has been disseminated through the ever pervasive mass media to saturate every segment of society, such that females living in this culture are largely affected by it. Pervasion of this value of a woman’s body has been so intense that females indulging in diet, exercise, applying cosmetics and even bewildering range of surgical procedures are commonly seen in many cultures around the world. Medical technology has provided the means and women are willing to go through the painful procedures like surgery for the correction of body shape and liposuction for the removal of fatty deposits in the craving for the ideal body shape. This high value given to body shape has reflected in an increasing distortion in the perception that women have of their bodies and the enhanced desire to do anything to have and maintain a slim body. Such is the pervasion of the value for a slim body that anorexia, which was traditionally considered an affliction of teenage and young adult females, no longer holds true, as women of all ages living in Western societies are at potential risk for anorexia.
In a female with anorexia it is believed that disturbances of the serotonin (5-hydroxytryptamine or 5-HT) pathways have occurred. This belief stems from the understanding that the modulation of a number of behaviors normally associated with anorexia, like behavioral inhibition, obsessionality, anxiety and fear, depression, and appetite regulation are contributed to by the serotonin pathways. This reasoning for the basis of the addictive eating behavior associated with anorexia has found support in recent research findings, wherein stimulation of serotonin 5-HT receptors led to anorexia-like behavior in mice.
Genetics has a role play in the development of anorexia nervosa in females. Evidence to this is emerging, and potential risk for females developing anorexia, as an attribute of the influence of genetic factors has been placed at a high of fifty-six percent.
In its early stages there are no external manifestations of anorexia, and it is the physical signs that make it possible to identify anorexia in women. These physical signs include an obvious low body weight with a body mass index that is less than 17, loss of muscle mass, dry hair and skin, an unusual growth of body hair called lanugo, and cold hands and feet. Abnormal vital body parameters normally seen are a slower than normal heart beat and low blood pressure. Anorexic females who binge eat and indulge in vomiting display swollen lymph nodes and dental caries.
The consequences in the later stages for females with anorexia are severe and result from starvation and malnutrition. Amenorrhea is a cardinal sign of anorexia and results from the decreased production of estrogen, as a result of the increased production of follicle stimulating hormone and luteinizing hormone. Estrogen deficiency coupled with inadequate calcium intake is the common cause for osteoporosis seen in female anorexic patients. In anorexic females there is a reduction in vasopressin secretion, causing difficulty in concentrating urine and hence the appearance of diabetes insipidus. Reduced food intake leads to deficiencies in zinc and magnesium, causing gastric distention and depression. The cardiovascular changes are also significant and include shrinking of the left ventricle, decrease in cardiac output, bradycardia, hypotension and a range of arrhythmias. Renal effects are seen in the decrease in glomerular filtration rate, leading to swelling particularly in the lower limbs. Other clinically significant manifestations include a generally diffused fatty liver, anemia, leukopenia, and thrombocytopenia. All these complications make anorexia a female psychiatric disorder with one of the highest mortality rates. Less than fifty percent of females afflicted with anorexia recover from the disorder, and those that demonstrate poor capability of social and work functioning possibility from the anxiety and depression that persists. The shorter the duration the disorder the better chances of recovery, making early detection and adequate treatment important.
Several treatment options like hospitalization, family therapy, cognitive-behavioral therapy, and pharmacological therapy are available for treating female anorexia. However these treatment options do not fulfill the requirements and gaps in the treatment options are present. These treatment options appear more useful in treating the other eating disorders, and prove less promising for females with anorexia nervosa. Yet Ben-Tovim, 2003, points out that treatment programs have essentially remained the same for decades.
Anorexia nervosa is caused by the distorted perception that a female has of her body size and body image. Such a craving for an ideal body shape and size has been enhanced, because of the social value that has been provided to it by society, and disseminated by mass media. The concern for anorexia in women stems from the poor recovery rate and severe complications associated with it. The poor recovery rate may lie in the gaps in treatment options available for anorexic female. The treatment options, however, have remained the same for many years.
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