The Main Symptoms of an Eating Disorder
Anorexia nervosa is classified as a severe mental illness characterized by a significant reduction in energy intake, resulting in weight loss (Stockford et al., 2018). It is an eating disorder that consists of physical and mental symptoms caused by starvation (Föcker, Knoll, & Hebebrand, 2013). It is more prominent in women, with an estimate of 94% of those diagnosed with Anorexia nervosa being female and 6% of those being male (Föcker et al., 2013). The severity of Anorexia Nervosa along with other eating disorders is often undermined in society today. Yet, this specific mental disorder has the highest mortality rate among all psychiatric illnesses, as it can result in medical complications which can be life-threatening (Moskowitz, & Weiselberg, 2017). And while many seek treatment, this specific mental disorder holds an exceptionally high relapse rate at 35% of treated patients (Gorwood, Blanchet-Collet, Chartrel, Duclos, Dechelotte, Hanachi, & Epelbaum, 2016).
Anorexia nervosa (AN) is a diagnostic term that means neurotic loss of appetite in greek (Moskowitz, & Weiselberg, 2017). The DSM-5 criteria for diagnosis states the individual must display persistent restriction of caloric intake leading to significantly low body weight along with have an intense fear of gaining weight and a disturbance of the way an individual perceives their body. (American Psychiatric Association, 2013). It is a serious mental illness that more prominent in women, with an estimate of 94% of those diagnosed with Anorexia nervosa being female and 6% of those being male (Föcker et al., 2013). It affects one in 200 American women and affects almost 5% of all college women in the United States, while effecting men as well in smaller rates (Sidiropoulos, 2007). Anorexia nervosa also has the highest mortality rate among all psychiatric illnesses, This is due to the fact that it can result in significant psychopathology along with life-threatening medical issues (Moskowitz, & Weiselberg, 2017). This is due to its symptoms associated with starvation.
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There are now two subcategories of Anorexia Nervosa which include the diagnosis of Anorexia Nervosa versus the diagnosis of Atypical Anorexia Nervosa. Anorexia Nervosa also has two different types, which include restrictive type and binge eating and purging type.(Moskowitz, & Weiselberg, 2017). Restrictive type is classified as meeting the diagnosis of anorexia while using a restrictive food intake technique, often along with excessive exercise, to keep a below average body weight (Moskowitz, & Weiselberg, 2017). Binge eating and purging type of anorexia is also maintaining a below average body weight, but through the means of binge eating and then purging the body. This is when someone consumes a mass amount of calories in one sitting, oftentimes up to a thousand calories, in a binge, then instantly ridding the body of their food intake after, which is the purging aspect. A purge can include self- induced vomiting, or misuse of laxatives, enemas, or diuretics (Moskowitz, & Weiselberg, 2017).
These are the multiple aspects of Anorexia Nervosa. With Atypical Anorexia nervosa, the same principles apply with behavior, however the difference is the weight of the patient. This category includes those close to meeting the 85% IBW cutoff for AN, and others with binge-eating disorders who were morbidly obese to begin with (Moskowitz, & Weiselberg, 2017). While the 85% below IBW cutoff was later revokes in the DSM-5, the diagnosis still stays relevant for those who are morbidly obese and are not significantly below weight, yet show unhealthy behaviors in food intake that are classified under Anorexia Nervosa (Föcker et al., 2013). These broad diagnosis guidelines are used to better treat patients and to give them better access to help in our health care system.
Symptoms for Anorexia Nervosa include, extreme weight loss, excessive exercise, fatigue, dizziness of fainting, insomnia, abnormal blood counts, irregular heart rhythms, low blood pressure, constipation, and many others that can be specific to an individual patient (Sidiropoulos, 2007). The medical complications resulting from starvation and over exercising affect almost every organ system (Sidiropoulos, 2007), leading to many serious and sometimes fatal complications, both acute and chronic. The more chronic complications are long term effects of starvation and excessive weight loss. This can include loss of gray and white matter in the brain. While the white matter can be restored with weight restoration, the gray matter loss can persist, which can have a long-term effect of cognitive function (Sidiropoulos, 2007). The muscles are also affected as well. Skeletal, smooth, and cardiac muscle responsive to hormonal changes and atrophy due to lack of nutrients. Underdevelopment and wasting of these systems leads to weakness which may result in fatigue, syncope, bradycardia, and arrhythmias (Sidiropoulos, 2007). Another long-term affect is that women who suffer from Anorexia nervosa also have higher rates of miscarriages and lower infant birth weights when compared to healthy women (Sidiropoulos, 2007). While these symptoms, both acute and chronic, do not present themselves in all individuals affected, it is important to understand the risks and severities that this specific mental disorder can lead to.
The exact etiology of Anorexia Nervosa, along with all other eating disorders is largely unknown. However, it is thought to be a combination of biological, psychological, and social factors (Moskowitz, & Weiselberg, 2017), though it is unclear which factor plays a biggest part in relevance to the mental illness. From a biological and standpoint, genes are thought to contribute anywhere from more than 50% up to 74% of the risk to developing Anorexia nervosa (Moskowitz, & Weiselberg, 2017). One tends to see a cluster in families and there was found to be an association of having a drive for thinness with chromosomes 1, 2, and 3 (Moskowitz, & Weiselberg, 2017).
Anorexia nervosa has also been found to abnormally effects the biology of the reward system pathway of the brain. This can lead to the addiction theory being applied to Anorexia nervosa in that physiological evidence shows that anorexia nervosa can be considered as a starvation addiction, driven by abnormalities of the food reward pathway (Gorwood et al., 2016). This theory was supported by the fact that appetite dysfunction (starvation and bingeing) stimulate endorphin activity in 80% of Anorexic patients, which creates dependency patterns that are also seen in individuals with an addiction to heroine (Gorwood et al., 2016). With psychological reasoning, it was found that body dysmorphia, which is a body size and shape distortion, is a core feature with Anorexia Nervosa, where patients experience their body as fat while being objectively thin (Zopf, Contini, Fowler, Mondraty, & Williams, 2016).
After researching this potential cause, it was found that multisensory body location perception is changed with Anorexia Nervosa (Zopf et al., 2016). Anorexic patients reported lower body satisfaction than those without AN; especially in the legs and stomach regions, where fat is usually found to accumulate. It was determined that body perception was found to be the leading cause and risk factor thought to cause Anorexia nervosa (Zopf et al., 2016). Body dysmorphia can also stem from the interaction of an individual in social situations. Through the correlation of social attributions to Anorexia Nervosa, it was found that individuals with Anorexia nervosa had difficulties providing social narrative and in identifying social salience (Oldershaw, A., DeJong H., Hambrook, D., & Schmidt, U., 2018). Individuals with Anorexia nervosa have also reported socioemotional difficulties as well. It was found that pre-existing difficulties in the socioemotional domain may intensify following the onset of Anorexia nervosa and may arise anew as consequences of starvation (Oldershaw et al., 2018). Yet these difficulties can persist following recover, making recovery more difficult of a process. Discovery for the direct etiology of Anorexia Nervosa can lead to efficacious treatment along with proactivity and prevention with diagnoses.
Treatment for Anorexia nervosa is difficult, due to the fact that the direct cause of the mental illness is still unknown. Oftentimes, those with Anorexia nervosa often do not want to be helped, which leads to difficulties in treatment (Gorwood et al., 2016). However, for those who do seek treatment, this specific mental disorder holds an exceptionally high relapse rate at 35% of treated patients, with the highest risk for relapse being 6 to 17 months after receiving treatment (Gorwood et al., 2016). Of those who receive treatment, a significant portion do not fully recovery from all symptoms, while up to 20% then develop chronic symptoms (Stockford, Stenfert Kroese, Beesley, & Leung., 2018). The most effective treatment is a controversial topic.
The National Institute for Health and Clinical Excellence (NICE) used a clinically assessed 5 step program to raise patients’ body weights and help regain their nutritional levels on an inpatient basis (Föcker et al., 2013). These individuals would be emitted to hospitals, stabilized with NICE program, then released, which this process applies to 50% of the patients in the United States (Föcker et al., 2013). However, these patients were only stabilized on a physiological standpoint, rather than addressing the underlying mental issues that can pertain. It is controversial as to if inpatient or outpatient care is more beneficial, with many mixed results with individuals (Föcker et al., 2013). Recovery models have proven to be unbeneficial when it comes to full recovery. They are often used instead of solely focusing on reducing symptoms in order to improve patients’ lives while supporting a healthy lifestyle. Treatment is often identified as maintaining and managing the disorder, rather than overcoming it (Stockford et al., 2018). However, recovery depend on motivation, social support, and treatment specific factors (Stockford et al., 2018).
Anorexia nervosa is a serious eating disorder that has the highest mortality rate among all psychiatric illnesses. In conclusion, this specific mental illness along with others has a need for services to move away from focusing on the physical attributes towards facilitating clients to address the underlying psychological issues of the disorder (Stockford et al., 2018). There is an evident need for primary prevention efforts, particularly by a physician (Sidiropoulos, 2007). There are multiple means to primary intervention which can include social interventions as well as individual focuses. These can include educating and counseling parents and patients at doctor’s visits along with allowing patients to have a more adequate, in depth conversation with their physician. Discussions in households and schools about proper nutrition and risks can also be helpful. It is most important to not only educate on prevention and risks, but also recognize how to take action if symptoms are observed. All of these actions are suggested in order to cause prevention to a serious mental illness and could also be beneficial in helping mental illness in its entirety.