Refusal Anorexia Nervosa Diagnostic Criteria Refusal to maintain body weight at or above a minimally normal weight for age and height (e. g. , weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected). Intense fear of gaining weight or becoming fat, even though underweight. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. In postmenarcheal females, amenorrhea, i.

e. , the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e. g.

, estrogen, administration. ) Specify type: Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i. e. , self-induced vomiting or the misuse of laxatives, diuretics, or enemas) Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i. e. , self-induced vomiting or the misuse of laxatives, diuretics, or enemas) GENERAL SUMMARY Anorexia nervosa is an eating disorder that usually strikes women.

Of the 7 million women aged 15 to 35 who have an eating disorder, many will die from the complications of anorexia. Probably the most famous case is that of Karen Carpenter, who died from heart failure resulting from anorexia nervosa. This disease can be defined as self-starvation leading to a loss of body weight 15% below normal, accompanied with hyperactivity, hypothermia, and amenorrhea. Hypothermia results when the body's natural insulation (fat stores) become non-existent and the victim becomes cold all the time. Amenorrhea is the absence of at least three menstrual cycles — this is also affected by the loss of fat stores in the body. Anorexia may not be noticed in the early stages because it often starts as an innocent diet.

They often become hyperactive because they exercise frantically in an attempt to burn calories to lose weight. In the later and more dangerous stages, the disease may not be noticed by family members because the anorexic usually wears layered and baggy clothes. Even though the anorexic is emaciated, she still feels "fat' and wants to hide her "ugly, fat body.' An anorexic may have ritualistic eating patterns such as cutting the food into tiny pieces and weighing every piece for food before she eats it. These behaviors can be found in people who are on a normal, healthy diet, but in anorexics these behaviors are extremely exaggerated. A number of research projects involving experimen- tal preventive measures have been reported in the current medical literature. Some of these experiments may prove to be helpful either in reducing the risk of anorexia nervosa, or perhaps preventing it altogether: (1) instruction on the harmful effects of unhealthy weight regulation; (2) intervention with programs of weight regulation by practicing sound nutrition and dietary principles and beginning a regimen of aerobic physical activity; and (3) development of coping skills for resisting the diverse sociocultural influences that appear linked to the current popular obsessions with thinness and dieting.

Current Research There are many reasons as to why women develop anorexia nervosa. One is that it is dieting taken to a dangerous extreme. Another is that societal pressures dictate a woman be thin in order to be beautiful — the "waif look' was recently popular. But what these theories come down to is an issue of control. Whatever else is going on in the anorexic's life, the one thing that she feels she can control is food. When problems in the family contribute to the feeling of loss of control, family therapy has provided a 90% improvement rate (Nichols & Schwartz, 1991).

Behavior therapy is also used to change the eating patterns of an anorexic who is seriously close to death. This is usually after the anorexic has been tube-fed to prevent death. Group and individual therapy has also proved effective — it depends on the person and the situation. But it is usually very difficult for these interventions to be implemented because the anorexic is almost always in denial. She cannot recognize that there is a problem because she still feels and sees herself as being fat.

If you know of someone who needs to be approached about an eating disorder, be prepared for resistance. Approach her when you think there is little chance of being interrupted. Know what you want to say, stay calm, and do not let the conversation escalate. Offer caring support, and supply information about sources where anorexics can obtain help in your community (Graves, 1994). Do these things, and anything else necessary to facilitate intervention, because she is slowly killing herself.

Intervention is especially important, since recent research indicates that women suffering from anorexia nervosa are at much greater risk of dying than either female psychiatric patients, or the general population at large (Sullivan, 1995). Another study involving a 10-year follow-up of 76 severely anorexic women has also shown such patients require intensive, on-going intervention to help them maintain normal weight and to help them avoid unsuitable eating behavior (Eckert and others, 1995). Although as yet highly speculative, a recent study has indicated the possibility that viral infections may play a causative role in some cases of anorexia nervosa (Park, Lawrie, and Freeman, 1995). Another new study indicates the possibility that children who display anxiety disorders between the ages of 5 and 15 may be expressing the first indication of a biological vulernability for anorexia nervosa (Deep and others, 1995). Generally speaking, early detection and treatment of this disease holds the greatest likelihood for positive outcomes (review: Woodside, 1995). Bodily Effects In a recent paper (Leibowitz, 1992) the neurochemical- neuroendocrine systems in the brain controlling macronutrient intake and metabolism are discussed.

According to the author, "appetite, energy balance, and body weight-gain are modulated by diverse neurochemical and neuroendocrine signals from different organs in the body and diverse regions in the brain. The hypothalamus plays an important integrative function in this process, acting through a variety of systems that involve a close interaction between nutrients, amines, neuropeptides and hormones. These systems underlie normal nutrient intake and metabolism and are thought to be responsible for shifts in feeding behavior across the circadian cycle and fluctuations relating to gender and age in both rats and humans. Moreover, alterations in these normal neurochemical-neuroendocrine systems may be associated with abnormal eating patterns, such as anorexia nervosa, bulimia and obesity. Understanding the systems that control eating behavior might provide a foundation for the treatment and possible prevention of such disorders.' In another study (Patton, 1992) dieting itself was examined relative to its role in anorexia nervosa. According to the author, "dieting in young women is for the most part a transient and benign activity without longer-term consequences.

However, a group of dieters do progress to develop the symptoms and behavior of eating disorders, so that dieting has been associated with an eight-fold rise in the risk of later eating disorder. Dieting or factors closely associated may account for most eating disorders in young women. Many antecedents of eating disorder appear to operate through increasing the risk of dieting rather than determining eating disorders specifically. Only the development of further neurotic and depressive symptoms characterizes dieters progressing to eating disorders. As the evidence implicating dieting in the origin of eating disorders becomes stronger so strategies for primary prevention become clearer.' GENERAL SUMMARY Anorexia nervosa is an eating disorder that usually strikes women. Of the 7 million women aged 15 to 35 who have an eating disorder, many will die from the complications of anorexia.

Probably the most famous case is that of Karen Carpenter, who died from heart failure resulting from anorexia nervosa. This disease can be defined as self-starvation leading to a loss of body weight 15% below normal, accompanied with hyperactivity, hypothermia, and amenorrhea. Hypothermia results when the body's natural insulation (fat stores) become non-existent and the victim becomes cold all the time. Amenorrhea is the absence of at least three menstrual cycles — this is also affected by the loss of fat stores in the body. Anorexia may not be noticed in the early stages because it often starts as an innocent diet. They often become hyperactive because they exercise frantically in an attempt to burn calories to lose weight.

In the later and more dangerous stages, the disease may not be noticed by family members because the anorexic usually wears layered and baggy clothes. Even though the anorexic is emaciated, she still feels "fat' and wants to hide her "ugly, fat body.' An anorexic may have ritualistic eating patterns such as cutting the food into tiny pieces and weighing every piece for food before she eats it. These behaviors can be found in people who are on a normal, healthy diet, but in anorexics these behaviors are extremely exaggerated. A number of research projects involving experimen- tal preventive measures have been reported in the current medical literature.

Some of these experiments may prove to be helpful either in reducing the risk of anorexia nervosa, or perhaps preventing it altogether: (1) instruction on the harmful effects of unhealthy weight regulation; (2) intervention with programs of weight regulation by practicing sound nutrition and dietary principles and beginning a regimen of aerobic physical activity; and (3) development of coping skills for resisting the diverse sociocultural influences that appear linked to the current popular obsessions with thinness and dieting. Current Research There are many reasons as to why women develop anorexia nervosa. One is that it is dieting taken to a dangerous extreme. Another is that societal pressures dictate a woman be thin in order to be beautiful — the "waif look' was recently popular.

But what these theories come down to is an issue of control. Whatever else is going on in the anorexic's life, the one thing that she feels she can control is food. When problems in the family contribute to the feeling of loss of control, family therapy has provided a 90% improvement rate (Nichols & Schwartz, 1991). Behavior therapy is also used to change the eating patterns of an anorexic who is seriously close to death. This is usually after the anorexic has been tube-fed to prevent death. Group and individual therapy has also proved effective — it depends on the person and the situation.

But it is usually very difficult for these interventions to be implemented because the anorexic is almost always in denial. She cannot recognize that there is a problem because she still feels and sees herself as being fat. If you know of someone who needs to be approached about an eating disorder, be prepared for resistance. Approach her when you think there is little chance of being interrupted. Know what you want to say, stay calm, and do not let the conversation escalate.

Offer caring support, and supply information about sources where anorexics can obtain help in your community (Graves, 1994). Do these things, and anything else necessary to facilitate intervention, because she is slowly killing herself. Intervention is especially important, since recent research indicates that women suffering from anorexia nervosa are at much greater risk of dying than either female psychiatric patients, or the general population at large (Sullivan, 1995). Another study involving a 10-year follow-up of 76 severely anorexic women has also shown such patients require intensive, on-going intervention to help them maintain normal weight and to help them avoid unsuitable eating behavior (Eckert and others, 1995). Although as yet highly speculative, a recent study has indicated the possibility that viral infections may play a causative role in some cases of anorexia nervosa (Park, Lawrie, and Freeman, 1995). Another new study indicates the possibility that children who display anxiety disorders between the ages of 5 and 15 may be expressing the first indication of a biological vulernability for anorexia nervosa (Deep and others, 1995).

Generally speaking, early detection and treatment of this disease holds the greatest likelihood for positive outcomes (review: Woodside, 1995). Bodily Effects In a recent paper (Leibowitz, 1992) the neurochemical- neuroendocrine systems in the brain controlling macronutrient intake and metabolism are discussed. According to the author, "appetite, energy balance, and body weight-gain are modulated by diverse neurochemical and neuroendocrine signals from different organs in the body and diverse regions in the brain. The hypothalamus plays an important integrative function in this process, acting through a variety of systems that involve a close interaction between nutrients, amines, neuropeptides and hormones. These systems underlie normal nutrient intake and metabolism and are thought to be responsible for shifts in feeding behavior across the circadian cycle and fluctuations relating to gender and age in both rats and humans. Moreover, alterations in these normal neurochemical-neuroendocrine systems may be associated with abnormal eating patterns, such as anorexia nervosa, bulimia and obesity.

Understanding the systems that control eating behavior might provide a foundation for the treatment and possible prevention of such disorders.' In another study (Patton, 1992) dieting itself was examined relative to its role in anorexia nervosa. According to the author, "dieting in young women is for the most part a transient and benign activity without longer-term consequences. However, a group of dieters do progress to develop the symptoms and behavior of eating disorders, so that dieting has been associated with an eight-fold rise in the risk of later eating disorder. Dieting or factors closely associated may account for most eating disorders in young women. Many antecedents of eating disorder appear to operate through increasing the risk of dieting rather than determining eating disorders specifically. Only the development of further neurotic and depressive symptoms characterizes dieters progressing to eating disorders.

As the evidence implicating dieting in the origin of eating disorders becomes stronger so strategies for primary prevention become clearer.' Anorexia Nervosa American Description — — — — — — — — — — — — — — — — — — — — — — — — — — – Diagnostic Criteria Refusal to maintain body weight at or above a minimally normal weight for age and height (e. g. , weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected). Intense fear of gaining weight or becoming fat, even though underweight. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. In postmenarcheal females, amenorrhea, i.

e. , the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e. g. , estrogen, administration. ) Specify type: Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.

e. , self-induced vomiting or the misuse of laxatives, diuretics, or enemas) Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i. e. , self-induced vomiting or the misuse of laxatives, diuretics, or enemas).