Eating Disorders Anorexia ANOREXIA NERVOSA Introduction: Eating Disorders are characterized by sever disturbances in eating behavior. The essential features of Anorexia Nervosa are that the individual refuses to maintain a minimal normal body weight, is intensely afraid of gaining weight, and exhibits a significant disturbance in the perception of the shape or size of his or her body. The individual maintains a body weight that is below a minimally normal level for age and height. When Anorexia Nervosa develops in an individual during childhood or early adolescence there maybe failure to make expected weight gains instead of weight loss due to the fact of growth. Usually weight loss is accomplished primarily through reduction in total food intake. Although individuals may begin by excluding from their diet what they perceive to be highly caloric foods, most eventually end up with a very restricted diet that is sometimes limited only to few foods.
Additional methods of weight loss include purging (self-induced vomiting or the misuse of laxatives) and increased or excessive exercise. Individuals with this disorder intensely fear gaining weight or becoming fat. This intense fear of becoming fat is usually not alleviated by weight loss. Concern about weight gain often increases even as actual weight continues to decrease.
The experience and significance of body weight and shape are distorted in these individuals. Some of these individuals feel overweight from every aspect, others realize that they are thin, but are still concerned with specific parts of their bodies. The self-esteem of individuals with Anorexia Nervosa is highly dependent on their body shape and weight. Weight loss is Page Two-Lariviere viewed as an impressive achievement and is a sign of self-discipline and self-control.
Though some individuals with this disorder may acknowledge being thin, they typically deny the serious medical implications of their malnourished state. It is rare for an individual with Anorexia Nervosa to complain of weight loss. Individuals frequently lack insight into, or have considerable denial of, the problem and may be unreliable historians. It is therefore necessary to obtain information from the parents or other outside sources to evaluate the degree of weight loss and other features of the illness. When seriously under weight, many individuals with Anorexia Nervosa manifest depressive symptoms such as depressed mood, social withdrawal, irritability, insomnia, and diminished interest in sex. Such individuals may have symptomatic presentations that meet criteria for Major Depressive Disorder.
Obsessive-compulsive features, both related and unrelated to food, are often prominent. Most individuals with Anorexia Nervosa are preoccupied with thoughts of food. When these individuals exhibit obsessions and compulsions that are not related to food, body shape, or weight, an additional diagnosis of Obsessive-Compulsive may be in order. Other features sometimes associated with Anorexia Nervosa include concerns of public eating, the feeling of ineffectiveness, a strong desire to have control, and over all a restraint on emotions. Many signs of and symptoms of Anorexia Nervosa are attributed to starvation.
In addition to amenorrhea (suppression or non-occurrence of menstruation), there may be complaints of constipation, abdominal pain, cold intolerance, lethargy (laziness), and Page Three-Lariviere excess energy. There may also be significant hypertension, hypothermia, and dryness of the skin. Some individuals find a yellowing of their skin, due to hypercarotenemia (which occurs because of the lack of proper vitamins). Anorexia Nervosa appears to be far more prevalent in industrialized societies, in which there is an abundance of food and in which, especially for females, being considered attractive is linked with being thin. This disorder rarely occurs before puberty. More than ninety percent (90%) of cases of Anorexia Nervosa occur in females (DSM-IV).
The onset of illness is often associated with a stressful life event, such as leaving home for college. The course and outcome of Anorexia nervosa are highly variable. Some individuals recover fully after a single episode, while some exhibit a fluctuating pattern followed by relapses. There is an increased risk of Anorexia Nervosa among first-degree biological relatives of individuals with the disorder (DSM-IV). One of the largest struggles that occur within this disorder is treatment.
There are numerous types of treatment, but which is most effective. How can different treatments help different people? In this paper I will discuss two different kinds of treatment. One is being compulsory treatment, which is when an individual is forced to seek out help. The other is the reliability of the Danish Version of the Morgan Russell Scale for Assessment of Anorexia Nervosa. This scale was made to help clarify the existing rating instructions for people with Anorexia Nervosa. The main focus of this paper will be Page Four-Lariviere whether or not force can still be used in helping someone with this disorder and the other will be if you can use a scale to be reliable.
Research Findings Compulsory treatment in Anorexia Nervosa The aim of this study is to identify the pre morbid and clinical features that predisposed to compulsory admissions, the short-term benefits of the treatment and the long-term mortality rates. There were eighty-one (81) compulsory patients compared with eighty-one (81) voluntary patients. Out of the compulsory patients, seventy-six (76) of them were female and five (5) of them were male. Their mean age was twenty-six (26) years. From the voluntary patients, seventy-nine (79) of them were female and two (2) of them were male. Their mean age was twenty-five (25) years.
For both groups, neither their ethnicity nor there geographic location was given. The results from this study was that predisposing factors to a compulsory admission were a history of childhood sexual or physical abuse or previous self-harm. Detained patients had more previous admissions. Also, they gained as much weight during admission as voluntary patients, but took longer. More deaths among compulsory patients compared to voluntary patients were found 5. 7 years after admission.
Patients were asked a number of questions pertaining to the illness and then steps were taken to try to improve their weight. The patients were then released and contacted 5. 7 years later. Interrater Reliability of a Danish Version of the Morgan Russell Scale for Assessment of Anorexia Nervosa Page Five-Lariviere The objective of this was to study the interrater reliability of a Danish version of the Morgan Russell scale for assessment of patients with anorexia nervosa, and subsequently to clarify the existing rating instructions. Ten (10) patients underwent treatment for anorexia nervosa at a regional center participated and had their interview videotaped. Two (2) interviews were reserved for a training phase only.
The group rates comprised of eight (8) clinicians, and measures of interrater reliability were computed using intra class correlation coefficient (ICC). The eight patients were interviewed, and the interview was videotaped. The patients gave informed consent to participation; the parents of minors also gave consent. The local ethical committee approved the study. Seven females and one male participated. The median age for the group was seventeen (17) years.
The duration of their illness was approximately eleven (11) months. The measures of interrater reliability were calculated using ICC. The ICC for the total score was good, while the reliability for the single items varied from poor to excellent. Internal consistency as expressed by Cron bach s coefficient was acceptable. The Morgan Russell scale stands out as an easily applied and reliable measure of severity of anorexia nervosa, though the rating instructions need clarification in some items. Discussion The purpose of this paper was to find out if these two types of treatment were successful in helping patients with anorexia nervosa.
The first study showed that there is a difference between those who seek out help on their own and those who are forced into seeking help. The findings were as follows: that patients who wanted help gained weight Page Six-Lariviere faster and had a lower mortality rate. While the compulsory patients found it harder to gain the weight back and had a higher mortality rate. So, in conclusion people who want help have a higher chance of survival. The second study showed that the Morgan Russell scale, which is used to help determine the severity of an individual's eating disorder, was a good scale. The problem that I found with this study was the fact the patients who were chosen only had the disorder for approximately eleven (11) months.
I think a larger variety of people who have had the disorder for longer should have been chosen. In doing this paper I found that there are many way and treatment types for this disorder. While I have only briefly discussed two of them, I feel that I have a better understanding on this topic.