● When a person participates in extreme dieting, changes may occur in how the brain and the body’s metabolism work. These changes may predispose someone to the development of an eating disorder. ● Studies have shown that clients with anorexia nervosa have below normal levels of the neurotransmitters serotonin and norepinephrine and above normal levels of cortisol and vasopressin. Such findings suggest that the disorder is linked to inadequate production of norepinephrine and serotonin. ● Computed tomography (CT) and positron emission tomography (PET) scans in clients with anorexia nervosa during starvation show some brain abnormalities. It should be noted, however, that the link between such abnormalities and anorexia nervosa is unclear. ● Genetics might make a person more vulnerable to the development of anorexia nervosa. A family history of eating disorders, obesity, or mood disorder such as anxiety or depression seems to increase the risk of developing the disease. ● Certain personality traits—such as low self-esteem, low self-confidence, and a drive for perfectionism—are linked to anorexia nervosa development. ● Some cultural issues seem to play a role in the disease’s development. For example, some teenagers and young adults feel a need to be thin because of peer pressure, societal expectations, or media emphasis on what the “ideal” woman (or man) should look like. Cultures that associate being thin with being attractive may help to trigger the disorder. ● Other mental health disorders such as obsessive-compulsive disorder, depression, and anxiety have been associated with the development of anorexia nervosa. Healthcare consideration : Some experts believe that refusing to eat is an effort to gain or regain control over one’s life. The resulting disease process is a manifestation of that attempt to achieve control. Additionally, because anorexia nervosa is diagnosed primarily in Western and industrialized countries, some experts believe that the disorder is caused by societal standards of the ideal body shape and the constant pressure to be thin (American Psychiatric Association, 2013; Gersch et al., 2016). Clinical Presentation The primary feature of anorexia nervosa is “self-imposed starvation, despite the patient’s obvious emaciation” (Gersch et al., 2016, p. 356). Healthcare consideration : The DSM-5 describes a subtype of anorexia nervosa characterized by periods of binge eating and purging. Some persons with this subtype binge eat and then purge by misusing laxatives, enemas, or diuretics or by self-induced vomiting. Some persons with this subtype of anorexia do not binge but regularly purge after eating only small amounts of food. It should be noted that crossover between the subtypes is not uncommon (American Psychiatric Association, 2013). It is imperative that nurses know about this subtype and that clients may exhibit not only starvation behaviors but also binging and purging behaviors. The DSM-5 identifies three essential characteristics of anorexia nervosa (American Psychiatric Association, 2013): 1. Persistent restriction of energy intake (nutrients that provide energy). 2. Intense fear of getting fat or gaining weight or ongoing behaviors that interfere with gaining weight. 3. Disturbance in perception of body image (disturbance in self- perceived weight or shape).
The starvation-like behaviors associated with anorexia nervosa can cause significant, possibly life-threatening, medical conditions. Although most of the physiological effects associated with malnutrition are reversible with proper treatment and nutritional rehabilitation, some effects such as loss of bone mineral density are not completely reversible (American Psychiatric Association, 2013; Gersch et al., 2016). A variety of medical conditions—including gastrointestinal disease, hyperthyroidism, cancers, and acquired immunodeficiency syndrome (AIDS)—can cause significant, serious weight loss. However, persons with these problems do not display the essential characteristics of anorexia nervosa (American Psychiatric Association, 2013). Occasionally, weight loss caused by another medical condition is followed by the onset or recurrence of anorexia nervosa. Anorexia nervosa rarely develops in persons who have had bariatric surgery for obesity (American Psychiatric Association, 2013). Coexisting Mental Health Disorders and Anorexia Nervosa Several mental health disorders are associated with anorexia nervosa. It is important, therefore, to differentiate between certain mental health problems and anorexia nervosa to determine if they coexist: ● Avoidant/restrictive food intake disorder (ARFID): People with this disorder could have serious nutritional deficiencies or significant weight loss but do not have a fear of weight gain, of becoming fat, or of a distorted body shape perception. This is a recent diagnostic category identified in the DSM- 5. Persons with a diagnosis of ARFID have symptoms that do not meet the criteria for traditional eating disorder diagnoses, but still have significant problems with eating food. Signs and symptoms of ARFID generally appear in infancy or childhood and may continue into adulthood (American Psychiatric Association, 2013; The Center for Eating Disorders at Sheppard Pratt, 2015). ● Bulimia nervosa: Bulimia nervosa is characterized by recurrent episodes of binge eating followed by inappropriate actions to avoid gaining weight such as self-induced vomiting and abuse of laxatives and diuretics. However, a key difference between those persons suffering from anorexia nervosa and bulimia nervosa is that persons with bulimia nervosa generally maintain body weight at or above minimal normal levels (American Psychiatric Association, 2013; Gersch et al., 2016). ● Major depressive disorder: Females and males who suffer from anorexia nervosa might also suffer from major depressive disorder. However, the two problems do not necessarily coexist. Significant weight loss can occur in persons with major depressive disorder. Of course, this does not mean that all persons who have major depressive disorder are also anorexic. The majority of persons affected by major depressive disorder do not have either an extreme need for excessive weight loss or a morbid fear of gaining weight (American Psychiatric Association, 2013; Gersch et al., 2016). ● Schizophrenia: Persons who have schizophrenia sometimes experience significant weight loss and have odd eating behaviors. However, they seldom show the extreme fear of weight gain and disturbance in body image perception necessary for a diagnosis of anorexia nervosa (American Psychiatric Association, 2013; Gersch et al., 2016). ● Substance abuse disorders: Substance abusers often experience weight loss because of poor nutritional intake. They usually do not fear gaini:ng weight and do not display disturbances in body image. Persons who abuse substances that reduce appetite and lead to weight loss—cocaine, for example—and express fear of gaining weight should be carefully assessed for coexisting anorexia nervosa (American Psychiatric Association, 2013; Gersch et al., 2016).
Page 121
Book Code: PYMA2024
EliteLearning.com/Psychology
Powered by FlippingBook