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Anorexia Nervosa


DSM IV describes Anorexia Nervosa as the refusal of an individual to maintain a ... The term anorexia refers to loss of appetite, and nervosa indicates for ... – PowerPoint PPT presentation

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Title: Anorexia Nervosa

Anorexia Nervosa
  • Andrea Toro
  • Elizabeth Sherwood


  • Eating Disorders
  • are characterized by severe disturbances in
    eating behavior (American Psychiatric
    Association, 1994, 539).
  • Anorexia Nervosa
  • Anorexia Nervosa often begins as an ordinary
    attempt at dieting to lose a few pounds
    (Sondon-Hagopian, 1992, 71). With the passage of
    time, however, the individual may obsess about
    his or her weight and appearance claiming he or
    she is still too fat in spite of contradictory
  • DSM IV describes Anorexia Nervosa as the refusal
    of an individual to maintain a minimally normal
    body weight, an intense fear of gaining weight,
    and a disturbance in the perception of the shape
    or size of his or her body (American Psychiatric
    Association, 1994, 539).

General Overview
  • Two Types of Anorexia
  • The restricting type is characterized by weight
    loss due to food restriction (Davison and Neale,
    1997, 208).
  • The binge-eating-purging type occurs when an
    individual is engaged in binge eating and purging
    (Davison and Neale, 1997, 208).
  • Many women have symptoms that resemble those of
    Anorexia Nervosa, but the symptoms are not severe
    enough to constitute a diagnosis for the disorder
    (Long, P.W., 1995). According to one study,
    two-thirds of college women have an eating binge
    at least once a year, forty percent at least once
    a month, and twenty percent a least once a week.

  • This disorder affects one to five percent of the
    population (American Psychiatric Association,
    1994, 543).
  • psychosociological disease which affects young
    and healthy girls primarily in adolescence
    (Sondon-Hagopian, N., 1992, 71).
  • Gender related Ninety percent of those who
    suffer from Anorexia Nervosa are women it
    usually begins in adolescence but may appear as
    early as nine years of age (Long, P.W., 1995).
  • Age differences Women of all ages rated their
    current figure as significantly larger than their
    ideal figure however, young womens ideals were
    congruent with their perceptions of male
    preferences while older women seem to aim for an
    ideal that is significantly larger than what they
    think men find attractive (Stevens Tiggemann,


Historical Background
  • First Descriptions
  • Eramus Darwin in 1796 stated, Some young ladies
    I have observed to fall into this general
    disability (can) just be able to walk about. I
    have sometimes ascribed this to their voluntary
    fasting when they believed themselves too plump…
    (Gordon, A.G., 1997, 1041).
  • William Gull in 1869 first described the disorder
    as a persistent lack of appetite and refusal of
    food resulting from emotional conflict
    (Goldenson, R.M., 1970, 83). The term anorexia
    refers to loss of appetite, and nervosa indicates
    for emotional reasons (Davison and Neale, 1997,

In recent years...
  • Eating disorders and Anorexia Nervosa first
    appeared in DSM for the first time in 1980 as one
    subcategory of disorders beginning in childhood
    and adolescence (Davison Neale, 1997, 207).
  • DSM-IV recognized eating disorders as a distinct
    category reflecting the increased attention they
    have received recently (Davison Neale, 1997,
  • There has been an dramatic increase in both the
    scientific literature and the popular press about
    eating disorders (Furnham Manning, 1997, 389).
    However, diet advertisements and articles appear
    ten times more frequently in womens than mens
    magazines (Cusumano Thompson, 1997).
  • Over the last twenty years, a higher portion of
    women in their late teens and early twenties have
    been hospitalized for Anorexia Nervosa (Long,


  • Diagnostic Criteria of Anorexia Nervosa
  • Refusal to maintain body weight over a minimal
    normal weight for age and height, e.g., weight
    loss leading to maintenance of body weight 85
    percent below that expected or failure to make
    expected weight gain during period of growth,
    leading to body weight 85 percent below that
    expected (American Psychiatric Association, 1994,
  • Intense fear of gaining weight or becoming fat,
    even though underweight ( American Psychiatric
    Association, 1994, 544).
  • Disturbance in the way in which ones 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
    (American Psychiatric Association, 1994, 545).

More DSM Criteria
  • In postmenarcheal females, 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.) (American Psychiatric
    Association, 1994, 545).
  • Associated features
  • Some people with this disorder cannot exert
    continuous control over their intended voluntary
    restriction of food intake and have bulimic
    episodes,often followed by vomiting ( American
    Psychiatric Association, 1987).
  • Other peculiar behaviors concerning food are
    common. They may be prepare elaborate meals for
    others. ( American Psychiatric Association, 1987).

DSM (Contd)
  • Also, compulsive behavior, such as hand-washing
    maybe present during the illness and may justify
    the additional diagnosis of Obsessive Compulsive
    disorder (American Psychiatric Association,
  • Many of the adolescents have delayed psychosexual
    development and adults have a markedly decreased
    interest in sex (American Psychiatric
    Association, 1987).
  • When seriously underweight, many individuals with
    Anorexia Nervosa manifest depressive symptoms
    such as depressed mood, social withdrawal,
    irritability, and insomnia (American Psychiatric
    Association, 1994, 541)

Associated medical conditions
  • Anorexia Nervosa- Medical Consequences
  • The heart muscle changes. Its beat becomes
    irregular resulting in heart failure and death.
  • Dehydration, kidney stones, and kidney failure
    may result.
  • A fine body hair, called lanugo, develops on the
    arms and can even cover the face.
  • Muscles waste away, resulting in weakness and
    lose of muscle function.
  • A lack of energy and slowed body function results
    delayed gastric emptying which causes bowel
    irritation and constipation.
  • Loss of bone calcium leads to osteoporosis.

More medical conditions
  • With the decrease of body weight and body fat,
    amenorrhea may result.
  • When left untreated it results in decreased bone
    density, and a higher incidence of stress
    fractures and osteoporosis. ( bone loss in an
    amenorrheic athlete is rapid and may not be
  • Amenorrhea is defined by the absence of a
    menstrual cycle for at least six consecutive
    months. ( the absence of a regular menstrual
    cycle is abnormal and unhealthy.


  • Biological Factors of Anorexia Nervosa
  • Eating disorders run in families. Twenty percent
    of anorectic patients have a family member with
    an eating disorder of some kind (Long, 1995).
  • For many years, researchers studying eating
    disorders have looked for abnormalities in the
    production and regulation of hormones and
    neurotransmitters by which the brain and body
    govern appetite and food intake. Low
    concentrations of the metabolites or the
    neurotransmitters serotonin and norepinephrine
    may occur in anorectic patients (Long, 1995).
  • Other research shows that eating disorders may
    also involve enkephalins and endorphines, the
    opiatelike substances produced by the body. The
    spinal fluid of patients with anorexia contains
    high levels of these endogenous opoids (Long,

Parental style and Perfectionism
  • Perfectionism has been linked specifically with
    Anorexia Nervosa (Ablard Parker, 1997). High
    expectations of parents and the desire to please
    others may foster a belief that parental love and
    social acceptance are contingent upon ones high
  • In a study of 127 sets of parents of academically
    talented children where reported achievement
    goals for their children (Ablard Parker, 1997).
  • Most parents reported learning goals in that they
    were more concerned with the understanding of the
    material than the external indicators.
  • The parents who reported performance goals were
    more concerned about the external indicators of
    achievement. Children of these parents are at
    high risk for performance anxiety and for
    developing depression and anorexia.

Etiologies of gender differences
  • Women appear to be more heavily influenced
    cultural standards reinforcing the desirability
    of being thin (Davison Neale, 1997, 214).
  • Male and female standards of beauty change
    differently over time. One study examined the
    differences between Playboy models, representing
    the mens ideal, and Vogue models, the womens
    ideal (Barber, 1998). The mens standard of
    ideal thinness correlated with the womens
    standard sixteen years later, indicating that
    changes in the standard of beauty may be
    determined by women.
  • Women are more concerned than men about being
    thin, are more likely to diet, and are thus more
    vulnerable to eating disorders (Davison Neale,
    1997, 214).

More about gender differences
  • History of sexual harrassment
  • There are statistically significant associations
    of eating disorder symptoms with sexual assault
    history (Laws Golding, 1996, 579).
  • Of the women in the sample with a history of
    sexual assault, 46.5 percent thought they were
    too fat and 48.6 percent demonstrated anorexic
  • However, of the women in the sample who did not
    have a history of assault, 31.8 percent thought
    they were too fat and 33.1 percent demonstrated
    anorexic symptoms (Laws Golding, 1996, 579).
  • Physiological-based theory During puberty,
    females develop two years before their male
    counterparts (Furnham Manning, 1997). Females
    may attempt to minimize these differences by
    dieting, resulting in a hormone imbalance.

Cultural influences
  • Eating disorders appear to be far more common in
    industrialized societies (Davison Neale, 1997,
    215). WHY?
  • Parents views about academic performance may be
    related to their education level, ethnic
    background and parenting style (Ablard Parker,
    1997). This influences whether they support
    learning goals or performance goals.
  • Social endorsements in Western cultures of an
    ideal body shape, such as those found in print
    and film media formats, have been related to body
    image disturbance as well as implicated in the
    development of eating disorders (Cusumano
    Thompson, 1997).
  • Women of industrialized countries are pressured
    to be thin, attractive, successful in the
    workplace and to maintain their traditional roles
    as nurturing homemakers (Sondon-Hagopian, 1992,
    80 Heywood, 1995, 43). A fanatical management
    of weight is used as a means of coping with
    conflicting demands.


  • Overview of the difficulties in treatment and
  • The treatment of this disorder is often
    difficult. This is because of the disorders
    insidious nature which wreaks havoc not only with
    the body, but just as seriously with the
    individuals negative self-perception (Mental
    Health Net, 1996).
  • The patient is often so weak and physiological
    functioning is so disturbed that hospitalization
    is medically imperative (Davison Neale, 1997,
  • If a person who suffers from Anorexia Nervosa is
    danger of committing suicide or choking on vomit,
    immediate hospitalization should be carefully
    considered (Mental Health Net, 1996).
  • Cognitive-oriented therapies, focusing on issues
    of self-image and self-evaluation, works to
    change the patientsdistorted body image (Mental
    Health, 1996).

  • Hospitalization is not only necessary, but a
    prudent treatment intervention since it ensures
    that the patients do not starve themselves to
    death (Mental Health, 1996).
  • The patients must first gain weight they are
    started on a liquid diet or frequent small meals
    and are weighed everyday (Long, 1995).
  • Because relapse is frequent, the patient must
    follow a medical plan set by a dietician who sees
    to it that the patient records what he or she
    eats and when (Long, 1995).
  • During three to six months of hospitalization,
    hypnosis is employed by some therapists but may
    be resisted by many anorexic who fear even a
    semblance of control by others. Some success is
    claimed by those teaching self-hypnosis and
    bio-feedback techniques (ANAD, 1998).

  • Medication should be carefully monitored since
    patients with Anorexia Nervosa may be vomiting
    which may have an impact on the medications
    effectiveness (Mental Health, 1995).
  • Prozac may work by stabilizing serotonin systems
    in the brain, thereby correcting the changes in
    brain function responsible for many of the
    disorders symptoms. Also, Anorexia Nervosas
    accompanying symptoms like depression, anxiety,
    obsessions, and compulsions could be linked to
    disturbances in serotonin, the neurotransmitter
    that helps regulate mood and appetite (Craig D,
  • Antidepressants, such as amitriptyline, are the
    usual drug treatment for depressive symptoms.
    Chlorpromazine, on the other hand, is beneficial
    for those individuals suffering from severe
    obsessions and increased anxiety and agitation
    (Mental Health, 1996).

Behavior and Family therapy
  • Behavior therapy includes isolating the patient
    as much as possible and giving him or her
    mealtime company, access to a television, radio,
    or stereo, and other privileges for eating or
    gaining weight (Davison and Neale, 1997, 221).
  • Family therapy is advocated by Salvador Minuchin.
  • It is based on his theory that the eating
    disordered child is deflecting attention away
    from underlying conflict in family relationships
    (Davison Neale, 1997, 221)
  • It focuses on changing the pattern of family
    interaction. The length of this therapy is
    approximately six months, with an eighty-five to
    ninety percent rate of cure (ANAD, 1994).


  • DSM-IV The course and outcome of Anorexia
    Nervosa are highly variable. Some recover fully
    after a single episode, some experience
    fluctuation in weight gain followed by a relapse,
    and others have a chronically deteriorating
    course of the illness (American Psychiatric
    Association, 1994, 543).
  • Of individuals admitted to university hospitals,
    the mortality from Anorexia Nervosa is over ten
    percent (American Psychiatric Association, 1994,
  • A patient diagnosed with Anorexia Nervosa and
    Obsessive-Compulsive Disorder will not
    necessarily have a poorer prognosis however, the
    patients whose eating disorders were most
    improved showed the highest reduction of
    obsessions and compulsions (Thiel, Zuger, Jacoby,
    Schussler, 1998, 244).

Body Mass Index
  • There is an association between low body weight
    at referral and poor general outcome (Hebebrand,
    Himmelman, Herzog, Herpertz-Dahlmann,
    Steinhausen, Amstein, Seidel, Deter, Remschmidt,
    Schafer, 1997, 567).
  • The mortality rate of 11 percent in patients
    whose body mass indexes at referral were less
    than 13 kg/m2 was significantly different from
    the rate of 0.6 percent of the patients whose
    body mass indexes at referral were 13 kg/m2 or
    more (Hebebrand et al., 1997, 567).
  • Of the fourteen patients in our study who had
    body mass indexes less than 11 kg/m2 at referral,
    only seven survived (Hebebrand et al., 1997,