Anorexia Nervosa

.. lar were also found more likely to be asexual (defined as having a lack of interest in sex for a year prior to assessment). This is also a common finding in females (Carlat, 1997; Murnen, 1997). With anorexia, it is thought to be to due to the testosterone lowering effect of protein-calorie malnutrition, combined with active repression of sexual desire (Carlat, 1997). The high rate of homosexuality and bisexuality among males with eating disorders can serve as evidence for both psychosocial and biological views of the etiology of eating disorders. Psychosocially, homosexuality can be seen as a risk factor that puts males in a subculture system that places the same importance on looks and appearance in men as the larger culture places on women (Carlat, 1997).

It is these similar cultural pressures toward thinness that cause eating disorders (Carlat, 1997). From a biological point of view, it can be argued that brain structure between homosexual men and heterosexual women are similar (Carlat, 1997), particularly a tiny precise cell cluster known as the third interstitial nucleus of the anterior hypothalamus or INAH3. This cluster of cells in gay men was found to be about half the size of the cluster in straight men which puts them in the same size range as heterosexual women. This particular part of the hypothalamus has been strongly implicated in regulating male-typical sexual behavior (Nimmons, 1994). It may be argued then that homosexual men react to environmental stressors in a biologically feminine way, increasing their risk of eating disorders (Carlat, 1997).

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Males, like the females studied by Carlat et al. , were shown to have high rates of co-morbid major depression, substance abuse, anxiety disorders, and personality disorders. One year after initially being treated, 59% still suffered from their eating disorder. (Carlat, 1997). This is a cause for concern as there are so many concurrent complications that can arise from eating disorders, especially anorexia nervosa. Adverse Effects of Anorexia Nervosa Anorexic patients are often found to suffer from osteoporosis, anemia, and hypotension (Carlat, 1997).

Chronic starvation due to anorexia has also been linked to seizure activity and fainting attacks (Blackman, 1996). The anorexic often looks pale, tired, wasted, bradycardia (slow heart rate) may be present, and the skin is cold to the touch. Another common feature is the presence of fine downy hair on arms and torso. Laboratory results often reveal quite abnormal values. These values are often caused by dehydration and severe electrolyte imbalances which can be life threatening. Amenorrhea, or absence of menstruation occurs in post menarchal girls who lose more than 20% of their expected body weight (Blackman, 1996; Rock, 1996).

Amenorrhea, in fact is another one of the diagnostic criteria for anorexia nervosa (for females) according to the DSM IV (Blackman, 1996). The absence of menarche is related to the bodies reaction to extreme fat loss and the non viability of pregnancy under these conditions (Blackman, 1996). Starvation itself as been shown to induce many hormonal changes in the body as well as inducing mental states such as anxiety, depression, and even psychosis (Kershenbaum, 1997). These are just a few of the consequences associated with anorexia nervosa. There are many others ranging from things as obscure as bilateral foot drop, which was observed in one 15 year old girl (Kershenbaum, 1997), to something as serious as sudden death and even suicide (Neumrken, 1997).

Sudden death is defined as the sudden, unexpected, and unexplainable occurrence of death. Some of those who died suddenly, did show abnormalities in ECG recordings days prior to death. As well, upon autopsy, changes in brain structure and cardia muscles (such as atrophy) were sometimes found (Neumrken, 1997). One would question with all of the adverse consequences, why anorexics still diet. Anorexia produces a *runners high= as does exercise.

This is a result of opiate release in the brain which in turn suppresses appetite and promotes increased levels of activity. Once anorexic behavior begins and becomes established, it promotes this endorphin secretion and becomes pleasurable and self reinforcing. The sufferer then is bound to self starve and the established cycle is no longer deliberate or easily stopped (Blackman,1996). Treatment Treatment comes in the form of psychotherapy, nutritional education, and refeeding. Nutritional education takes time however as the farther a person is below their healthy weight, the more their cognitive ability is impaired (Merriman, 1996).

The first of the higher mental functions to be lost is the capacity for abstract thinking. As the condition progresses, the anorexic may not even be able to assimilate information (Merriman, 1996). The nutritionist then must carefully plan nutrition education sessions to make them as meaningful to the person as is possible. Refeeding is also not a straightforward process as anorexics often find it quite difficult to gain weight. This is due to an increased diet induced thermogenesis and a lower metabolic efficiency.

Anorexic patients can waste about 50% of the energy of their food due to this inefficient metabolism at the start of refeeding, making the maintenance of any gain in weight difficult (Moukadden, 1997). Another study concluded that even with weight gain after 3 months to a year, it was not enough to maintain a desirable nutritional status. This was because patients did not reach an adequate body mass index and their immunological indexes were lower than in control subjects during an entire one year follow-up (Marcos, 1997). Conclusions From the information presented, one can only imagine just how complex the issues really are that the anorexic attempts to deal with via dieting. The anorexic may be dealing with substance abuse, depression, sexual abuse, confusion about their sexual orientation, or bodily dissatisfaction to name a few.

The individual anorexic may be suffering from a combination of such issues in varying degrees. To what extent, psychological, societal, and biological factors affect the onset of the disorder is, as of yet, too complex to determine. It appears to vary from individual to individual, although there are some features seen more commonly than others. The variability seen with the disorder on an individual basis is why the anorexic sufferer can not be categorized into a particular stereotypical group. It is not just the white adolescent girl who is affected.

The disorder affects various other groups as well and is being seen more frequently in groups it did not typically affect. It has been mentioned how the disorder is becoming more prevalent among immigrants who move to westernized cultures; yet, the disorder is rarely ever seen in less developed countries. Males also are being seen more frequently to be sufferers of this traditionally female disorder. This data seems not to point to a particular group as being more prone to developing anorexia, but instead points to society=s unrealistic and unachievable ideals, as encouraging more sensitive, insecure, or emotionally disturbed individual members of society to lose weight. Weight loss often provides these people with short lived confidence, and for a while they feel good about their weight loss and in control of something in their life.

They inevitably desire to feel like this again so they set out to lose more weight. This cycle continues until someone steps in and helps the sufferer by convincing them to seek help. This can be hard as the anorexic is usually so far in denial that they are the last to realize just what shape they are in. The road to recovery is difficult and the body seems to resist any weight gain during the initial refeeding period. Even after an entire year of treatment, evidence suggests that recovery has not been achieved and many anorexics still continue to suffer from their disorder.

There are so many complications that anorexia can be attributed to that it would appear that the quicker a person complies with treatment and can be recovered, the better. It is quite obvious that anorexia is a complex disorder that partly involves how one perceives his or her self and what physical standard society dictates they should live up to. The topic has many areas that require further research as society has been shown not to be the entire causative factor for the development of the disorder. It has been shown to be one of them however; so until society becomes more realistic in the ideals it endorses, it is responsible, at least in part, for the prevalence of this disorder. Bibliography Blackman, M. A Anorexia Nervosa: Diagnosis and Management, @ Medical Scope Monthly, July/August, 1996 (or see Carlat, D.

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, 1996. Eating Disorder Resource Centre of British Columbia. Do I Have an Eating Disorder?. Vancouver: Working Design, 1997. Kershenbaum, A. ; Jaffa, T.

; Zeman, A. ; and Boniface, S. A Bilateral Foot Drop in a Patient With Anorexia Nervosa, A International Journal of Eating Disorders, 22, November 1997, 335-337. Kinzl, J. F. ; Mangwelth, B.

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Moukadden, M. ; Bouler, A. ; Apfelbaum, M. ; and Rigaud, D. A Increase in diet-induced thermogenesis at the start of refeeding in severely malnourished anorexia nervosa patients, A American Journal of Clinical Nutrition, 66, July 1997, 133-140.

Murnen, S. K. ; and Smolak, L. A Feminity, Masculinity, and Disordered Eating: A Meta-Analytic Review, A International Journal of Eating Disorders, 22, November 1997, 231-242. Neumrker, K.

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