Contribution of social and family factors in anorexia nervosa

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HEALTH SCIENCE JOURNAL® Volume 6, Issue 2 (April – June 2012)

_REVIEW_

Contribution of social and family factors in anorexia nervosa Greta Wozniak1, Maria Rekleiti2, Zoe Roupa3 1. MD, PhD, Nursing Department, Applied University of Larissa, Greece 2. RN, MSc, General Hospital of Korinthos, Greece 3. RN, MD, PhD, Professor Coordinator for the Nursing Program School of Sciences, European University, Cyprus

ABSTRACT Background: Anorexia nervosa is probably the most substantial eating disorder, with basically unknown causes, centered on psychological factors and affected by many social, biological and cultural ones. The aim of this study was to emerge the complex issues regarding the treatment, the early intervention and the prevention of the anorexia nervosa. The method οf this study included a search of the literature in several databases (Medline, EMBASE and CINAHL) to identify articles related to anorexia nervosa. Results: Patients with anorexia nervosa develop a refusal in ingestion of food, maintaining a distorted self-perception of their body, considering themselves as overweighed. The diagnosis even though is made according international established criteria, varies among the patients taking into consideration additional factors like family and social environment. As the patients refuse to admit the seriousness of their condition, they seek for medical assistance when disorders appear in vital organs, due to de-nutrition. In most cases hospitalization is necessary and includes a suitable diet program and medication treatment. Conclusions: Psychological therapy is a basic part of the treatment, in long-term basis and is employed by behavior therapy and the patient's support. Advising the public and especially parents with children in adolescence, where usually anorexia nervosa occurs, is necessary as the prevention and the early diagnosis is the best treatment. Keywords: Anorexia nervosa, treatment, prevention. CORRESPONDING AUTHOR

Greta Wozniak, MD, PhD Applied University of Larissa Larissa, GREECE, Phone: +30-2410 – 684252 Fax: +30-24210 - 72462 E-mail: [email protected]

INTRODUCTION

D

isorders in food injection have

last years due to the constantly increased

raised the interest of scientists the

number, mainly of women, that report Page | 257

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Quarterly scientific, online publication by Department of Nursing A’, Technological Educational Institute of Athens

severe behavioral problems regarding the

melancholy

and

usually

appears

to

7

food. Two clinical syndromes appear in

sexual immature females.

adolescent

Anorexia nervosa is more commonly

and

adult

age:

Anorexia

Nervosa and Bulimia nervosa.1

appeared during

the recent decades

Anorexia nervosa appears at a rate of 80-

comparing

former

85%, in young women at the age of 12-

reported in females in preadolescence

25 years old, in the middle and upper

age and males. Epidemiological data

socio-economic

report that eating disorders climb up to

profession

a

status,

whose

appearance

ones,

and

and

4% in adolescent females and anorexia

thinness are considered as a professional

nervosa is estimated that appears at 0.5-

and especially desirable requirement,

1% in the same group. It occurs 10-20

while the small male percentage that

times more in females than in males and

suffer

mainly at developed countries, (western

from

good

in

with

anorexia

nervosa

exercising.2,3

compulsive

with

Although

countries).8

anorexia nervosa is described as primary,

Study

many patients may suffer from medical

children come from families that have

disorders,

neurosis,

lost a member, they have been abussed.9

and

depressive

Respective studies reach the conclusion

of

emotional

that the 1/3 of the anorectic patients

psychosis,

personality

disorders

inclination

with

lack

results

show

that

anorectic

expression.4

have

Anorexia nervosa is characterized by

childhood

severe and serious disorders of self-

common

perception

the

abused victims, like low self-esteem,

determined pursuit of thinness.5 It was

feelings of shame and a negative attitude

described for the first time by Morton in

towards their body and the opposite

1689, and was a subject of study in the

sex.4

middle of last century, as a form of

Although the mental, social and physical

hysteria.

was

consequences are particular serious, the

described as a hereditary abnormality of

scientific studies are few and there is a

the central neurological system that

considerable delay in elaboration of

appears only to young females6. In 1883

proof based approaches, especially for

Huchard established the term "anorexia

children and adolescents, in spite the

nervosa" and Freud (1895) suggested

fact that eating disorders occur to this

that

age groups.10-12

of

At

their

first

anorexia

is

body

the

and

disorder

associated

with

been

sexual

and

they

abused seem

characteristics

Contribution of social and family factors in anorexia nervosa

during to

with

have sexual

Page | 258

HEALTH SCIENCE JOURNAL® Volume 6, Issue 2 (April – June 2012)

The social conventions and the emphasis

mother associated with the occurrence

to external appearance, that influences

of the disorder to children and especially

mainly

to adolescent females.13

young

associated

people,

with

eating

are

factors

disorders

in

Psychical theory

addition with advertisement and the

According to Bruch (1982) the psychical

contribution of mass media projecting

factors associated with the appearance of

anorectic models as the only way to

the disorder are:

success, the non-acceptance of other

1. Adolescent crisis and new experiences,

values like educational, cultural, social

as inclinatory factors

enlarge the problem. The modern society

2. Raising a child that is only ostensibly

enervates family bonds and reduces the

"normal". They usually hide behaviors

time spent between parents and children,

with lack of recognition, enhancement

setting new priorities, altered from those

and confirmation of child's abilities.

of previous generations.

3.

Purpose of this study is to highlight the

mechanism,

complex

the

control of the body, as an effort to

treatment, the early intervention and the

maintain a level the dominance over

prevention of the anorexia nervosa.

their selves.14

Etiology

issues

of

concerning

anorexia

nervosa

and

The

preponderant which

is

psychological the

complete

Social-Psychological factors

associated factors

Many scientists ascribe the disorder to

The causes of anorexia nervosa are multi

psychological and social mechanisms.

factored and there are many relative

They

theories from the scientific community.

seems to be a reaction to the demands of

It is supported that the disorder is

adolescence for more independence and

caused by a coalescence of biological,

increased social and sexual activity. In a

social-cultural

way,

and

psychological

-

believe

patients

that

anorexia

through

the

nervosa

disorder

psychical factors. There also the view

replace the normal adolescent quests

that the causes of anorexia nervosa are

with the constant concern of food and

only psychical or that there is no clear

control of their body weight. They report

evidence

that there are troubled relationships

regarding

the

exact

pathogenesis that induces the disorder.

between

parents

and

the

anorectic

But all scientists agree at the significant

children try to draw their attention. In

role of the family and particularly the

patients' family history are mentioned Page | 259

E-ISSN: 1791-809X

Health Science Journal © All rights reserved

www.hsj.gr

Quarterly scientific, online publication by Department of Nursing A’, Technological Educational Institute of Athens

cases of depression, alcoholism, and eating disorders.

15

the causes of anorexia nervosa. They believe

that

the

importance

of

Biological factors

psychological,

1. Heredity: Anorexia nervosa is reported

factors

in significally higher frequency among

Biological factors may be associated with

individuals that are biological related to

hormonal changes that occur during

anorectic patients and in genetic level

adolescence. Psychological mechanisms

there are evidence that it is occurred at a

may be involved in the changes in

rate of 50% between identical twins and,

personality and behavior during the

at rate of 10% in fraternal twins or twin

human life and social factors may be

sisters.

related with the idealization of thinness,

2.

Neurochemical

factors.

Biological

theories are focused in the function of hypothalamus,

where,

based

that

social

varies

plays

a

to

and each

powerful

biological individual.

role

in

our

culture.18,19

on

observations and clinical results, there is

Beginning and probability of prognosis

a protogenic dysfunction. Over-secretion

of anorexia nervosa

of cortisol is detected to malnutrition

Few data are available by researchers

and depression. There are increased

regarding the onset of the disorder. 85%

corticotropin

is

of the incidence is detected between 13-

released to cerebrospinal fluid of these

20 years of age, with adolescence being

patients. Also amenorrhea is reported

the most critical period of lifetime, and

before the occurrence of weight loss. An

the

increased level of ceretonin in brain

disorder after the age of 40 almost non-

reduces the appetite, and leptin seems to

existent,

have an important roll in regulation of

disorder is often

fat sites in the body, and as a result to

stressful event. The prognosis of the

the regulation of appetite. Anorexics

disorder is extremely difficult to be

have lower leptin levels in blood that are

defined, as it is influenced by the

increased with the temperature rise.16,17

structure of personality. Persons that are

Theory of unknown etiology

hysteric, with intense obsessions, and a

Group of scientists support the view that

bad

anorexia nervosa is an open question in

relationship, are very likely to develop

medicine and there is no psychiatric

the disorder in future. Also individuals

theory to support sufficiently by its own

with family history of anorexia nervosa,

CRG

levels

and

it

probability also

of

the

developing beginning

of

the the

associated with

background

Contribution of social and family factors in anorexia nervosa

of

a

maternal

Page | 260

HEALTH SCIENCE JOURNAL® Volume 6, Issue 2 (April – June 2012)

or

with

medical

history

of

diseases are at the same risk.

serious

20,21

anorexia nervosa are discriminated to medical complications of the disorder, including

Progress

and

prognosis

of

anorexia

hypokalemia,

bronchopneumonia, cardiac arrhythmia,

nervosa

coronary disease, pancreatitis, necrotic

Anorexic patients ask for medical advice

colitis and suicides.25

long after the appearance of very serious symptoms, many of them unwillingly,

Symptoms and behavior characteristics

after their family encouragement. The

The self-enforcement starvation of the

progress of the disease varies, from

patients, who are not having disorders in

immediate recovery after the treatment,

appetite, and are visibly obvious, causes

to unsteady progress of weight recovery

the

with recurrences, and to constant fatal

behavioral and physical changes.

aggravation. Studies report that the 1/3

Behavior of anorexic

of the patients is cured, at the 1/3 there

Anorexic persons have a disorder image

health condition is improved and at 1/3

of the normal weight and shape of the

the disorder becomes chronic.22

body and they consciously chose ways

Generally the prognosis is not good. The

for weight loss that gradually lead to

extended

disease,

dying. They seem to have obsessive

depression, frequent vomits and the

characteristics, high sense of duty and

excess

morality

duration weight

of

loss

the are

negative

symptoms

of

and

the

an

disorder

inclination

by

to

prognostic points, including hospitalized

independence. At the beginning they are

treatment, sensitivity to various diseases,

intensively busy preparing their meals,

and

family

with

intense

and they avoid high calorie foods, weight

As

positive

at least four times daily, and follow strict

prognostic points are considered the

exhausting diets.26 After a while they are

reduction of stress, a strongly supportive

entering the second phase, where their

family and friendly environment, and

behavior constantly changes, the family

also strongly structured personality.3

begin to realize the problem, although

The mortality of the hospitalized patients

patients still deny it and refuse any

is more 10% due to either excess weight

conversation about it, as a result there

loss or inanition or to suicide attempts.24

are

The causes of death in patients with

members, and gradually they become

psychopathology.

23

daily

conflicts

within

family

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Quarterly scientific, online publication by Department of Nursing A’, Technological Educational Institute of Athens

isolated. Their interest for any kind of activity is lost and reduced, their ability

Diagnosis of anorexia nervosa

to concentrate is reduced as well as their

The patents with anorexia nervosa seem

sexual activity. The patients adopt a

to have a certain behavior regarding the

contrary behavior, obstinacy, laziness,

shape

emotional instability and detachedness.27

Diagnosis of anorexia nervosa is based

Physical symptoms

on diagnostic criteria established by

Abrupt weight loss at a rate of 25% of

American Psychiatric Association (DSM-

the normal body weight, initially in

IV) that are in valid worldwide and are

males

referred

causes

delay

in

stature

and

and

weight

of

to

their

body.

psychopathological

pubescence and in female’s amenorrhea,

symptoms and signs and to evidence of

and in

endocrinologic disorders (Table 2). 33

both

metabolism.

sexes

In

continue

deterioration depression,

reduced

of

thyroid

occurs

body’s

intense

the

shape,

xerodermia,

Treatment

approaches

of

anorexia

nervosa

intolerance of high and low temperature.

There

Gradually

getting

treatment of anorexia nervosa. The first

thinner and the presence of lanugo (hair

is to rehabilitate the state of nutrition.

that looks like neonatal lint) becomes

For anorexic patients this means to

obvious on face, shoulder blade and

regain the body weight to normal levels.

hands

The

head’s

as

inflammation

well of

hairs

as

are

inflation

salivary

two

second

main

aim

is

aims

to

in

alter

the

the

As

pathological behavior of eating, so that

organism tries to adapt with low intake

the body weight is preserved to normal

of energy, appears a variety of organic

limits and to control the use of laxatives

disorders,

and other pathological behaviours.34

such

as

glands.

and

are

bradycardia,

arrhythmias and decrease of arterial

Usually

blood pressure having as result periods

outpatient

of

hospitalization is a severe weight loss

hypotension.

dental

problems,

formicary,

It

exceeds hands’

inflexibility,

anemia,

and

legs’

stress

and

anorexia

and

is

setting.

treated

in

Evidence

emaciation,

an for

hypotension,

hypothermia,

electrolyte

upheaval, insomnia and early awakening.

presence

suicidal

During laboratory testing the endocrine

psychosis, and the failure outpatient

disorders become obvious by disorders at

treatment.

hormonal prices (Table 1).30-32

The

of

treatment

disorders, ideation

approach

Contribution of social and family factors in anorexia nervosa

is

or

a

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HEALTH SCIENCE JOURNAL® Volume 6, Issue 2 (April – June 2012)

combination of behavior therapy and supportive psychotherapy.

35,36

The

modern

social

models

idealize

It is very

women with low body weight, with

important the approaching way of the

result the increasing number of incidents

person, in order to develop positive

of anorexia nervosa, especially among

behavior. This includes the learning of

adolescents. Long-term aim should be

behavior, and then follows de learning

the reducing effects of eating disorders

and relearning,

and the associated risk factors.

causes

of

the

without seeking the previous

pathologic

Scientists

emphasize

the

need

of

behavior. The aim of this behavior

encouraging the patients to seek therapy

treatment is to restore the normal way of

and to treat them with understanding,

eating. In

37

while the goals and limits of treatment

hospitalized

treatment

a

strict

are attainable. Also, they suggest specific

protocol is followed to anorectic patients

instructions regarding the level of the

in order to gain a certain weigh daily,

needed treatment to psychological and

regarding the intakes and outtakes of

behavioral

calories, and there is a close monitoring

anorexia

till 2 hour after the meal, to avoid

professionals should realize that the

induced vomiting to patients with excess

recovery of the disorder is a slow

weight loss.

procedure.

issues nervosa.

that All

characterize the

medical

The financial cost for this kind of Conclusions

disorders is high and onerous for the

Although there is a significant progress

families of the patients. Beside the long

in treatment of anorexia nervosa, the

period of time, there are many variations

conclusions, of the few studies during

in the force of the disease, and many

the

times hospitalization is necessary and

last

decade,

have

showed

a

wackiness in research, as it seems that

treatment

the ways of developing prevention and

multidisciplinary team of professionals

treatment programs of anorexia nervosa

for the patients and their families.

are not connected with the risk factors

Anorexia nervosa is a psychiatric disease

and the necessity of finding a treatment

with high mortality rates in young

approach that combines the traditional

patients. It is need the state to organize

methods of therapy with new ones, and

units for patients with eating disorders

this due to limited knowledge.

and

to

is

fully

common

cover

to

engage

treatment

a

and

Page | 263 E-ISSN: 1791-809X

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www.hsj.gr

Quarterly scientific, online publication by Department of Nursing A’, Technological Educational Institute of Athens

hospitalization. The public information is

6. Silverman JA. Richard Morton's

essential and especially to parents with

second case of anorexia nervosa:

adolescent children, as we believe that

Reverend Minister Steele and his

prevention and early recognition of the

son - An historical vignette. Inter J

problem are better than treatment.

Eat Disord, 2006; 7(3): 439 – 441. 7. Habermas

BIBLIOGRAPHY

T.

The

psychiatric

history of anorexia nervosa and

1. Patel DR, Phillips EL, Pratt HD.

bulimia nervosa: Weight concerns

Eating disorders. Indian J Pediatr,

and bulimic symptoms in early

1998; 65(4): 487-94.

case reports. Inter J Eat Disord,

2. Lewinsohn

PM,

Striegel-Moore

2006; 8(3): 259 – 273.

RH, Seeley JR. Epidemiology and

8. Berkman ND, Bulik CM, Brownley

natural course of eating disorders

KA, Lohr KN, Sedway JA, Rooks A

in young women from adolescence

et

to young adulthood.

disorders.

J Am Acad

Child Adolesc Psychiatry, 2000; 39 (10): 1284-92.

al.

Management Evid

of

Rep

eating Technol

Assess, 2006; 135: 1-166. 9. Krahn DD. The relationship of

3. Abraham S, Llewellyn-Jones D.

eating disorders and substance

Eating disorders and disordered

abuse. J Subs Abuse, 1991; 3(2):

eating. Ashwood House, Australia,

239-253.

1987. 4. Steiner

10.Lock J, Fitzpatrick KK. Advances H,

Lock

J.

Anorexia

in psychotherapy for children and

nervosa and bulimia nervosa in

adolescents with eating disorders.

children and adolescents: a review

Am J Psychother, 2009; 63(4):

of the past 10 years. J Am Acad

287-303.

Child Adolesc Psychiatry, 1998; 37(4): 352-9. Childhood onset anorexia nervosa and related disorders. Editors B and

A.

Eating

disorders

in

children and adolescents. MMW

5. Bryant-Waugh R Epidemiology. In:

Lask

11.Meyer

R

Bryant-Waugh.

Fortschr Med, 2007; 149(18): 2730. 12.Ruhl

U,

behavioral

Jacobi

C.

Cognitive-

psychotherapy

for

Lawrence Erlbaum and Associates

adolescents with eating disorders.

Ltd, Hove. 1993.

Prax

Contribution of social and family factors in anorexia nervosa

Kinderpsychol

Page | 264

HEALTH SCIENCE JOURNAL® Volume 6, Issue 2 (April – June 2012)

Kinderpsychiatr, 2005; 54(4): 286302.

20.Carter PI, Moss AR. Screening for anorexia and bulimia nervosa in a

13.Izydorczyk B, Czekaj B. Review of certain

conceptions

disorders.

on

eating

Suggestions

on

college population: Problems and limitations. Addict Behav, 1984; 9(4): 417-419.

psychotherapy for women with

21.Jacobi C, Abascal L, Taylor CB.

anorexia and bulimia nervosa (the

Screening for eating disorders and

authors'

high-risk

own

experience).

Psychiatr Pol, 2006; 40(1): 65-74. 14.Bruch

H.

therapy

Anorexia

and

Am

J

Psychiatry 1982; 139: 1531-1538. 15.McClelland L, Crisp A. Anorexia nervosa and social class. Intern J Eat Disord, 2001; 29(2): 150 – 156. 16.Ericsson Foreyt

M, JP.

Poston

WS

Common

Addict

KJ.

Mortality

and

sudden death in anorexia nervosa. Intern

J

Eat

Disord,

1998;

21(3): 205 – 212. 23.Golberg R. Practical guide to the

biological

Mosby, USA, 1995; 15 5: 221-225.

Behav,

1996;

24.Palmer nervosa.

R.

Death

The

in

anorexia

Lancet,

2003;

361(9368): 1490-1490.

17.Scott DW. Anorexia nervosa in the A

22.Neumärker

care of the psychiatric patient.

21(6): 733-43. male:

Disorders, 2004; 36(3): 280 – 295.

2nd,

pathways in eating disorders and obesity.

Caution.

International Journal of Eating

Nervosa:

theory.

behavior:

review

clinical,

K. General and program-specific

biological

moderators of two eating disorder

findings. Intern J Eat Disord, 2006;

prevention programs. Int J Eat

5(5): 799 – 819.

Disord, 2008; 41(7): 611-7.

epidemiological

18.Bryant

R,

of

25.Stice E, Marti N, Shaw H, O'Neil

and

Bates

B.

Anorexia

26.Mills IH, Medlicot L. Anorexia

nervosa: a etiological theories and

Nervosa

treatment

Behaviour Disease. Q J Med 1992;

methods.

J

Adolesc,

1985; 8(1): 93-103.

as

a

Compulsive

83: 507-522.

19.Keating C. Theoretical perspective

27.Pike KM, Walsh BT, Vitousek K,

on anorexia nervosa: The conflict

Wilson GT, Bauer J. Cognitive

of reward. Neuroscien Biobehav

behavior

Rev, 2010; 34(1): 73-79.

posthospitalization treatment of

therapy

in

the

Page | 265 E-ISSN: 1791-809X

Health Science Journal © All rights reserved

www.hsj.gr

Quarterly scientific, online publication by Department of Nursing A’, Technological Educational Institute of Athens

anorexia nervosa.

Am J Psych,

2003; 160: 2046-2049. in

female

university

dietetic majors. J Am Diet Assoc, 1989; 89(1): 97-98. 29.Castro

J,

Lazaro

L,

Psychotherapy

28.Drake MA. Symptoms of anorexia nervosa

35.Varchol

Cooper

H.

approaches

for

adolescents with eating disorders. Curr Opin Pediatr, 2009; 21(4): 457-64. 36.Richards PS, Berrett ME, Hardman

L,

Pons

F,

RK,

Eggett

DL.

Comparative

Halperin I, Joro J. Predictors of

efficacy of spirituality, cognitive,

Bone Mineral Density Reduction

and emotional support groups for

in

treating eating disorder inpatients.

Adolescents

with

Anorexia

Nervosa. J Am Acad Child Adolesc Psych, 2000; 39(11): 1365-1377. 30.Borson

S,

Katon

W.

Chronic

Eat Disord, 2006; 14(5): 401-15. 37.Kirkcaldy BD, Siefen GR, Kandel I, Merrick J. A review on eating

Anorexia Nervosa: Medical Mimic.

disorders

West J Med, 1981; 135(4): 257–

Minerva Pediatr, 2007; 59(3): 239-

265.

48.

31.Ramsay R, Treasure J. Treating

38.Halmi

KA.

and

adolescence.

Psychobiology

and

anorexia nervosa. BMJ, 1996; 312:

treatment of Anorexia nervosa and

182-182.

Bulimia

32.Hollander E, Neville D, Frenkel M,

nervosa.

American

Psychiatric, 1992: 241-333.

Josephson S, Liebowitz MR. Body

39.Agras WS, Robinson AH. Forty

dysmorphic disorder. Diagnostic

years of progress in the treatment

issues

disorders.

of the eating disorders. Nord J

Psychosomatics 1992; 33: 156-

Psychiatry, 2008; 62(Suppl 47):

165.

19-24.

and

related

33.Waldman HB. Is your next young patient

pre-anorexic

or

pre-

40.Kotler

LA,

disorders

bulimic? ASDC J Dent Child, 1998;

adolescents:

65(1): 52-6.

therapies.

34.Robin AL, Gilroy M, Dennis AB. Treatment of eating disorders in children

and

adolescents.

Clin

Psychol Rev, 1998; 18(4): 421-46.

Walsh in

BT.

Eating

children

and

pharmacological Eur

Child

Adolesc

Psychiatry, 2000; 9(Suppl 1): 10816. 41.Schmidt U. Cognitive behavioral approaches in adolescent anorexia and

bulimia

Contribution of social and family factors in anorexia nervosa

nervosa.

Child

Page | 266

HEALTH SCIENCE JOURNAL® Volume 6, Issue 2 (April – June 2012)

Adolesc Psychiatr Clin N Am,

disorders

2009; 18(1): 147-58.

adolescents. Cochrane Database

42.Michler P, Wolter-Flanz A, Linder M.

Intensive

outpatient

in

children

and

Syst Rev, 2002; (2): CD002891.

group

48.American Psychiatric Association

treatment for adolescents with

(APA). Diagnostic and statistical

eating

manual of mental disorders DSM-

disorders.

Kinderpsychol

Prax

Kinderpsychiatr,

2007; 56(1): 19-39.

IV.

4th

edit,

Washington,

American Psychiatric Association,

43.Schmidt U, Lee S, Beecham J,

1994.

Perkins S, Treasure J, Yi I et al. A randomized family

controlled

therapy

trial

and

of

cognitive

behavior therapy guided self-care for

adolescents

with

bulimia

nervosa and related disorders. Am J Psychiatry, 2007; 164(4): 591-8. 44.Le Grange D, Crosby RD, Rathouz PJ, Leventhal BL. A randomized controlled comparison of familybased treatment and supportive psychotherapy bulimia

for

nervosa.

adolescent Arch

Gen

Psychiatry, 2007; 64(9): 1049-56. 45.Vandereychen W. Anorexia

Treatment of

Nervosa.

Eat

Disord,

2003; 34(4): 409-422. 46.Varchol

L,

Psychotherapy

Cooper

H.

approaches

for

adolescents with eating disorders. Curr Opin Pediatr, 2009; 21(4): 457-64. 47.Pratt

BM,

Woolfenden

SR.

Interventions for preventing eating Page | 267 E-ISSN: 1791-809X

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ANNEX Table 1: Abnormalities in Anorexia Nervosa

FUNCTIONAL SYSTEM

FINDINGS

Endocrine metabolic

Normal thyroid gland Normal TSH* Decreased T3 and BMR Increased serum cholesterol Normal pelvic examination results Decreased FSH, LH, response to LHRH Decreased estrogen production Increased cortisol and urine free cortisol ACTH normal or increased Decreased suppressibility by dexamethasone Decreased serum insulin and RBC insulin bitting GTT flat or diabetic Salt and water balance maybe abnormal Deficient ADH Normal or increased serum GH Decreased GH response to glucagon, propranolol, TRH and levodopa Decreased, increased or normal serum Ca ++ and PTH

Hematologic

Anemias Leucopenia Thrombocytopenia

Miscellaneous

Increased ESR (mild) Decreased serum albumin Changes in serum globulins

Contribution of social and family factors in anorexia nervosa

Page | 268

HEALTH SCIENCE JOURNAL® Volume 6, Issue 2 (April – June 2012)

Table 2. Diagnostic criteria DSM-IV for anorexia nervosa (APA, 1996) DIAGNOSTIC CRITERIA

The refusal to maintain body weight at or above a though the person is underweight

DETERMINATION

A) Restrictive type Β) Hyper-appetite/ Purgative type

Excessive fear of weight’s increase or fear of fat although the individual is thin

Grossly distorted self-perception regarding the weight or the shape of the body.

Amenorrhea, for at least three consecutive periods.

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