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Apellido: Timiliotis Asignatura: Psicología de la Salud Nombre: Joanna Profesor: José Navarro Góngora Curso: B (3) Fecha: 30/03/
Comentario de texto 2 Anorexia Nervosa Abstract: The article to be commented on, written by E. Attia and B.T Walsh is about Anorexia nervosa which is a serious mental illness characterized by maintaining a low and inappropriate body weight. The DSM -IV lists four criteria for the diagnosis. The prevalence of anorexia is usually estimated 0.5-1 % for women and a tenth of it for men. The course of anorexia nervosa is very variable. The evaluation should include specific questions about eating behavior. The physical and behavioral characteristics have led to the development of a variety of neurobiological hypothesis. For younger patients the family-based treatment appears promising.
Development of the main ideas: The main idea of this article is to inform about anorexia nervosa, as well as the diagnoses, the origin, the evaluation and treatment.
Diagnostic Anorexia is a mental illness that drives people to lose more weight than is considered healthy and to suffer from distorted cognitions about shape and weight. Usually weight loss is achieved by a decrease in total food intake or binge eating and /or purging. The identification of anorexia nervosa can be very complicated, as sufferers carry it in secret, they are embarrassed and deny it and as a result the disease can stay undetected. In the current diagnosis, there are four criteria outlined by the DSM –IV: (1) the refusal to maintain body weight at or above a minimally normal weight for age and height, (2) intense fear of gaining weight or becoming fat, even though underweight, (3) Disturbance in the way in which one’s body weight or shape is experienced and (4) in postmenarchal females, amenorrhea Furthermore, DSM-IV describes two subtypes of anorexia nervosa—the restricting subtype and the binge- purge subtype. The DSM-IV criteria are most easily applied when patients are both sufficiently ill to fulfill all four diagnostic criteria and able to describe their ideation and behavior accurately. However, because ambivalence and denial frequently lead those with anorexia nervosa to minimize their symptoms, the clinician must make inferences about mental state and behavior. An additional problem in diagnosis is that many individuals meet some but not all of the formal diagnostic criteria. Proper diagnosis of any condition that includes low weight and restrictive eating must include consideration of other psychiatric and medical conditions that include these problems. Medical conditions, including endocrine disturbances, gastrointestinal disturbances, infections, and neoplastic processes may present with weight loss and should be considered when evaluating a patient for a possible eating disorder.
Background and Epidemiology Anorexia nervosa has been recognized for centuries, medieval stories are characterized by a large weight loss from a self-imposed starvation diet that transforms the sufferer. However, their first clinical descriptions were given by Morton in 1689 and the term Anorexia nervosa were coined by Gull in 1873. A 2002 review in the American Journal of Psychiatry concluded that little progress was made during the second half of the 20th century in understanding the etiology, prognosis, or treatment of the disorder. Despite its long-standing recognition, remarkably little is known about the etiology of, and effective treatment for, anorexia nervosa This disease is highly prevalent in more developed countries. Prevalence rates for anorexia nervosa are generally described as ranging from 0.5% to 1.0% among females with males being affected about one-tenth as frequently.
Risk Factors and the course of the illness The identification of risk factors for anorexia nervosa is challenging because the low incidence of the disorder makes the conduct of prospective studies of sufficient size very difficult. A variety of possible risk factors have been identified, including early feeding difficulties, symptoms of anxiety, perfectionistic traits, and parenting style, but none can be considered to have been conclusively demonstrated. Similarly, cultural factors undoubtedly play some role in the development of anorexia nervosa, although the disorder’s long history and its presence in regions around the globe. Genetic factors are increasingly accepted as important contributors to the risk of anorexia nervosa. The course of anorexia nervosa is highly variable, with individual outcomes ranging from full recovery to a chronic and severe psychosocial disability accompanied by physical complications and death. Intervention early in the course of illness and full weight restoration appear to be associated with the best outcomes and adolescent patients have a better prognosis than do adults Several studies have found that there are alterations in the function of serotonin in various clinical conditions, which are eating disorders, depression, aggressive behavior, anxiety. The neuroanatomical evidences indicate that serotonergic neurons have an inhibitory effect on the activity of various brain areas involved in mediating anxiety. If Anorexia is not threatened it can lead to physiological problems such as damaged organs (especially the heart, brain and kidneys), fall in blood pressure, pulse and respiratory rate, brittle nails and hair, low body temperature, bone thinning…
Physiological disturbances and neurobiological hypotheses A multitude of biological disturbances may occur in underweight patients, but most appear to be normal physiological responses to starvation. Clinically significant abnormalities may develop in the cardiovascular, gastrointestinal, reproductive, and fluid and electrolyte systems. These abnormalities usually do not require specific treatment beyond refeeding, and they return to normal on weight restoration. A worrisome possible exception is reduced bone density; since peak bone density is normally achieved during young adulthood, a
- Hospital-based treatments may be used when weight is significantly low or when there has been rapid weight loss or medical signs of malnutrition.
- Cognitive behavior therapy which is superior to nutritional counseling in preventing relapse after hospital-based weight restoration.
- Medications for patient, but studies have consistently reported disappointing results: several psychopharmacologic agents have been studied, without identification of clear benefit.
Conclusions: Anorexia is a serious mental illness, both from the standpoint of physics and psychology, which has dramatically increased in frequency the recent years. It must be prevented through education of body image for greater confidence, be aware of healthy eating and exercise. Furthermore, it is a disease where interacting biological, psychological, familial and sociocultural aspects in order to adapt to the environment in which they live. The feeling to be too fat is one of the most common causes in the occurrence of this disorder. Most people who develop this condition are perfectionist women with low self- esteem, they think they need to be thin to be beautiful and achieve their goals in life. Today there are different solutions, treatments to this problem to help people recover slowly.
Personal comment:
The article emphasizes the important facts about the diagnoses, the origin, the evaluation and treatment of Anorexia Nervosa. Otherwise the influence of broader factors should not be neglected. We know that risks factors of this disease are determined by personality traits, biological and environmental factors but especially the influence of other factors on the proliferation of anorexia but also on other eating disorders such as bulimia nervosa cannot be refuted. Research has demonstrated that the media contributes to the development and maintenance of eating disorders: Magazine articles, television shows, and advertisements have created a social context that may contribute to body dissatisfaction and disordered eating in girls and women. There is plenty of evidence demonstrating that the media glorify slenderness and weight loss and emphasize the importance of beauty and appearances. The messages and images that focus on the value of appearances and thinness for females have a significant negative impact on body satisfaction, weight preoccupation, eating patterns, and the emotional well-being of women in western culture. Given the prevalence of body dissatisfaction and disordered eating in females in our society, and the associations which have been found between eating disorders and the media, it would be prudent for professionals and the public to advocate for more positive and self-esteem building messages to be conveyed to females by the media. Recent research supports the current idea that the incidence of anorexia nervosa and related eating disorders is increasing in Western societies. This phenomenon raises questions regarding the possibilities of prevention. It seems difficult, if not impossible, to change sociocultural influences such as the fashion of slenderness, and upper/middle-class family characteristics. It is more fruitful to search for different risk factors and ‘suspicious’ signs instead of deducting preventive measures
from any linear theory of causation. Specific attention should be paid to early recognition of (pre) anorexics, but this secondary prevention is seriously hampered both by patient delay and doctor delay. Prevention and treatment of eating disorders should therefore include media literacy, activism, and advocacy. Future research should focus on ways to counter-act the effects of the media, in order to improve body satisfaction and self-esteem for girls and women in western culture.
Summary: Anorexia nervosa is a serious mental illness characterized by lack of weight and the pursuit of thinness. Although recognized for centuries, anorexia nervosa remains enigmatic, often difficult to treat, and potentially lethal. The current approach to treatment includes careful medical assessment, ongoing medical and weight monitoring, and behaviorally oriented treatment aimed at normalizing weight and eating behaviors. Family-based treatment appears promising for younger patients. One of the diagnostic challenges of this disease is that patients can minimize their symptoms because of their denial of the disorder: the therapists can get better results if the patient is motivated to identify the symptoms. The course of the disease is highly variable and depends on the individual, but the earlier the intervention starts the easier it is to recover and decrease physiological problems.
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URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2533817/ http://baywood.metapress.com/app/home/contribution.asp? referrer=parent&backto=issue,3,9;journal,130,182;linkingpublicationresults,1:300314,
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC, American Psychiatric Association, 1994
