Discussion

Authors:

Cecilia Ragsdale

Nisha Santhosh

Patience Ndubuike

Walter Akwo

What is Anorexia Nervosa?

· Anorexia nervosa is a complex mental health condition and a potentially life-threatening eating disorder that often involves emotional challenges, an unrealistic body image, and an exaggerated fear of gaining weight. An individual with anorexia nervosa will intentionally restrict their food intake as a way to help them manage their fear of gaining weight or desire to lose weight (White, M. 2021).

Pathophysiology

· According to Moore and Bokor (2020), the onset is said to be late adolescence and early adulthood and risk factors include childhood obesity, female sex, mood disorders, personality traits, sexual abuse or weight-related concerns from family or environment.

· Research indicates that biological and environmental factors play a role in the development of Anorexia Nervosa, and patients with Anorexia Nervosa have altered brain function and structure related to deficits in neurotransmitters Dopamine and Serotonin, and these patients are said to have also comorbid psychiatric disorders such as major depressive disorder and generalized anxiety disorder (Moore & Booker, 2020).

· Although Anorexia Nervosa disorder most frequently begins during adolescence, it can also affect people of all ages, gender, sexual orientations, races, and ethnicities (National Eating Disorder Association (NEDA) 2018).

Signs & Symptoms

· Purging for weight control

· Obsession with food, calories, and dieting

· Changes in mood and emotional state

· Distorted body image

· Excessive exercise

· Denial of hunger and refusal to eat

· Engaging in food rituals

· Feeling of tiredness and weakness all the time

· Extreme weight loss or not expected developmental weight gains

· Reduced interest in sex

· Bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products.

Diagnosis of the Disorder

· The diagnosis for anorexia nervosa is based on the diagnostic criteria for anorexia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and physical examination by a trained professional which includes height and weight, vital signs, skin, and nail check, listening to the heart and lungs, and abdominal exam.

· Lab tests include a complete blood count (CBC), liver, and kidney function test, thyroid test, and a urinalysis also may be done.

· A psychological evaluation by a psychiatrist is also needed to assess the thoughts, feelings, and eating habits of the patient and self-assessment questionnaires may be performed also.

· Other studies that may be useful include X-rays to check bone density, stress fractures, or broken bones, and check for pneumonia or heart problems. Electrocardiograms may be performed to monitor heart irregularities (U.S. DHHS, 2018).

Treatment Options

· The treatment goal for anorexia nervosa is to restore the patient's nutritional state, which includes dehydration, starvation, and electrolyte imbalance. The decision of treatment depends on the patient's individual needs (Sadcok et al.,2014).

  Treatment Modalities

1-     Psychotherapy

   Psychotherapy emphasizes changing the behavior of a person with an eating disorder. Treatment comprises methods for developing healthy attitudes toward food and weight and tactics for changing how the person responds to challenging situations (Cleveland clinic, 2019).

· Cognitive Behavioral Therapy (CBT). CBT'S goal is to address distorted opinions and attitudes about weight, shape, appearance, and exercise behavioral alteration (Cleveland clinic, 2019). Through CBT, patients learn to monitor their food intake, feelings, emotions, binging and purging behaviors, and interpersonal relationship problems (Sadock et al., 2014).

· Family-based Treatment. This therapy contains family-based refeeding, which means putting the parents/family in charge of getting the appropriate nutritional intake consumed by the individual with the eating disorder. It is the most evidence-based method to physiologically restore health to Anorexia nervosa under 18 years (Cleveland clinic, 2019).

2-    Nutrition counseling

· It helps to lead a healthy approach to food and weight, help restore normal eating patterns, and teach the importance of nutrition and a balanced diet.    

3-     Pharmacotherapy

· Use of Cyproheptadine (Periactin), useful in patients with restricting the type of anorexia nervosa. In patients with depressive symptoms associated with Anorexia Nervosa, tricyclic antidepressants may be sufficient. Adequate nutritional status can reduce the adverse effects of antidepressants in patients with Anorexia.

4-     Hospitalization

· The criteria for hospitalization based on the patient's medical condition and the patient's co-operation. The hospital management approach includes monitoring daily weight, daily fluid intake, and output, monitoring serum electrolyte levels to prevent hypokalemia. Staff may monitor the patient after meals to avoid the opportunity for vomiting (Sadock et al., 2014). 

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