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Focus on .... Anorexia Nervosa

The term ‘anorexia nervosa (AN)’ is, in itself, misleading and generally considered a misnomer.

1) ‘Anorexia’ implies that the individual has lost all interest in food, never hungry and has no appetite. Yet, this is rarely the case. The opposite is more accurate of the AN experience.

The person is not only very interested in food and frequently very hungry, but as weight continues to decrease, and the person reaches low-weight stages AN, their preoccupation and obsession with food becomes overwhelming.

Nevertheless, the person experiencing AN will do everything in their power to deny and ignore these feelings and sensations and not permit themselves to eat. This is a particularly important characteristic AN, along with individual’s attempt to strictly control food and eating, with great time & effort.

The question of ‘what is AN?’ is difficult one to answer given particularly complex and multidimensional nature of the illness.

A large spectrum of physical, psychological, social, emotional, behavioural and cognitive features documented. Many of these have acknowledged and generally accepted as being defining features of AN.

However, it may be argued (I would certainly argue this) that the list of defining features is not complete. We must remember that AN is a complex illness with many consequences and implications. This is evidenced by the point that not all individuals experience exactly the same symptoms/implications in degree or severity.

We can paint a general picture of the AN experience but we must remember the the experience is very much an individual one.

Epidemiological studies suggest that approximately 85-90% of AN are female, about 10-15% are male. It is now widely accepted that AN is not restricted to young, white, girls and women from middle class backgrounds. AN (and all eating disorders for that matter) do not discriminate. AN can affect anyone of any gender, sex, age, background, religion, culture, ethnicity, nationality and occupation.

A number of signs & symptoms to look out for with AN include:

• Food abstinence, semi-starvation, restricted dietary/food intake – person deliberately & consciously works to restrict food consumption. Calorie intake is drastically cut.
• Typically forbids all foods considered fattening or high in fat.
• May allow self to eat bulky, low calorie, low-fat foods e.g. cottage cheese, carrots or crisp-bread.
• Often diet becomes so restricted they eat only 1 or 2 types of food.
• Food intake - often become quite eccentric in its constituent foods. E.g., yellow pigmentation some individuals develop as result of eating large amounts of carrots but little else.
• Delusional disturbances in body image. Unable to see themselves as they really are - why deny extreme thinness/lightness (if present).
• Abuse of strenuous and/or compulsive exercise, laxatives, diuretics to control weight & bodily functions.
• Dry, chapped skin.
• Hyperactivity & periods of feeling ‘high’ (due to lack of food).
• Heart arrhythmias.
• Low blood pressure.
• Muscle weakness & atrophy.
• Lanugo (increased hair growth on face & body).
• Loss of periods (amenorrhoea).
• Bradycardia (slow pulse rate).
• Acrocyanosis (blueness to hands, feet & other extremities).
• Extremely low self-esteem.
• Socially anxious.
• Excessively dependant.
• Social withdrawal & isolation.
• Hair loss.
• Malnutrition
• Sleep disturbances.
• Conflict avoidant.
• Stealing.
• Electrolyte disturbances.
• Zinc deficiency.
• Dehydration.
• Osteopenia/osteoporosis.
• Cognitive impairments, e.g. memory, concentration, decision-making, problem-solving, black-&-white thinking.
• Self-harm.
• Feelings of being out of control.
• Chronic depression.
• Suicidal ideation.
• Neutropenia.
• Perfectionism.
• Acute dilation of stomach.
• Lack of self-worth, self-loathing, self-doubting.
• Feelings of despair, loneliness & desperation.
• Obsessive compulsive behaviours are common.
• Rituals & routines pervade almost every aspect of life - food, relationships, work, body shape, chores, daily activities etc.
• Psychiatric co-morbidity.
• Bloating & gastrointestinal symptoms.
• Seizures.
• Oedema.
• Cardiac problems.
• Anaemia.
• Myopathy.
• Death.

Individuals with AN often finds an outlet via their body: distress and pain are mirrored in their extreme control of body – not for beauty or vanity’s sake – but because they have no other way of coping with such distress.

The body becomes canvas for which such distressing emotional and psychological thoughts and feelings are represented.

As with all types of Eating Disorder, AN is a complex, multidimensional illness that has complications affecting all areas of life – physical, psychological, emotional, social, sexual, behavioural, occupational.

Evidence suggest that the sooner you seek and receive help and support (wherever that may be), the more effective treatment and therapy will be, and the more likely you will become well again.

(Alexandra O'Brien. Talking EDs: Glasgow & West Eating Disorder Service, 2012, 2018. All rights reserved © )
 
www.eatingdisorderscotland.co.uk
support@eatingdisorderscotland.co.uk 
 
 

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