Eating disorders Anorexia

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Eating disorders - Anorexia
Eating disorders anorexia

• Well-being

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What is anorexia?

• There are many diseases, disorders, problems and
  conditions involving food, eating, and weight,
  but in everyday conversations, the term eating
  disorders has come to mean anorexia nervosa,
  bulimia, and binge eating.

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Anorexia nervosathe relentless pursuit of
thinness

• A person with anorexia deliberately loses weight.
  The weight loss may become severe and
  life-threatening.
• Is an eating disorder, many people when talking
  about anorexia think in terms of models and
  actresses. However anorexia is a serious illness
  which affects all sorts of people.

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Anorexia nervosaSymptoms

• Person refuses to maintain normal body weight for
  age and height.
• Weighs 85 or less than what is expected for age
  and height.
• In women, menstrual period stops. In men levels
  of sex hormones fall.
• Young girls do not begin to menstruate at the
  appropriate age.

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• Person denies the danger of low weight.
• Is terrified of becoming fat.
• Is terrified of gaining weight even though s/he
  is markedly underweight.
• They feeling fat even when very thin.
• AN has significant physical consequences
• Low body weight in females causes the body to
  stop producing estrogen
• Low estrogen levels contribute to significant
  losses in bone density
• Production of excessive amounts of the adrenal
  hormone cortisol, which is known to trigger bone
  loss
• A decrease in the production of growth hormones
  and other growth factors
• Calcium deficiency and malnutrition
• In males tesosterone deficiency may be
  responsible for the low bone density. Which
  leads to a condition known as osteoporosis.
• In addition, anorexia nervosa often includes
  depression, irritability, withdrawal, and
  peculiar behaviors such as compulsive rituals,
  strange eating habits, and division of food into
  good/safe and bad/dangerous categories.

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• To lose weight they use
• laxatives
• appetite suppressant drugs
• diuretics
• doing excessive amounts of excercise
• People with anorexia weight 15 or more below the
  expected weight for their age, sex and heigh. BMI
  is below 17,5.
• A wrong idea of body size.

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• Other features
• Vomit secretly after eating
• Often wear baggy clothes to hide their thinnes
• Try hard to hide also unusual things what they do
  to lose weight
• They lie about how much they eat and about
  everything to do with food.
• They like food and feel hungry, but it is the
  consequenses of eating that frightens them.

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• Many people with anorexia dont want to see that
  they have a problem. They eather never get help,
  or delay getting help for many years.

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What is the cause of anorexia?

• Person may have low tolerance for change and new
  situations may fear growing up and assuming
  adult responsibilities and an adult lifestyle.
  May be overly engaged with or dependent on
  parents or family. Dieting may represent
  avoidance of, or ineffective attempts to cope
  with, the demands of a new life stage such as
  adolescence.

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• The exact cause is not clear. Part of the cause
  is a fear of getting fat but it is not just as
  simple as that.
• Different causes possibly work together to bring
  on the illness. These may include the following
• The pressure from society and media to be thin
  and beatiful -gt this is probably why anorexia is
  much more common in westernised countries

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• Personality and family environment probably play
  a role too -gt people with anorexia often have
  poor self-esteem and they have a feeling that
  they have to be perfect. Often they have
  disturbed family relationships.
• Genetic factors

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What thoughts are used by the anorectic patient
to maintain their illness?

• Their usual thoughts are
• Nothing will be better if I eat.
• I am already too fat and if I eat I will be even
  fatter.
• Everything I put in my mouth must be removed by
  exercises.

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Anorexia in other countries

• India most people in India have not yet heard
  of the condition but there is a high number in
  anorectic cases, thus leads to death
• Africa in some places in Africa according to
  the study carried out in rural Ghana, found that
  eating disorders may not be soley western
  phenomenon. The reasons for dieting include
  religious fasting particularly around times of
  stress and for feeling of self-control.
• Czech.R. people are mostly under the influence
  of westernphenomenon.

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What is the treatment for anorexia nervosa?

• The aims of treatments are
• Reduce risk of harm which can be caused by
  anorexia.
• To encourage weight gain and healthy eating.
• To reduce other related symptoms and problems.
• To facilitate recovery of mental and physical
  well-being.

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When patient with anorexia comes to the hospital

• Its good to search and think how serious
  situation is.
• First there is social, physiologic and
  psychological tests.
• Make sure that patient dont have any medical
  problems which can lead to weight loss,
  differential diagnoses.

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• She or he has to learn how to eat again. That is
  not easy, because anorexia patients dont want to
  eat. Usually they dont eat warm meals and they
  eat only couple of times a day and mostly only
  fruits and vegetables (normally people eat 3-5
  times a day).
• They have 1,5 hours time to eat, and its their
  decision whether she/he want to eat or not.

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• Psychological treatment
• Such as cognitive behavioural therapy.
• Talking treatment helps to look at the reasons
  why the patient developed anorexia, aims to
  change any false believes that they may have
  about their weight and body, and how to identify
  and deal with emotional issues. This treatment
  takes time.

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• In the acute phase of anorexia nervosa the
  patient is unwilling to accept rational arguments
  and it may be necessary to stop the starvation in
  order to prevent destruction of the body. If
  possible the parents should take part in the
  treatment. The purpose is to normalise the
  patients weight. If it is possible to persuade
  the patient to eat or drink nutrients in
  sufficient quantities at home, it may be
  necessary to insist on hospital care where
  tube-feeding or drip-feeding can be used. If the
  patient still refuses to accept nutrition then
  sedatives may be required in order to make it
  possible.

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• The patient should not go to school or be exposed
  to stress and demands, but she should take it
  easy, keep warm and have a pleasant time.
• The treatment of anorexia requires enormous
  patience from both parents and hospital staff.
  The co-operation of the patient will eventually
  be needed and this calls for many discussions and
  motivations initiated by relatives,
  psychotherapists and staff.

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• The parents should not be accused of causing the
  illness, but should be seen as an asset in the
  care of the patient. The main problems are the
  patients false conseptions conserning food and
  the body.

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• Non verbal therapy like occuptional therapy,
  group therapy and cooking therapy. Patient with
  anorexia fear touching food an eating. It is
  good if therapy helps them find new ways to
  handle food. Than we try to find a way how to
  speak about eating disorders.
• Complementary therapy for the well-being of
  anorexia patient.

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Are there any medicines which help in the
treatment of anorexia nervosa?

• Antidepressive medicines usually do not help in
  the acute stages of anorexia nervosa. But resent
  studies indicates that Prozac can prevent
  anorexia from reccuring, after the patient has
  achieved normal weight. Two-thirds of former
  anorectics who used Prozac succided, while only
  16 could avoid reccurance of anorexia among
  those who were threated with placebo.

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Self help measurments

• Antidepressant medication in some situations
• Treatment of any physical or teeth problems
• Self help measures may be appropriate for some
  people. These provide strategies on how to cope
  with and over come anorexia. They are not
  suitable for everyone, particularly if the
  anorexia is severe.

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Complementary therapy Psycho-motoric therapy

• To help our patients get a better body image, we
  do this by helping them change their bodies and
  teaching them to accept themselfs.
• How to achieve this?
• Rebuilding a realistic self-image.
• Finding a part of your body that you like.
• Looking into the mirror and looking in your eyes
  and tell ourself that you are worthful.
• Excercise with ropes.

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• Curbing hyperactivity tension
• Ask the audience how many setups are you able to
  do in a day. Anorectic patient would answer that
  they can do more than 10 000 a day, which is
  about 25 h a day setups! That is impossible and
  they are only making their own muscles tired -gt
  damage.

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• Developing social skills
• Some patients dont like to be touched and
  they have difficulties touching others. We
  developed an excersice which will make it easy
  to get used to being touched with out a fear that
  some thing bad will happen to them.
• Excersice with the cloth with different colours,
  trying to work together to change the surface of
  the cloth.
• Learning to enjoy the body.
• - Relaxation, breathing exercises.
• Communication or body interaction
• - dancing, playing, group exercises.

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Multi disciplinary approach

• Psychiatric -gt oversight and monitoring of
  medications to help stabilise her mental health
• Primary care provider-gt evaluate physical health
• Registered dietician-gt develop individualised
  meal plan to meet her nutritional requirments
• Physotherapist-gt individual and group sessions to
  discover the roots of her eating disorders

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• Psychologist-gt provide psychometric testing and
  diagnostic services to assist with planning and
  group therapy
• Nurse-gt ensure an atmosphere of consistency,
  nurturance, safety and accountability. Giving
  eating advice to the youth and their parents,
  thus preventing anorexia.
• Even though our disciplines might take different
  approach, our aim is common, which is the
  well-being of our patients.

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How many patients recovery from anorexia? Or die?

• Anorexia nervosa, when properly treated, recovers
  completely in about 40 of the cases recovers
  with defect(some permanent subsymptom remaining)
  in 35 of cases, and envolves towards an
  incurable chronic condition in 25 of cases.
• Anorexia nervosa is the psychiatric pathology
  with the highest index of mortality(20 within 17
  years from the diagnosis.) These percentages do
  not include, obviously, the related figures about
  the recovery of the mind, do not consider the
  scarf a serious pathology can leave, nor the
  benefits coming from fighting such a cruel
  battle. Such knowledge is highly subjective and
  can be retrieved only in the hearts of the ones
  who have lived such an experience.

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References

• Link between psychotherapy and physiotherapy
  Prof.dr.Michel Probst K.U.Leuven, Belgium.
• Complementary therapies Marc Velghe
• Visit of the University Hospital Gent (K12)
  Co-ordinator Dr Bart Thomas
• Internet www.remudarange.com, www.bbc.com,
  www.bulimiaandanorexia.com.

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Discussion

• What are your views on the legalisation and use
  of Euthanasia in severe anorextic conditions?
• With lots of thanks from Gent group 6 in
  co-operation with Belgium, Czech Republic,
  Finland, Hungary and Namibia.