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..click & see is a developmental period fraught with the physical and psychological changes that accompany the transition from childhood to adulthood. Teenagers must cope with the establishment of independence from parents, the creation of personal identity, the development of intimate relationships with members of the opposite sex, and the bodily changes that herald adulthood. Often, the key to self esteem lies in feelings about physical attractiveness. In our society, the high premium placed on thinness can create anxiety during this metamorphosis. Considering the myriad of social, academic, and parental pressures adolescents must face, it s no wonder some adolescents develop physical and psychological disturbances….click & see
A common manifestation of such disturbances is the development of an eating disorder. The incidence of the three common eating disorders anorexia nervosa, bulimia, and obesity have increased in the last decade. Among women aged 15 to 30, incidence rates are roughly 30 percent for obesity, 10 percent for bulimia, and one percent for anorexia nervosa. Although the least common of these three eating disorders, anorexia nervosa carries the gravest medical and psychological consequences.
Anorexia nervosa is a serious condition wherein a person systematically restricts food intake to the point of extreme emaciation. In 1689, a physician first described a patient with this illness as “a skeleton wrapped up in skin.” Anorexia nervosa is also characterized by an irrational fear of becoming obese, denial of physical discomfort, excessive physical activity, and high self expectations. Although “anorexia” means lack of appetite, people with anorexia nervosa may actually be concealing a large appetite. In fact, they are morbidity preoccupied with food and fear losing control and falling victim to binge eating.
Alarmingly, the incidence of anorexia nervosa has doubled over the past two decades. Most anorectics are white and come from middle class or upper middle class families. Some 90 to 95 percent of those with anorexia nervosa are female.
Anorexia nervosa usually begins in adolescence. A typical case is a mildly overweight teenager who believes herself to be overweight. She reduces her weight by 5 to 10 pounds. Rather than stopping there, she finds it becomes easier and easier to lose weight. Whether this continued weight loss stems from a boost to her self esteem or from physiologic changes secondary to starvation is unclear. The weight loss is maintained by severe restriction of caloric intake or food restriction alternating with periods of binge eating that end in self-induced vomiting or purging with laxatives and diuretics (“water pills”).
Regardless of the method of attaining the weight loss, the danger is that further emaciation may progress unremittingly until death. The overall mortality rate has been reported to be between two and 15 percent. One reason the patient allows herself to pursue this macabre wasting course is attributed to a “body image disturbance.” Specifically, patients with anorexia nervosa deny they are too thin or that they experience any physical discomfort from their self-imposed starvation. In fact, they may insist they are still slightly overweight even when severely emaciated. Surprisingly, the parents may also deny the existence of a problem. Therefore, teenagers with anorexia nervosa often come to medical attention in a severe state of inanition. The physical and psychological consequences can be severe.
Of the psychological consequences, the most feared is suicide. Although the incidence of suicide among anorectics is relatively low (two to five percent), it is high compared to the general population. Other psychological problems, such as depression, obsessive-compulsive behavior, and difficult family relationships may persist even after weight gain.
The most common physical manifestations of anorexia nervosa in women are amenorrhea (absence of menstruation) and estrogen deficiency. The latter may contribute to osteoporosis (brittle bones). A host of other hormonal disturbances often accompany anorexia nervosa. Imbalance in body chemistry can also have dire consequences. For example, starvation, vomiting. laxative, and diuretic abuse can all cause dangerous lowered levels of potassium in the blood. Low potassium can cause disturbances in the heart s rhythm and even cardiac arrest, the leading cause of death in anorexia nervosa. Additionally, many anorectics also have abnormally slow heart rates and low blood pressure.
Disorders of the gastrointestinal tract, such as constipation, are common. Anorexia nervosa also predisposes patients to kidney stones. Because malnourishment impairs the immune system, patients are at an increased risk for infection.
In short, the consequences of anorexia nervosa are diverse and many are serious. But, what causes anorexia nervosa? No one knows for sure. This disease can vary along a broad spectrum of severity ar-id may have just as broad a spectrum of contributing causes. Theories incorporate sociocultural factors, occupational and recreational environments. psychological causes, and neurochemical abnormalities.
Western society may play an important role because of the emphasis placed on thinness, especially for women. In a society where one is held personally responsible for one s body type (“you are what you eat”), obesity is tantamount to failure. Other societal pressure such changes in the ecology of food and eating (eg. high calorie fast foods), alterations in family and community life, and nuclear threat have also been implicated as contributing to rising rates of anorexia nervosa.
Occupational and recreational environments that put women at risk for anorexia nervosa are those that stress thinness such as ballet and athletics. Both the strenuous physical training and the restricted calorie intake contribute to the development of the disease.
Anorexia nervosa used to be viewed as primarily a psychological disorder. Now, the many physical complications are given equal attention. However, normal psychological functioning is often impaired. Patterns of early developmental problems and disturbed family interactions, accompanied by depression are often noted. Patients often experience a paralyzing feeling of ineffectiveness. Weight loss may be a defense against such feelings, a way to gain control over one s self.
Current research is focusing on a search for abnormalities in the hormones and chemicals that transmit nervous impulses in the brain. Whether these disturbances are the underlying cause of anorexia nervosa or are a result of starvation remains to be seen.
While the definitive cause of anorexia nervosa is unknown, treatment will probably continue to be largely unsatisfactory. Denial of the illness by the teenager and family alike impede compliance with treatment.
Current treatments include nutritional rehabilitation, individual, group, and family psychotherapy, and occasionally, antidepressants. In severe cases, the teen is hospitalized to correct physical imbalances or to prevent possible suicide. Unfortunately, relapses are common.
Anorexia nervosa is a serious illness with grave consequences. It is disturbing to health care professionals that the incidence is rapidly rising. Hopefully, in the future, the exact cause of anorexia nervosa will be discovered allowing for better treatment.
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