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Konstantine Zakzanis

Chapter 9 Eating Disorders - 0.5% of Canadians 15 years of age or older reported that they had been diagnosed wit an eating disorder in the preceding 12 months - women are more likely than men to report an eating disorder - eating disorders can cause long-term psychological, social, and health problems - hospitalization is sometimes necessary; hospitalization rates are highest among young women in the 15- 24 range; rates are also high among those aged 10-14 and 20-24 Clinical Description - anorexia nervosa and bulimia nervosa both share features; the most important being an intense fear of being overweight Anorexia Nervosa anorexia nervosa (AN) a disorder in which a person refuses to eat or to retain any food or suffers a prolonged and severe decrease of appetite; the individual has an intense fear of becoming obese, feels fat even when emaciated, refuses to maintain a minimal body weight, and loses at least 25% of hisher original weight - anorexia refers to loss of appetite and nervosa indicates that this is for emotional reasons - there are 4 features required for the diagnosis: the person must refuse to maintain a normal body weight this is usually taken to mean that the person weighs less than 85% of what is considered normal for that persons age and height; weight loss is typically achieved through dieting, although purging (self-induced vomiting, heavy use of laxatives or diuretics) and excessive exercise can also be part of the picture the person has an intense fear of gaining weight and the fear is not reduced by weight loss; they can never be thin enough patients with AN have a distorted sense of their body shape their self-esteem is closely linked to maintaining thinness; the tendency to link self esteem and self-evaluation with thinness is known as over-evaluation of appearance in females, the extreme emaciation causes amenorrhea, the loss of the menstrual period of the 4 diagnostic criteria, amenorrhea seems least important to determining a diagnosis of anorexia; comparisons conducted in Canada show few differences between women who meet all 4 criteria and women who meet the other 3 but not amenorrhea; amenorrhea occurs in a significant minority of women before any significant weight loss and the symptom can persist after weight gain amenorrhea loss of menstrual period that is sometimes caused by eating disorders - the distorted body image that accompanies AN has been assessed in several ways, most frequently by questionnaires such as the Eating Disorders Inventory (EDI) - the EDI is one of the most widely used measures to assess self-reported aspects of eating disorders - patients with AN overestimate their own body size and choose a thin figure as their ideal - DSM-IV-TR distinguishes 2 types of AN in the restricting type, weight loss is achieved by severely limiting food intake - in the binge eating-purging type, the person also regularly engages in binge eating and purging - the binging-purging subtype appears to be more psychopathological; patients exhibit more personality disorders, impulsive behavior, stealing, alcohol and drug abuse, social withdrawal, and suicide attempts than do patients with the restricting type of anorexia - also, relative to the restricting type, binging-purging patients tend to weigh more in childhood, come from heavier families with greater familial obesity, and use more extreme weight-control methods - AN typically begins in the early to middle teenage years, often after an episode of dieting and exposure to life stress - its about 3-10 times more frequent in women than in men, with a lifetime prevalence of 1% in women - twas found that males had lower levels of drive for thinness and body dissatisfaction, but there were many more similarities than differences between the males and females - patients with AN are diagnosed frequently with depression, OCD, phobias, panic disorder, alcoholism, oppositional defiant disorder, and various personality disorders - comorbidity is higher in clinical samples than community samples Physical Changes in Anorexia Nervosa - self-starvation and use of laxatives produce numerous undesirable biological consequences in patients with AN - blood pressure often falls, heart rate slows, kidney and gastrointestinal problems develop, bone mass declines, the skin dries out, nails become brittle, hormone levels change, and mild anemia may occur - some patients lose hair from the scalp, and they may develop laguna, a fine, soft hair, on the bodies - levels of electrolytes, such as K and Na are altered; these are essential for the process of neural transmission, and lowered levels can lead to tiredness, weakness, cardiac arrhythmias, and even sudden death - brain size declines in patients with AN, and EEG abnormalities and neurological impairments are frequent - deficits in white matter volumes in the brain are restored upon recovery from AN, but deficits in grey- matter volumes appear irreversible, at least in the short term Prognosis - about 70% of patients with AN eventually recover; recovery often takes 6-7 years, and relapses are common before a stable pattern of eating and maintenance of weight is achieved - AN is a life-threatening illness; death rates are about 10 times higher among patients with the disorder than among the general population and twice as high among patients with other psychological disorders - suicide rates are not elevated in bulimia nervosa like they are in AN, though people with BN are more likely to have suicide ideation Bulimia Nervosa bulimia nervosa (BN) a disorder characterized by episodic uncontrollable eating binges followed by purging either by vomiting or by taking laxatives
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