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Anorexia Nervosa — A mental health disorder

Anorexia Nervosa is an eating disorder in which sufferers are obsessed with food and being thin. There are some people that are bent on becoming so thin that may result to measures such as self-starvation. Anorexics are underweight and may even be skeletally thin and still think that they are fat. To lose weight or prevent weight gain, individuals with anorexia may exercise excessively or starve themselves. In addition to the fact that anorexia centres around food, it is also seen as a way to try to cope with emotional problems, a desire for control and perfectionism and sufferers often equate their self-worth with how thin they are. It is commonly seen in teenagers as the condition usually starts during this period. The condition is more common in women but boys and men may also be affected. Anorexia could be difficult to overcome but with treatment and a healthier perception of self, healthy eating habits may return and there could be a reversal of the serious complications that may be associated with the condition.

There are two categories of anorexia which often overlap namely “Restricting” where weight loss is achieved by severely restricting food intake and exercising excessively and “Binge-eating/Purging” where excessive amounts of food are eaten then there is an attempt to control weight by purging through the processes of inducing vomiting after meals and misusing laxatives, diuretics and enemas. In some cases even the consumption of a small amount of food such as a single piece of candy or sweet will be followed by purging. Anorexics frequently move between these two categories or may combine these processes.

In addition to excessive weight loss there are physical, emotional and behavioural signs associated with anorexia. Physical signs include thin to skeletal appearance, dizziness or fainting, fatigue, abnormal blood counts, thinning, breaking hair that falls out, brittle nails, soft downy hair covering the body, constipation, cessation of menstruation, cold intolerance, dry skin, osteoporosis, irregular heart beats, dehydration and low blood pressure. Emotional and behavioural characteristics include refusal to eat, preoccupation with food, denial of hunger, exercising excessively, difficulty concentrating and dull mood or lack of emotion.

Signs and symptoms of anorexia may not always be obvious and oftentimes anorexics disguise their thinness and other physical or behavioural problems. If you suspect someone has anorexia, you should watch for the following indicators such as making excuses for not eating, skipping meals, eating only a few “safe foods” low in fat and calories, adopting rigid meal or eating rituals such as spitting food out after chewing or cutting food into tiny pieces, weighing food, cooking elaborate meals for others but refusing to eat, frequent checking in the mirror for perceived flaws, repeated weighing of themselves, complaining about being fat and wearing baggy or layered clothing.

Anorexia usually starts in the teenage years but may occur in childhood, midlife and old age. The reason some individuals develop anorexia is not well known and it is thought to likely be as a result of a combination of psychological, biological and socio-cultural factors. Anorexics may have psychological and emotional characteristics that contribute to the condition. They may have low self-esteem or may have obsessive-compulsive personality traits that make it easier to for them to adhere to strict diets and starvation. They may also have an extreme drive for perfectionism leading them to think that they are never thin enough. Some people may be genetically vulnerable to developing this disorder. A family history puts individuals at a higher risk which suggests a possible genetic link which may create a tendency towards perfectionism, sensitivity and perseverance. It is also thought that a chemical in the brain known as Serotonin may also play a role. Unfortunately, modern, Western culture often reinforces the desire to be thin. Exposure to the Western media which glorifies skeletal looking models and actors suggests that success is equated to thinness and this has a negative effect particularly on our young girls.

There are risk factors associated to the development of anorexia. Dieting and unintentional weight loss may often be complimented reinforcing the practice, weight gain may lead to ridicule which may lead to excessive dieting, pubertal teens may suffer peer pressure about size, may be extremely sensitive to criticism about body shape and may have trouble coping with changes in the body during this period. Emotional life stressors such as moving town or school, the break-up of a relationship or the death of a loved one may lead to anorexia. Athletes, actors, dancers and models are at a higher risk as ultra-thinness may be a professional requirement. The media such as television and fashion magazines feature skeletal beauties leading people to equate thinness to success.

Anorexia may take over the lives of sufferers. Individuals constantly think about food, spend hours agonising about food options in the market and exercise to the point of exhaustion. The physical problems mentioned above make them feel miserable. The attention of a medical doctor is needed immediately this condition is suspected. Most anorexics refuse treatment initially as they are more concerned about thinness than general health. Physical examination and lab tests are carried out at consultation. X-rays may be necessary to check for broken bones, pneumonia and heart problems. A psychological evaluation is also very important. The DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria for diagnosing anorexia are:

l Refusal to maintain a body weight that is at or above the minimal normal weight for age and height

lIntense fear of gaining weight or becoming fat, even though the person is underweight

lDenying the seriousness of having a low body weight, or having a distorted image of one’s appearance or shape

lIn women who’ve started having periods, the absence of a period for at least three consecutive menstrual cycles

Some people may not meet all the criteria but still have the disorder.

There are several complications associated with anorexia and it can be fatal having one of the higher death rates of all mental illnesses of about 5%. Sudden death may result from electrolyte imbalances and arrhythmias (abnormal heart rhythms). A severely malnourished anorexic may suffer damage to all body organs including the brain, heart and kidneys. Other complications include Anaemia, bone loss, absence of menstrual periods in females and low testosterone in males, gastrointestinal problems like bloating, constipation and nausea, mitral valve prolapse in the heart and lung problems.

Anorexics need several types of treatments including medical care, psychiatric care, nutritional therapy, medications and hospitalisation in complicated cases. For some individuals anorexia is life-long battle as relapse is common after treatment. The greatest challenge in the treatment of anorexia is refusal of treatment by sufferers who often times believe that they don’t need treatment. Anorexia which was once considered a Western disorder is fast gaining ground here with the exposure of our youths to the media attention paid to beauty pageants and fashion modelling. Of recent, winners of beauty pageants in Nigeria have been as thin as models and do not possess the healthy, curvy body types that were acceptable in the past. These criteria put a lot of pressure on our girls.


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