About Symptomatology of Anorexia Nervosa

Introduction

Anorexia nervosa is characterized by intense and severe disturbance in the perception of the image that the patient is forming for his body and by an uninterrupted search for the weakness to the point of starvation (American Psychiatric Association 1994).
The specific disorder could be understood as an "absurd fear of thickness," which deliberately leads the patient to a self-imposed limitation in food intake and choice of food in quantity and quality to achieve weight loss and wasting (Stice und Shaw 2002). This disorder has been recognized for many decades and, indeed, the similarity of its descriptions by various people is remarkable. It is more common in women than in men, and usually begins in puberty (Hoek 1998).
According to other scientific theories, the development of the disorder is another psychological factor that is related to a person's sense of being helpless and incapable of autonomy. The specific disorder is included on feeding and eating disorders and can be defined as a severe and potentially fatal disorder (APA., 2013). The sufferer has a heavily disturbed image of his / her body and imposes on himself / herself severe dietary restrictions, which usually lead to severe malnutrition. The mortality ranges from 5-18%. Feeding and Eating Disorders also include Rumination Disorder, Pica, Bulimia Nervosa, Avoidant/Restrictive Food Intake Disorder, Binge-Eating Disorder, Other Specified Feeding or Eating Disorder and Unspecified Feeding or Eating Disorder.

There are specific diagnostic criteria, as there are mentioned from the research, concerning anorexia nervosa. The primary symptom is the person's denial to maintain body weight at or above the level of the minimum weight, meant for age, height, sex, physical health and evolvent-development (e.g. weight loss resulting in weight maintenance below 85% of expected or failure to have the expected weight gain over the development period resulting in a body weight less than 85% of the expected) (Gaskill & Sanders., 2000). The second diagnostic criterion is the person's acute fear of getting pounds and weight, excessive terror of not being thin and become fat even when the weight is below normal. The third criterion is described as a perturbation regarding the experiencing of an individual about his weight or body shape, exorbitant impact of self-image concerning body weight and shape and tenacious deficiency of acknowledgment of the staidness of the abnormal low weight (APA., 2013)

Combining symptomatology of anorexia nervosa, the key feature that is recognized is expedient and intentional loss of weight which is managed by demanding, rigorous diet and dodge food. The self-starvation can cause an abnormal absence of menstruation and vital abnormalities because of endocrine system (APA, 2013). Also, individuals with anorexia nervosa deal with self-vomiting, usually with emetics, self-purging, usually with the use of laxatives, excessive physical exercise and the use of medical pills as diuretics and appetite sedatives. Morover the main psychological key features that can be observed from anorexic patient are sleep disturbances, perfectionism, depression, anxiety, irritability, obsessive thoughts and loss of consecration (Beaumont, 2000; APA, 2013).

Differential Diagnosis

The diagnosis of the disorder is complicated by the patient's refusal to discuss the symptoms, or the secrecy surrounding rituals in eating behavior and resistance to seeking help. Thus, it is difficult to prove the patient's thought mechanism about the image of his body.
However, the clinician should make sure that the patient is not suffering from bodily diseases that may be responsible for weight loss, i.e. the more informal the characteristics of weight loss (e.g., the onset of the disorder after 40), both the disorder should include general medical conditions. Such pathological conditions may be gastrointestinal diseases (malabsorption syndrome, Cronh's disease and digestive disorders), brain tumor, other "concealed" malignant tumors, AIDS sparing syndrome, endocrinopathies (e.g., hyperthyroidism, fibrocystic disease) (APA, 2013).

If clinical and defamatory control excludes the organic causes of symptoms, then mental disorders such as depression should be studied. Although weight loss is observed, there is no intense fear of obesity or disturbed physical image. In schizophrenia, there may be paradoxical and strange behavior in food intake, but the disorder is complete. Also, ribs, personality disorder, and substance use can lead us to a different diagnosis.

As anorexic people may have symptoms reminiscent of social phobia (e.g., eating publicly), body dysmorphic disorder (e.g. intense engagement with the imaginary defect in the appearance of the body), obsessive-compulsive disorder (e.g. obsessive-compulsive disorder and coercion associated with food). Additional diagnoses of these disorders will only occur when there are symptoms that are not related to food intake or the shape and size of the body (Gaskill & Sanders., 2000).

Epidemiology

The various types of food intake reported have been related to teenagers and young students up to 4% (Hoek H, 2003). Anorexia nervosa appears to be more common in recent decades compared to older, with increased reports of disorder in girls and men in pre-elderly age (Inagaki et al. 2002). The most common age of onset of the disease is 15-19 years old, with a rate of up to 5% and is in the early years of the third decade (20-25 years) (Gaskill & Sanders., 2000). Anorexia nervosa is estimated to be present in 0.5-1% of teenage girls. It occurs 10-20 times more often in women than in men (Bruch, H. 1962). Anorexia nervosa also occurs with a high frequency in young girls who are engaged in thin-body jobs, such as models, ballet dancers and sportsmen of some sports (Garner & Garfinkel 1980).

Etiology

The causes of anorexia nervosa are multifactorial and complex and many aspects of it remain unclear even today. The causes are different for each individual. Each individual's examination should aim at highlighting the various factors that contribute to the appearance and development of anorexia.Finding causal factors should therefore guide therapeutic intervention rather than vice versa.

There are some factors that can influence an individual to develop anorexia nervosa such as genetic, biological, , sociocultural and psychological factor(Jacobi et al., 2004; Treasure et al., 2015) . Firstly, genetic factors are considered that affect the development of the disorder. The onset of anorexia nervosa following studies of families with anorexia and twin studies showed that about 50% have a predisposition to the disease that can be attributed to genetic factors (Klump., & Gobrogge, 2005). Families of these patients have a 3-fold greater chance of having another member suffering from a dietary intake disorder, as well as three times as likely to have a relative grade 1 or 2. Studies have been done in molecular genetics, focusing mainly on chromosomes 1 and 10.

Similarly, relating to biological factor, endocrinological disorders mainly focus on hypothalamic function, which regulates the body's basic functions, such as appetite, weight, temperature and homeostasis in general In anorexia nervosa there is a hypothalamic dysfunction that is evidenced by various observations and findings. Such as the increase in the corticotropin releasing factor (CRF) in the cerebrospinal fluid of patients (Clarke & Berrettini., 2012).

Another important factor that can also induce anorexia nervosa disorder is the sociocultural one. Specifically, social media project direct and indirect messages for the advantages of "being weak and thin" is synonymous not only with beauty but also with professional success (Smink & Hoek, 2012). Besides, for today's society to be fashionable and successful, you must be impossible. In many cultures women and men are perceived as pretty, acceptable and attractive regarding their thin body (Blau & Gullotta 1996; Davis etal. 1999).

The beauty and the idolization of the thin body by simple aesthetic suggestion is distorted in a moral-remarkable context (obesity = ignorance and sloth, delicacy = self-control, energy, success) and results in a racist type of exclusion of mild overweight women, men (Garner & Garfinkel., 1980).

Moreover, anorexia nervosa can also become an outcome of psychological issues of an individual. Anorexia nervosa in this concept can be understood as the tendency to avoid the person's normal and independence of a social and sexual development; or avoiding the free expression of negative emotions such as depression, anxiety, anger, insecurity that patients are afraid of getting disastrous dimensions if they expressed freely ( Herzog etal. 1992).

These negative feelings cannot be handled because of their low self-esteem. So many times, they replace normal quests by dealing with their eating habits and body weight, and for this reason they realize that it is difficult to control situations around their lives (Sassaroli & Ruggiero, 2005).

Anorectic patients have deficiencies in their sense of autonomy and self-determination. They often feel that their body is somehow in control of their parents. Self-inflicted malnutrition can be seen as an attempt to gain value and self-esteem. Only through acts of excessive self-discipline can an anorectic ill develop a sense of autonomy and self-esteem (Chan & Ma., 2004).

Treatment

As many adults suffer from anorexia nervosa there is a need of treatment globally. An evident successful treatment could be the Cognitive Behavioral Therapy (CBT) (Fairburn., 2005). Cognitive-behavioral theory argues that anorexic symptoms are perpetuated and maintained through a set of beliefs about body weight. Once the dominant anorexic concept is formed, the individual is affected and thus gets perturbed into the food or reinforces additional beliefs that are not reasonable, often vulnerable to eccentric boosting and information processing.

Cognitive behavioral therapy is based on Becks treatment of anxiety and depression as also to the anorexia nervosa. This intervention will help the individual, who deals with anorexia nervosa, to work on the a) ego-syntonic nature, b) the fundamental relationship between psychological essentials and physical ones, with c) exact disturbing beliefs and attitudes about food and weight and d) corrosive deficits about self-image and concept (Vitousek, K. B., 2002). Cognitive-behavioral therapy includes diet calendars and nutrition education that highlights the risks of malnutrition and encourages debate on health issues and eating habits. Regarding the research evidence, CBT could be more beneficial with the combination of fluoxetine use, as to obviate relapse and counselling of a nutrition. Treatment of anorexia nervosa could work also by adding participation on self-health groups of anorexia nervosa.

Conclusion

Anorexia nervosa is a mental health disorder, included in feeding and eating disorders. The last decades there is an increasement of the disorder in older people due to psychological factors. As many studies and investigations shows, the outcome of several types of treatment such as psychoanalysis do not have beneficial results, contrariwise cognitive and psychodynamic therapies with medication have better results to the patients. It is important to mention that science is trying to create new and more helpful medicine regarding anorexia nervosa.

Otherwise, as the disorder has a difficulty to be treated it could be beneficial to pay attention on the risk and protective factor of the disorder as to prevent it. Future studies should pay attention also not only in women but to take into consideration men as well, as throughout the years males also tent to deal with those type of disorders.

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