INTRODUCTION

The increased prevalence of anorexia nervosa (AN) in western

societies has encouraged many developments and

theimplementation of new approaches in the treatment of the

disorder. Many patients are hospitalized in psychiatric departments

where they often adopt others’ symptoms and frequently relapse

following discharge from the hospital. Foster care can be an

alternative to hospitalization. It is a professional treatment

resource which is as close as possible to the normalcy of typical

home surroundings, and one used widely in the psychiatric domain.

It can provide the appropriate environment for diminishing the

anorexic experience, especially when it is available to the narrative

approach. The narrative approach assumes that our lives are

constituted through narrative. To deconstruct the stories which

persons narrat their lives by, Michael White has proposed to do this

deconstructing through objectification of the problem [3].

Objectification engages the individual in an externalizing of

conversations relevant to his or her problem, rather than in

internalizing conversations. Externalizing conversations are crucial

so that the patient may experience an identity distinct from his or

her view of himself or herself in order to clear the way for

distinguishing areas in the patient’s life not co-opted by this view,

thus exploring alternative, positive versions of who he or she might

be. Externalizing conversations encourage persons to verbalize how

the problem impacts on his or her life (including emotional states,

relationships, social and work spheres and the like) with emphasis

on how the problem has affected his or her “view” of himself or

herself and his or her relationships. The individual is then invited to

“map” the influence this view or perception has on his or her live.

Using the narrative approach in treating AN enables patients to

separate themselves from the “totalizing” stories that are

constitutive of their lives and to orient themselves toward those

aspects contradicting these perceptions. This approach helps the

patient to engage in change rather than guilt or blame, which are

often the dominant feelings among patients with anorexia nervosa.

The foster family setting serves as an therapeutic environment in

which intensive externalizing talks can occur; the “normal”

behavior of family members serves as a counter behavior to the

anorectic one, as well as a model of healthy attitudes toward food

and eating. The containing and holding environment and the

presence of caregivers with therapeutic backgrounds (a clinical

dietitian, in the present case) gives the patient an opportunity to

change maladaptive patterns of interaction. The following is a case

study of a 17-year-old girl with severe anorexia nervosa, of the

restricted type. After a threemonth hospitalization, she was

transferred to a foster family for a period of two months. The

process of her recovery will be described.

People who have anorexia have problems with eating. They are very

anxious about their weight. They keep it as low as possible, by

strictly controlling and limiting what they eat.

They starve themselves to lose weight because they:

• Think they are fat or overweight.

• Have a very strong fear of being fat.

• Want to be thin.

Even if they are already very thin and underweight, they continue to

want to lose weight. People with anorexia are obsessed with food,

eating and calories. Sometimes they try to get rid of food from their

body, for example, by making themselves vomit. Anorexia means

'loss of appetite'. People can lose their appetite because of other

conditions, such as cancer. Doctors may use the medical term

anorexia to describe this. However, it is not the same as the

condition anorexia nervosa. People with anorexia nervosa do not

usually lose their appetite. Anorexia can affect anyone. It is much

more common in developed countries such as the UK than

developing countries. Anorexia is more common in women and girls.

It can also affect men and boys, and some experts think that this is

increasing. Anorexia usually develops over time. It most commonly

starts in the mid-teens. In teenagers and young adults, the

condition affects about 1 in 250 females and 1 in 2000 males.

It can be very difficult to understand why someone close to you has

problems with eating. Anorexia can be very upsetting, both for the

person affected and everyone close to them. Supporting each other

is very important. It can play a key part in helping the person to

recover. Anorexia can be a serious condition. Starving yourself

affects every part of your body and can lead to health problems. If

anorexia is not treated, these problems can become severe and even

life-threatening.

Sometimes people can have anorexia for years before seeking help.

Anorexia can be treated, usually with a combination of:

• Psychological treatment.
 • Advice, help and support on gaining weight safely and healthy

eating.

Treatment also aims to reduce the symptoms of medical problems

caused by the anorexia.

Some people make a full recovery from anorexia, and others can

improve their condition. However, anorexia can also become a

chronic condition.
 MEANING AND DEFINITION

Amenorrhea: Absence of menstrual periods. Binge eating: A

pattern of eating large quantities of food in a short period of time.

Purging: The use of vomiting or other techniques to empty the

stomach of food. Anorexia is a psychiatric illness that describes an

eating disorder characterized by extremely low body weight and

body image distortion with an obsessive fear of gaining weight.

Individuals with anorexia are known to control body weight

commonly through the means of voluntary starvation, purging,

excessive exercise or other weight control measures such as diet

pills or diuretic drugs. While the condition primarily affects

adolescent females approximately 10% of people with the diagnosis

are male[1]. Anorexia nervosa, involving neurobiological,

psychological, and sociological components[2] is a complex condition

that can lead to death in severe cases.

Anorexia nervosa is an eating disorder that occurs primarily

among girls and women. It is characterized by a fear of gaining

weight, self-starvation, and a distorted view of body image. The

condition is usually brought on by emotional disorders that lead a

person to worry excessively about the appearance of his or her

body. There are generally two types of anorexia: one is characterized

by strict dieting and exercising; the other type includes binging and

purging. Binging is the act of eating abnormally large amounts of

food in a short period of time. Purging is the use of vomiting or

other methods, such as laxatives, to empty the stomach. An

individual who suffers from anorexia is called anorexic.

Anorexia is a serious psychological disorder. It is a condition

that goes well beyond out-of-control dieting. The person with

anorexia, most often a girl or young woman, initially begins dieting

to lose weight. Over time, the weight loss becomes a sign of mastery

and control. The drive to become thinner is thought to be secondary

to concerns about control and fears relating to one's body. The

individual continues the endless cycle of restrictive eating, often to

a point close to starvation. This becomes an obsession and is

similar to an addiction to a drug. Anorexia can be life-threatening.

Anorexia is characterized by a significant weight loss resulting from

excessive dieting. Most women and an increasing number of men

are motivated by the strong desire to be thin and a fear of becoming

obese. Anorexics consider themselves to be fat, no matter what their

actual weight is. Often anorexics do not recognize they are

underweight and may still "feel fat" at 80 lbs. Anorexics close to

death will show you on their bodies where they feel they need to

lose weight. In their attempts to become even thinner, the anorexic

will avoid food and taking in calories at all costs, which can result

in death. An estimated 10 to 20% will eventually die from

complications related to it.

Anorexics usually strive for perfection. They set very high standards

for themselves and feel they always have to prove their competence.

They usually always put the needs of others ahead of their own

needs. A person with anorexia may also feel the only control they

have in their lives is in the area of food and weight. If they can't

control what is happening around them, they can control their

weight. Each morning the number on the scale will determine

whether or not they have succeeded or failed in their goal for

thinness. They feel powerful and in control when they can make

themselves lose weight. Sometimes focusing on calories and losing

weight is their way of blocking out feelings and emotions. For them,

it's easier to diet then it is to deal with their problems directly.

Anorexics usually have low self-esteem and sometimes feel they

don't deserve to eat. The anorexics usually deny that anything is

wrong. Hunger is strongly denied. They usually resist any attempts

to help them because the idea of therapy is seen only as a way to

force them to eat. Once they admit they have a problem and are

willing to seek help, they can be treated effectively through a

combination of psychological, nutritional and medical care.

Bulimia is characterized by a cycle of binge eating followed by

purging to try and rid the body of unwanted calories. A binge is

different for all individuals. For one person a binge may range from

1000 to 10000 calories, for another, one cookie may be considered a

binge. Purging methods usually involve vomiting and laxative

abuse. Other forms of purging can involve excessive exercise,

fasting, use of diuretics, diet pills and enemas.

Bulimics are usually people that do not feel secure about their own

self worth. They usually strive for the approval of others. They tend

to do whatever they can to please others, while hiding their own

feelings. Food becomes their only source of comfort. Bulimia also

serves as a function for blocking or letting out feelings. Unlike

anorexics, bulimics do realize they have a problem and are more

likely to seek help.

Compulsive overeating is characterized by uncontrollable eating and

consequent weight gain. Compulsive overeaters use food as a way to

cope with stress, emotional conflicts and daily problems. The food
can block out feelings and emotions. Compulsive overeaters usually

feel out of control and are aware their eating patterns are abnormal.

Like bulimics, compulsive overeaters do recognize they have a

problem.

Compulsive overeating usually starts in early childhood when

eating patterns are formed. Most people who become compulsive

eaters are people who never learned the proper way to deal with

stressful situations and used food instead as a way of coping. Fat

can also serve as a protective function for them, especially in people

that have been victims of sexual abuse. They sometimes feel that

being overweight will keep others at a distance and make them less

attractive. Unlike anorexia and bulimia, there is a high proportion

of male overeaters.

The more weight that is gained, the harder they try to diet and

dieting is usually what leads to the next binge, which can be

followed by feelings of powerlessness, guilt, shame and failure.

Dieting and bingeing can go on forever if the emotional reasons for

the bingeing is not dealt with.

In today's society, compulsive overeating is not yet taken seriously

enough. Instead of being treated for the serious problem they have,

they are instead directed to diet centers and health spas. Like
anorexia and bulimia, compulsive overeating is a serious problem

and can result in death. With the proper treatment, which should

include therapy, medical and nutritional counseling, it can be

overcome.
 SYMPTOMS

The symptoms of anorexia nervosa have a wide range. Extreme

weight loss leads to many secondary symptoms. Note that the

physical, mental, and behavioral worlds of a person struggling with

anorexia overlap: Each area has the potential to affect the other

two.

Physical Symptoms of Anorexia Nervosa

The most visible symptom of anorexia nervosa is weight loss, which

is often clear to the casual observer. But the body of a person with

anorexia changes in many ways:

• Weight loss (achieved via restricting food or purging it): A

person with anorexia will lose weight because, by definition,

she refuses to maintain or achieve a body weight of 85% of

the expected weight for her age and height.

Amenorrhea (interruption of the menstrual cycle): Amenorrhea

is present if there is an absence of at least three consecutive

menstrual cycles, or if the person needs to take estrogen for

her normal cycle to occur. Amenorrhea is a menstrual

condition characterized by absent menstrual periods for more

than three monthly menstrual cycles. Amenorrhea may be

classified as primary or secondary.

• Primary amenorrhea - from the beginning and usually

lifelong; menstruation never begins at puberty.

• secondary amenorrhea - due to some physical cause and

usually of later onset; a condition in which menstrual

periods which were at one time normal and regular become

increasing abnormal and irregular or absent.

• Bone loss (osteoporosis or osteopenia)- Osteoporosis, or a

condition of porous bone, is a disease in which bones

become more fragile. Left untreated, osteoporosis can

progress silently until a bone breaks. In many cases, early

prevention and treatment can make a big difference.

Bone is living, growing tissue constantly being formed and

broken down. Early in life, more bone tissue is formed than

broken down, allowing the skeleton to grow. By about age 30

your bones are at your lifetime best, or your "peak bone mass."

After this peak, bone maintains an equilibrium until about age

50 in women and 60 in men. Then, bone breaks down faster

than it forms. The resulting bone loss affects both men and

women. Bone loss can lead to osteoporosis.

Today, osteoporosis is a major health threat for 44 million

Americans, 80 percent of whom are women. In the United

States, 10 million individuals already have the disease and 34

million more have low bone density, placing them at increased

risk for osteoporosis and bone fractures.

Osteoporosis is the most common cause of hip fractures, a

tragedy that can result in permanent disability, loss of

independence or death. A woman's risk of a hip fracture is

equal to her combined risk of breast, uterine and ovarian

cancer.

• Extra sensitivity to cold- There is much variation in

the sensitivity to cold experienced by different people,

with some putting on many layers of clothing while

others in the same environment feel comfortable in one

layer.Cold sensitivity may be a symptom of

hypothyroidism, anemia, or vasoconstriction (according

to article Sauna). There may also be differences in people

in the expression of uncoupling proteins, thus affecting

their amount of thermogenesis.

• Bloated stomach after eating (since the stomach loses its

ability to deal with a normal quantity of food at one sitting)

• Lanugo--a fine hair that grows on the skin in response to

the body's need for warmth Downy hair on the body of the

fetus and newborn baby. It is the first hair to be produced

by the fetal hair follicles, usually appearing on the fetus at

about five months of gestation. It is very fine, soft, and

usually unpigmented. Although lanugo is normally shed

before birth around seven or eight months of gestation, it is

sometimes present at birth. This is not a cause for concern:

lanugo will disappear within a few days or weeks of its own

accord.

• Yellowed skin (often from getting too much vitamin A as a

result of eating only certain foods, like carrots)

• Thinning hair
Mental and Behavioral Symptoms of Anorexia Nervosa

In addition to physical changes, friends and family may notice

changes to the person's thoughts and behaviors:

• Distortion of body image or excessive importance placed on

body composition or shape

• Denial of seriousness of low weight

• Intense fear of gaining weight or becoming fat, even if the

person is considered underweight

• Confused thinking (since the brain needs fuel to function

properly)

• Ritualistic eating (including cutting food into a planned

number of bites)

• Spitting out food before swallowing

• Much more attention paid to nutrition labels

• Major increase in exercise output, even when exhausted

• Hatred for foods that used to be favorites

• Refusal to eat with others

• Binge eating (for the binge eating/purging subtype of

anorexia)
• Increased or unnecessary use of laxatives, or vomiting after

eating (for the binge eating/purging subtype of anorexia)

 FOOD AVOIDANCE

Retrospective and longitudinal study was carried out on all

children and adolescents who presented to a child psychiatry

service over a period of 26 years to identify the nature, course, and

outcome of cases meeting criteria for anorexia nervosa (n = 27). Two

groups of the same age were identified for comparison, firstly those

with food avoidance and emotional disorders (n = 23), and secondly

those with emotional disorders but no symptoms associated with

eating (n = 22). The results confirm previous reports that early onset

anorexia nervosa shows a similar nature, course, and outcome to

the adult disease. Being tall at presentation seems to be associated

with a poor outcome. Self starvation of early onset may result in

short stature in some cases. There seem to be more boys among the

group in whom the disease was of early onset than would be

predicted from the sex ratio among adult patients. In addition boys

with anorexia nervosa may have a better prognosis than girls.

Children with food avoidance emotional disorders seem to have a

worse prognosis than expected for childhood emotional disorders.

They may represent a middle group between those with anorexia

nervosa and those with emotional disorders but no symptoms

associated with eating.

Scientists have identified a new eating disorder which affects

children - fear of food. Researchers from the Institute of Child

Health and Great Ormond Street Hospital have dubbed the disease

Food Avoidance Emotional Disorder (FAED).

Children with the illness want to get better and gain weight, but are

afraid to eat - unlike those with anorexia nervosa who are scared of

putting on weight. The researchers said FAED children tended to be

younger than those with anorexia nervosa and were more likely to

be boys and of non-British origin. Anorexia nervosa mainly affects

young girls with a poor self image. Most are aged around 13-and-a-

half.

Stunted growth

The average age of children with FAED is just under 12 years old.

The researchers found that the young age of onset of the illness

could lead to "significant stunting". But they said that this could be

reversed if children received proper treatment. Dr Dasha Nicholls of

the Institute of Child Health said she saw around 60 children a year

with eating disorders. Half had anorexia nervosa, but as many as a

quarter were simply afraid to eat. Twice as many girls had the
disorder as boys, but nine times as many girls had anorexia

nervosa as boys. A large proportion of the children from ethnic

minorities with the fear were Asian. Dr Nicholls said this could be

to do with the way Asian families interpret eating disorders. They

might, for example, be less likely to put an eating disorder down to

fear of putting on weight.

Fear of choking

She said there were many reasons a child might become afraid to

eat. The children she saw were aged between seven and 15. Most

had grown normally until suddenly something went wrong and they

began to avoid food. Some were worried they would choke or be sick

if they ate. Some complained of stomach pains. Dr Nicholls said one

reason for the disease could be an earlier illness which caused a

child to have a bad experience with food. "They may have felt

anxious and their throat tightened and they were unable to swallow

and they linked this feeling to food," she said. The research team

also found that children with the disorder tended to go to doctors

because of physical rather than psychological problems associated

with the illness. "Losing weight is always abnormal for children as

they are growing," said Dr Nicholls. She added that doctors often

felt the reason for food avoidance was solely physical and began lots
of investigations. She said they should consider that the problem

may also be psychological. She added that children with FAED

might also have a physical problem which caused their fear.

Extremely thin

Some of the children she has seen are thinner than children with

anorexia because doctors have spent so much time investigating the

cause rather than treating the disease. At Great Ormond Street

Hospital, treatment includes parental counselling. This is tailored to

each individual child and involves looking at what the fear is and

how much food the child needs to eat and when. Some children are

afraid to eat because they feel full very quickly and they should eat

small meals regularly rather than big meals.

 MEDICAL COMPLICATIONS

Medical complications can frequently be a result of eating

disorders. Individuals with eating disorders who use drugs to

stimulate vomiting, bowel movements, or urination may be in

considerable danger, as this practice increases the risk of heart

failure.

In patients with anorexia, starvation can damage vital organs

such as the heart and brain. To protect itself, the body shifts into

"slow gear": monthly menstrual periods stop, breathing, pulse,

and blood pressure rates drop, and thyroid function slows. Nails

and hair become brittle; the skin dries, yellows, and becomes

covered with soft hair called lanugo. Excessive thirst and frequent

urination may occur. Dehydration contributes to constipation,

and reduced body fat leads to lowered body temperature and the

inability to withstand cold.

Mild anemia, swollen joints, reduced muscle mass, and light-

headedness also commonly occur in anorexia. If the disorder

becomes severe, patients may lose calcium from their bones,

making them brittle and prone to breakage. They may also

experience irregular heart rhythms and heart failure. In some

patients, the brain shrinks, causing personality changes.

Fortunately, this condition can be reversed when normal weight

is reestablished.

In NIMH-supported research, scientists have found that many

patients with anorexia also suffer from other psychiatric illnesses.

While the majority have co-occurring clinical depression, others

suffer from anxiety, personality or substance abuse disorders,

and many are at risk for suicide. Obsessive-compulsive disorder

(OCD), an illness characterized by repetitive bouts and behaviors,

can also accompany anorexia. Individuals with anorexia are

typically compliant in personality but may have sudden

outbursts of hostility and anger or become socially withdrawn.

Bulimia nervosa patients -- even those of normal weight -- can

severely damage their bodies by frequent binge eating and

purging. In rare instances, binge eating causes the stomach to

rupture; purging may result in heart failure due to loss of vital

minerals, such as potassium. Vomiting causes other less deadly,

but serious, problems -- the acid in vomit wears down the outer

layer of the teeth and can cause scarring on the backs of hands

when fingers are pushed down the throat to induce vomiting.

Further, the esophagus becomes inflamed and glands near the

cheeks become swollen. As in anorexia, bulimia may lead to

irregular menstrual periods. Interest in sex may also diminish.

Some individuals with bulimia struggle with addictions, including

abuse of drugs and alcohol, and compulsive stealing. Like

individuals with anorexia, many people with bulimia suffer from

clinical depression, anxiety, OCD, and other psychiatric illnesses.

These problems, combined with their impulsive tendencies, place

them at increased risk for suicidal behavior.

People with binge eating disorder are usually overweight, so they

are prone to the serious medical problems associated with

obesity, such as high cholesterol, high blood pressure, and

diabetes. Obese individuals also have a higher risk for gallbladder

disease, heart disease, and some types of cancer. Research at

NIMH and elsewhere has shown that individuals with binge

eating disorder have high rates of co-occurring psychiatric

illnesses -- especially depression.

Anorexia is an extremely dangerous illness with a shockingly

high mortality rate. A person with anorexia starves herself to

dangerously thin levels, at least 15% below what would be

considered normal body weight. Although men can and do

struggle with anorexia, it is far more prevalent in women.

Because the body needs food to function correctly, starving takes

a significant toll on a woman’s health. The medical impact of

anorexia is huge and includes:

Amenorrhea - Loss of Menstrual Cycle - This occurs in nearly

all women with anorexia. The body simply shuts down its

reproductive capacity because it is finding it difficult to sustain

one life, let alone, two. Although a woman’s ability to bare

children usually returns once sufficient weight is gained, that is

not always the case. Anorexia, if engaged in long enough or at a

critical time during adolescence, can contribute to infertility.

Anemia -Without sufficient nutrition, the blood is affected and

anemia results. Fortunately, this condition is only temporary;

blood health returns once food is reintroduced.

Dry Skin and Hair Loss- Dehydration causes the skin to

drastically dry out and become flaky. The woman’s scalp, starved

for protein and nutrients, often becomes bald or patchy.

Paradoxically, extremely fine hair growth often occurs on other

parts of the torso; this is an attempt by the body to keep itself

warm.
Feeling Cold-Without protective fat stores to keep them warm,

those with anorexia are usually cold. In fact, their body

temperature is rarely at a healthy 98 degrees; it’s typically a

couple of degrees less that normal.

Slowness of Thought/Brain Shrinkage -Although retardation of

thought is temporary, due to lack of fuel to keep the brain

functioning well, actual brain shrinkage, due to prolonged

starvation, is not. Studies show a drop in actual IQ, which does

not always return once the woman gets well.

Osteopenia/Osteoporosis- These degenerative bone conditions

result from lack of calcium and other dietary deficiencies. Most

bone loss is permanent, leaving even young women at severe risk

of bone fractures and spinal curvature.

Heart Rhythm Abnormalities, Heart Attacks - Electrolyte

abnormalities often trigger arrhythmias in the heart. This is a

significant indication that the heart is undergoing stress. When a

body is starving, it starts attacking its own muscle tissue in an

effort to stay alive. The heart is a muscle and is not immune to

this attack. In the case of extreme starvation, the heart simply

stops. Many of these medical complications can improve once a

person recovers from the disorder. And for those that don't
resolve, the sooner a person seeks treatment, the less severe the

complication will be.

 PSYCHOLOGICAL FACTORS

A number of theories have been advanced to explain the

psychological factors of the disorder. No single explanation covers

all cases. Anorexia nervosa has been interpreted as:

• A rejection of female sexual maturity. This rejection is

variously interpreted as a desire to remain a child, or as a

desire to resemble men as closely as possible.

• A reaction to sexual abuse or assault.

• A desire to appear as fragile and nonthreatening as possible.

This hypothesis reflects the idea that female passivity and

weakness are attractive to men.

• Overemphasis on control, autonomy, and independence. Some

anorexics come from achievement-oriented families that stress

physical fitness and dieting. Many anorexics are perfectionistic

and "driven" about schoolwork and other matters in addition

to weight control.

• Evidence of family dysfunction. In some families, a daughter's

eating disorder serves as a distraction from marital discord or

other family tensions.

 • Inability to interpret the body's hunger signals accurately due

to early experiences of inappropriate feeding.

Although anorexia nervosa is still considered a disorder that largely

affects women, its incidence in the male population is rising. Less is

known about the causes of anorexia in males, but some risk factors

are the same as for females. These include certain occupational

goals and increasing media emphasis on external appearance in

men. Moreover, homosexual males are under pressure to conform

to an ideal body weight that is about 20 pounds lighter than the

standard "attractive" weight for heterosexual males.

 BODY OF FIGURE CONSCIOUSNESS

Contemporary culture increasingly suffers from problems of

attention, over-stimulation, and stress, and a variety of personal

and social discontents generated by deceptive body images. This

book argues that improved body consciousness can relieve these

problems and enhance one’s knowledge, performance, and

pleasure. The body is our basic medium of perception and action,

but focused attention to its feelings and movements has long been

criticised as a damaging distraction that also ethically corrupts

through self-absorption. In Body Consciousness, Richard

Shusterman refutes such charges by engaging the most influential

twentieth-century somatic philosophers and incorporating insights

from both Western and Asian disciplines of body-mind awareness.

Rather than rehashing intractable ontological debates on the mind-

body relation, Shusterman reorients study of this crucial nexus

towards a more fruitful, pragmatic direction that reinforces

important but neglected connections between philosophy of mind,

ethics, politics, and the pervasive aesthetic dimensions of everyday

life.
Many kids — particularly teens — are concerned about how they

look and can feel self-conscious about their bodies. This can be

especially true when they are going through puberty, and undergo

dramatic physical changes and face new social pressures.

Unfortunately, for a growing proportion of kids and teens, that

concern can grow into an obsession that can become an eating

disorder. Eating disorders such as anorexia nervosa or bulimia

nervosa cause dramatic weight fluctuation, interfere with normal

daily life, and damage vital body functions.

Parents can help prevent kids from developing an eating disorder by

nurturing their self-esteem, and encouraging healthy attitudes

about nutrition and appearance. Also, if you are worried that your

child may be developing an eating disorder, it's important to

intervene and seek proper medical care. This is also true if there is

any family history of eating disorders.

Generally, eating disorders involve self-critical, negative thoughts

and feelings about body weight and food, and eating habits that

disrupt normal body function and daily activities.

While more common among girls, eating disorders can affect boys,

too. They're so common in the U.S. that 1 or 2 out of every 100 kids
will struggle with one, most commonly anorexia or bulimia.

Unfortunately, many kids and teens successfully hide eating

disorders from their families for months or even years.

People with anorexia have an extreme fear of weight gain and a

distorted view of their body size and shape. As a result, they strive

to maintain a very low body weight. Some restrict their food intake

by dieting, fasting, or excessive exercise. They hardly eat at all and

often try to eat as few calories as possible, frequently obsessing over

food intake. The small amount of food they do eat becomes an

obsession.

Bulimia is characterized by habitual binge eating and purging.

Someone with bulimia may undergo weight fluctuations, but rarely

experiences the low weight associated with anorexia. Both disorders

can involve compulsive exercise or other forms of purging food they

have eaten, such as by self-induced vomiting or laxative use.

Although anorexia and bulimia are very similar, people with

anorexia are usually very thin and underweight but those with

bulimia may be a normal weight or even overweight. Binge eating

disorders, food phobia, and body image disorders are also becoming

increasingly common in adolescence.

It's important to remember that eating disorders can easily get out

of hand and are difficult habits to break. Eating disorders are

serious clinical problems that require professional treatment by

doctors, therapists, and nutritionists.

If you suspect your child has an eating disorder, it's important to

intervene and help your child get diagnosed and treated. Kids with

eating disorders often react defensively and angrily when confronted

for the first time. Many have trouble admitting, even to themselves,

that they have a problem. Sometimes getting a family member or

friend who has been through treatment for an eating disorder can

help encourage someone to get help.

Trying to help when someone doesn't think he or she needs it can

be hard. As hard as it might be, getting the professional assistance

needed, even if your child resists, is the best help you can give as a

parent. Approach your child in a loving, supportive, and non-

threatening way when your child feels comfortable and relaxed and

there are no distractions.

Your child may be more receptive to a conversation if you focus on

your own concerns, and use "I" statements, rather than "you"

statements. For example, steer clear of statements like "you have an

eating disorder" or "you're obsessed with food," which may only

prompt anger and denial. Instead, try "I imagine that it's very

stressful to count calories of everything you eat" or "I'm worried that

you have lost so much weight so quickly." Cite specific things your

child has said or done that have made you worry, and explain that

you want your child to see a doctor to put your own mind at ease.

If you still encounter resistance, talk with your doctor or a mental

health care professional about other approaches.

Treatment focuses on helping kids cope with their disordered eating

behaviors and establish new patterns of thinking about and

approaching food. This can involve medical supervision, nutritional

counseling, and therapy. The professionals will address a child's

perception about his or her body size, shape, eating, and food.

Kids who are severely malnourished may require hospitalization

and ongoing care after their medical condition stabilizes.

Generally, the earlier the intervention (ideally, before malnutrition

or a continual binge-purge cycle starts), the shorter the treatment

required.

You can play a powerful role in your child's development of healthy

attitudes about food and nutrition.

Your own body image can influence your kids. If you constantly say

"I'm fat," complain about exercise, and practice "yo-yo" dieting, your

kids might feel that a distorted body image is normal and

acceptable.

At a time of great societal concern about obesity, it can be tricky for

parents to talk with their kids about their eating habits. It's best to

emphasize health, rather than weight. Make sure your kids know

you love them for who they are, not how they look. It's OK to

appreciate attractiveness in celebrities — if your kids (and you!) feel

OK about how they look, it won't prompt them to try to change to be

like someone else. Getting the message that they're great as they

are and that their bodies are healthy and strong is a wonderful gift

that parents can give their kids.

Try to avoid power struggles regarding food — if your teen wants to

"go vegetarian," be supportive even if you're an avid meat-eater.

Teens frequently go through "faddy" eating periods, so try to set

good limits, encourage healthy eating, and avoid fighting over food

issues. Kids can catch on pretty quickly if their parents panic over

one skipped meal. Try to gain perspective and talk to your kids

about what's going on if they don't want to eat with the family.
Finally, take an active role in creating a healthy lifestyle for your

family. Involve your kids in the preparation of healthy, nutritious

meals. Let them know that it's OK to eat when hungry and refuse

food when they're not. Also, make exercise a fun, rewarding, and

regular family activity. Developing your own healthy attitudes about

food and exercise will set an excellent example for your kids.

TREATMENT OF ANOREXIA

There are a number of treatments used for anorexia nervosa. A

treatment plan is developed to address the specific needs of the

individual. It usually includes treating any serious medical

problems first and then focusing on weight gain and addressing the

psychological issues that have led to the development and

maintenance of the anorexia nervosa.

Regaining weight is a key part of any treatment plan since

improvements in mood, personality, and interpersonal relationships

cannot be sustained without it.

Factors that determine the types of treatments are:

• The person's age

• Current living arrangements

• How long the person has had anorexia nervosa

 • Overall medical condition, including weight

• Other eating disorder symptoms, such as binge eating,

vomiting, or laxative abuse

• Poor results with previous treatments

• Severity of other associated psychological symptoms, such as

depression, problems controlling impulses, and personality

problems

The overall goals of treatment are to:

• Treat medical complications

• Gradually gain weight to a level that allows normal menstrual

periods to begin

• Normalize eating

• Eliminate inappropriate weight control behaviors

• Help the person cope with changes in eating and weight

• Deal with psychological and family problems that have caused

the disorder or have led to it being maintained over time

The types of treatments that may be used for anorexia nervosa

include:

• Psychotherapy

• Support groups
 • Medication

• Hospitalization

Psychotherapy

• Individual psychotherapy is the cornerstone of treatment for

anorexia nervosa, especially for people who are beyond

adolescence and who are not living at home. Individual

therapy provides a safe place to learn how to identify concerns,

solve problems, overcome fears, and test new skills.

There are many types of individual therapy. Cognitive

behavioral approaches can help to develop healthy ways of

thinking and patterns of behavior, particularly with food and

relationships. Other kinds of therapy emphasize important

interpersonal relationships and psychological issues, such as

self-esteem.

• Family therapy is almost always used as part of treatment

when the person with anorexia nervosa is young or living at

home. Family therapy can be useful to provide information

about anorexia nervosa, assess the impact of the disorder on

the family, help members overcome guilt, improve

communication and decision-making skills, develop strategies

 for coping, and develop practical strategies for overcoming the

disorder.

• Marital therapy is almost always valuable when the person

with anorexia nervosa is married. The primary goal of marital

therapy is to strengthen the relationship. It can provide

practical suggestions on how to deal with the disorder. It may

also help identify and resolve communication problems.

• Group therapy can play an important role as part of hospital

treatment, partial hospitalization or intensive day treatment.

There are many different types of groups, each with different

goals and orientations. Some groups are "task-oriented" and

may focus on food, eating, body image, interpersonal skills,

and vocational training. Other groups are aimed at

understanding the psychological factors that may have led to

the development and maintenance of the disorder.

Groups can assist in dealing with other associated emotional

symptoms, such as anxiety, depression and anger. Sharing

experiences with others in a group can be very effective in

helping reduce guilt, shame, and isolation, and can lead to

important insights regarding strategies for recovery.

Support Groups
Support groups led by non-professionals may be helpful under

certain circumstances; however, it is usually best to have groups

facilitated by a professional. Support groups can provide people

with anorexia nervosa and their families with mutual support and

advice about how to cope with the disorder. They can also prepare

someone for therapy who is afraid of it. Support groups can be

counterproductive if they foster an "anorexic identity" or provide

peer-group support for maintaining eating disorder behaviors.

Medication

Many medications have been tried in treating anorexia nervosa. It is

generally agreed that medication alone is not effective. Because

depression and other emotional problems are often a result of

starvation, it is best to focus on weight gain rather than medication.

In addition, the effects of starvation decrease the effectiveness of

antidepressants and worsen the side effects. However, occasionally,

medication may be required to deal with overwhelming anxiety,

obsessions, depression, or gastric discomfort following meals.

Hospitalization

Hospitalization is rarely sufficient to cure anorexia nervosa.

However, it may be required to:

 • Interrupt steady weight loss or promote weight gain if there

has been a failure to gain weight in outpatient care

• Interrupt bingeing and vomiting

• Control weight gain that is occurring too rapidly

• Evaluate and treat physical complications

• Address other serious psychological problems reflected by

severe depression, suicidal behavior, self-destructive behavior,

or substance abuse

One of the advantages of hospital treatment is that it provides a

safe environment where food and weight can be carefully monitored

while psychological concerns are explored.

There are various settings in which hospitalization can occur,

including general hospitals, psychiatric hospitals, and specialized

eating disorders programs. Although there are advantages and

disadvantages to each of these settings, they can all lead to

treatment success. While in the hospital, a variety of types of

treatment may be used, such as family meetings, individual

therapy, group therapy, occupational therapy, and occasionally

medication.
Partial care programs share many features with inpatient programs.

Patients receive similar therapeutic services; however, the major

difference is that they do not stay overnight. Partial hospitalization

has economic and clinical advantages over inpatient treatment.

Partial programs usually provide enough structure around meal

times, plus the possibility for intensive therapy, that is sufficient for

most patients to make behavioral changes, without requiring them

to be totally disengaged from the supports and the therapeutic

challenges outside of the hospital.

Nutritional therapy

A dietitian offers guidance on a healthy diet. A dietitian can provide

specific meal plans and calorie requirements to help meet weight

goals. In severe cases, people with anorexia may require feeding

through a tube that's placed in their nose and goes to the stomach

(nasogastric tube).

Treatment challenges in anorexia

Anorexia occurs on a continuum. Some cases are much more severe

than others. Less severe cases may take less time for treatment and

recovery. But one of the biggest challenges in treating anorexia is

that people may not want treatment or think they don't need it. In

fact, some people with anorexia promote it as a lifestyle choice.

They don't consider it an illness. Pro-anorexia Web sites are

proliferating, even offering tips on which foods to avoid and how to

fight hunger pangs. Even if you do want to get better, the pull of

anorexia can be difficult to overcome. Anorexia is often an ongoing,

lifelong battle. It may wax or wane. Even if symptoms subside, you

remain vulnerable and may have a relapse during periods of high

stress or during triggering situations. For some women, for

instance, anorexia symptoms may subside during pregnancy but

return after pregnancy. Ongoing therapy or periodic appointments

during times of stress may be helpful.

CONCLUSION

There is a lot of blame surrounding anorexia and other eating

disorders.There are two very sensitive issues involved. The first is

that 'mental illness' carries enormous stigma. The fact that research

on anorexia nervosa continues to assert that eating disorders are

psychiatric illnesses means that they, too, carry a stigma.

The second is that parents are highly sensitive to any criticism of

their parenting skills. Regarding the first issue background is in

psychology, philosophy and social anthropology. Like to question

and uncomfortable with the idea of statics such as 'mental illness.'

It is my belief that there is no such thing. There are simply healthy

and unhealthy ways of thinking. Having recovered from anorexia,

ountable. I, as a parent, am fully aware of how the slightest

criticism can be painful. I am far more aware, however, of my need

to continually grow as a person in order to be the best parent .

Honestly put your hand on yours heart and say that you are able to

put your son first, and give him the love and integrity he deserves,

We are in an age of enlightenment. Gone are the days when we can

be content with the image we portray to others. The human race

has taken huge leaps and bounds in terms of our consciousness

and our awareness of where it can take us.

If we are to help those suffering from anorexia - whether they are

our children, our partners, our students, or our friends, we must

stop looking for who is to blame. We must stop depending on

research on anorexia that is stagnant and misleading.

We must stop being scared and understand that eating disorders

are simply about low self esteem and that the remedy is available to

us all, as parents, as families, as educators and as friends.

Low self esteem and depression are endemic in western society, and

are rapidly rising. Yet more than ever we have access to ways to

build self esteem in ourselves and our children. If we are to truly

prevent anymore anorexia in teenage girls, and all forms of

depression in our children and our society, we must access those

ways.
 COUNSELING IMPLICATIONS

It is also a means to sustain and nourish our bodies. But to

someone suffering from anorexia, food is the enemy. Anorexia is a

true medical condition in which someone will literally starve

themselves to death in an attempt to stay dangerously thin. While

all of us diet from time to time, an anorexic is continually obsessed

with their body weight, which is closely linked to their self-image

and esteem level. The thinner they are, the better they believe they

will look. However, what they find is thin is never thin enough.

According to the Journal of the American Academy of Child and

Adolescent Psychiatry, the prevalence of eating disorders has

doubled in the last 40 years. Alarmingly, doctors now see children

as young as seven with symptoms of anorexia. Even more

disturbing is the fact that 40 percent of all nine-year-old girls have

already dieted. It is further estimated that up to 3.7 percent of all

females between the ages of 15 and 35 currently suffer from

anorexia. The National Institute of Mental Health (NIMH) states that

the mortality rate among anorexics is 12 times higher than the

annual death rate for all causes of death in females between the
ages of 15 and 24. This translates to almost 18 percent of all

anorexics, a death rate that is actually higher than some

cancers. The good news is that anorexia can be cured. While the

first step is to ensure healthy weight gain, therapy and counseling

is an essential and highly effective component to a full recovery.

There is no one specific reason why someone will develop an eating

disorder but researchers have found that certain people are at

higher risk than others. According to a review in the International

Journal of Eating Disorders, 90 percent of all anorexics are females,

40 percent of which are young adolescents between the ages of 15

and 19.

Generally, it is believed that anorexia stems from a combination of

psychological, social and biological factors. From a psychological

standpoint, if you suffer from anorexia, typically you will have self-

esteem issues, which manifest as an intense fear of gaining weight

or becoming fat, poor coping skills and difficulty making and

keeping close relationships. Additionally, most anorexics tend to be

extreme perfectionists. People with anorexia see their bodies much

differently than the rest of us. Where most of us may see ourselves

as more attractive than others might actually rate us, anorexics,

according to one study published in the British Journal of Clinical

Psychology, tend to lack what is termed a self-esteem boosting

bias. Simply put, if you are anorexic, you will see yourself in a less

flattering light than the rest of us and as such, no matter what your

weight, you will consistently believe you are obese. This, in part,

accounts for why so many anorexics are also highly anxious and

clinically depressed.

Social contributors such as inappropriate family dynamics play a

big part in any eating disorder. For instance, almost half of all

anorexics admitted to hospital have been sexually abused,

according to the Department of Psychiatry at Toronto General

Hospital. As well, the media constantly portrays perfect, skinny

women as the ideal image. “You can’t be too thin” is a common

motto among models, dancers and celebrities. Young girls quickly

become obsessed, looking to unrealistic role models for an image

they will never realistically obtain.

For people who don’t suffer from an eating disorder, it is often hard

to understand why someone would purposely starve themselves to

death. But we now understand that much of anorexia has a

biological component. Recent studies conducted at Michigan State

University show that more than 50 percent of anorexia cases have a

genetic basis. As well, according to the University of Pittsburgh,

anorexia is further linked to abnormal levels of the

neurotransmitter serotonin. What this means is that if you are

anorexic, you do in fact suffer from a true medical condition.

Eating disorders have the highest mortality rate of all the

psychiatric disorders. When you starve yourself of food, you are

essentially slowly killing every organ in your body. Most deaths

among anorexics result from heart failure. Typically, anorexics

weigh only 85 percent of what is considered within healthy

limits. Poor nutrition results in reduced immune system

functioning and white blood cell count, poor circulation, creaking

bones, amenorrhea (stopped menstruation), low blood pressure and

fainting spells, hypothermia, slowed heart rate and nerve damage

just to name a few of the many negative implications of this

disorder. Psychologically, anorexia creates intense emotional

turmoil, compounding already low self-esteem with feelings of guilt

and shame, which ultimately put you at further risk for such things

as alcohol and drug abuse. Anorexia is a life-threatening illness,

but you can get help. Because anorexia is such a complex

condition, often both individual and family counseling are effective.

The sooner anorexia is treated, the better chance you have for a full

physical and emotional recovery.

Fear is the most common first response to the idea of treatment for

anorexia. “Help” and “health” are heard as gaining weight and

becoming fat. A feeling of being out of control can take hold. The

first step to recovery in counselling treatment is understanding

what anorexia is, and why you have embarked on this relentless

pursuit for thinness. Anorexia may appear on the surface to be

about body size, however your slowly disappearing body is telling a

story of what you are feeling and believing about yourself and your

place in this world. Unless you are at a life threatening stage, this

first step encompasses a process of time to allow you to understand

your pursuit of thinness, and then for the steps of learning new and

healthier coping skills to replace your pursuit that is slowly killing

you. Change is an important yet difficult element in recovery from

anorexia. It is unavoidable, and often just understanding its natural

results and affect on us can ease a good portion of our fear of

recovery. Recovery from anorexia is really about recovery of a self

that has become lost beneath the “voice” and the “demands” of

anorexia. It is a step to choosing such things as life over death, the

restoration of your self-worth and your emotions, and reclaiming

positive attitudes and belief’s, which make for a truly better life.
 PAST STUDY

Anorexia nervosa is a psychiatric illness that describes an eating

disorder characterized by extremely low body weight and body

image distortion with an obsessive fear of gaining weight.

Individuals with anorexia are known to control body weight

commonly through the means of voluntary starvation, purging,

excessive exercise or other weight control measures such as diet

pills or diuretic drugs. While the condition primarily affects

adolescent females approximately 10% of people with the diagnosis

are male[1]. Anorexia nervosa, involving neurobiological,

psychological, and sociological components[2] is a complex condition

that can lead to death in severe cases.

The term anorexia is of Greek origin: a (α, prefix of negation), n (ν,

link between two vowels) and orexis (ορεξις, appetite), thus meaning

a lack of desire to eat.[3]

"Anorexia nervosa" is frequently shortened to "anorexia" in the

popular media. This is technically incorrect as the term "anorexia"

may be misinterpreted as a symptom of reduced appetite while the

medical condition is technically called anorexia nervosa. There is no

definition to "nervosa" in the English language. Bulimia nervosa is a

related condition to anorexia nervosa. Orthorexia nervosa may be

added to the DSM, but is currently a psychological illness that has

been coined by Steven Bratman, a Colorado MD. .[4] Argyreia

nervosa, Mahonia nervosa, Utricularia nervosa and Lettsomia

nervosa are all unrelated genus and species names for plants.

Established by the Diagnostic and Statistical Manual of Mental

Disorders (DSM-IV-TR) and the World Health Organization's

International Statistical Classification of Diseases and Related

Health Problems (ICD).

Although biological tests can aid the diagnosis of anorexia, the

diagnosis is based on a combination of behavior, reported beliefs

and experiences, and physical characteristics of the patient.

Anorexia is typically diagnosed by a clinical psychologist,

psychiatrist or other suitably qualified clinician. Notably, diagnostic

criteria are intended to assist clinicians, and are not intended to be

representative of what an individual sufferer feels or experiences in

living with the illness.

The full ICD-10 diagnostic criteria for anorexia nervosa can be

found here, and the DSM-IV-TR criteria can be found here.

be diagnosed as having anorexia nervosa, according to the DSM-IV-

TR, a person must display:

1. Refusal to maintain body weight at or above a minimally

normal weight for age and height (e.g., weight loss leading to

maintenance of body weight less than 85% of that expected; or

failure to make expected weight gain during period of growth,

leading to body weight less than 85% of that expected).

2. Intense fear of gaining weight or becoming obese

3. Disturbance in the way in which one's body weight or shape is

experienced, undue influence of body weight or shape on self-

evaluation, or denial of the seriousness of the current low body

weight.

4. The absence of at least three consecutive menstrual cycles

(amenorrhea) in women who have had their first menstrual

period but have not yet gone through menopause

(postmenarcheal, premenopausal females).

Furthermore, the DSM-IV-TR specifies two subtypes:

• Restricting Type: during the current episode of anorexia

nervosa, the person has not regularly engaged in binge-eating

or purging behavior (that is, self-induced vomiting, over-

exercise or the misuse of laxatives, diuretics, or enemas)

 • Binge-Eating Type or Purging Type: during the current episode

of anorexia nervosa, the person has regularly engaged in

binge-eating OR purging behavior (that is, self-induced

vomiting, over-exercise or the misuse of laxatives, diuretics, or

enemas).

The ICD-10 criteria are similar, but in addition, specifically mention

1. The ways that individuals might induce weight-loss or

maintain low body weight (avoiding fattening foods, self-

induced vomiting, self-induced purging, excessive exercise,

excessive use of appetite suppressants or diuretics).

2. Certain physiological features, including "widespread

endocrine disorder involving hypothalamic-pituitary-gonadal

axis is manifest in women as amenorrhoea and in men as loss

of sexual interest and potency. There may also be elevated

levels of growth hormones, raised cortisol levels, changes in the

peripheral metabolism of thyroid hormone and abnormalities of

insulin secretion".

3. If onset is before puberty, that development is delayed or

arrested.

Changes in brain structure and function are early signs often to be

associated with starvation, and is partially reversed when normal

weight is regained.[6] Anorexia is also linked to reduced blood flow in

the temporal lobes, although since this finding does not correlate

with current weight, it is possible that it is a risk trait rather than

an effect of starvation.

• Extreme weight loss

• Body mass index less than 17.5 in adults, or 85% of expected

weight in children

• Stunted growth

• Endocrine disorder, leading to cessation of periods in girls

(amenorrhoea)

• Decreased libido; impotence in males

• Starvation symptoms, such as reduced metabolism, slow heart

rate (bradycardia), hypotension, hypothermia and anemia

• Abnormalities of mineral and electrolyte levels in the body

• Thinning of the hair

• Growth of lanugo hair over the body

• Constantly feeling cold

• Zinc deficiency

• Reduction in white blood cell count

• Reduced immune system function

• Pallid complexion and sunken eyes

 • Creaking joints and bones

• Collection of fluid in ankles during the day and around eyes

during the night

• Tooth decay

• Constipation

• Dry skin

• Dry or chapped lips

• Poor circulation, resulting in common attacks of 'pins and

needles' and purple extremities

• In cases of extreme weight loss, there can be nerve

deterioration, leading to difficulty in moving the feet

• Headaches

• Brittle fingernails

• Bruising easily

• Fragile appearance; frail body image

• Slowing of the rate of growth of breasts

• drastic changes in blood pressure upon standing

Psychological

• Distorted body image

• Poor insight
 • Self-evaluation largely, or even exclusively, in terms of their

shape and weight

• Pre-occupation or obsessive thoughts about food and weight

• Perfectionism

• Obsessive compulsive disorder (OCD)

• Belief that control over food/body is synonymous with being in

control of one's life

• Refusal to accept that one's weight is dangerously low even

when it could be deadly

• Refusal to accept that one's weight is normal, or healthy

Emotional

• Low self-esteem and self-efficacy

• Phobia of becoming overweight

• Clinical depression or chronically low mood

• Mood swings

Behavioral

• Excessive exercise, food restriction

• Secretive about eating or exercise behavior

• Self-harm, substance abuse or suicide attempts

• Very sensitive to references about body weight

 • Aggressive when forced to eat "forbidden" foods

• social withdraw or being anti-social

• body checking

Diagnostic issues and controversies

The distinction between the diagnoses of anorexia nervosa, bulimia

nervosa and eating disorder not otherwise specified (EDNOS) is

often difficult to make in practice and there is considerable overlap

between patients diagnosed with these conditions. Furthermore,

seemingly minor changes in a patient's overall behavior or attitude

(such as reported feeling of 'control' over any binging behavior) can

change a diagnosis from 'anorexia: binge-eating type' to bulimia

nervosa. It is not unusual for a person with an eating disorder to

'move through' various diagnoses as his or her behavior and beliefs

change over time.

Additionally, it is important to note that an individual may still

suffer from a health- or life-threatening eating disorder (e.g., sub-

clinical anorexia nervosa or EDNOS) even if one diagnostic sign or

symptom is still present. For example, a substantial number of

patients diagnosed with EDNOS meet all criteria for diagnosis of

anorexia nervosa, but lack the three consecutive missed menstrual

cycles needed for a diagnosis of anorexia.[2]

Feminist writers such as Susie Orbach and Naomi Wolf have

criticized the medicalization of extreme dieting and weight-loss as

locating the problem within the affected women, rather than in a

society that imposes concepts of unreasonable and unhealthy

thinness as a measure of female beauty.

A vigorous debate exists on the topic of whether eating disorders are

a choice or a biological illness. In 2006, Dr. Thomas Insel, director

of the US National Institute of Mental Health, wrote an open letter

to the National Eating Disorder Association stating