Anorexia

Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder characterized by low body weight and body image distortion with an obsessive fear of gaining weight.

Individuals with anorexia often control body weight by voluntary starvation, purging, vomiting, excessive exercise, or other weight control measures, such as diet pills or diuretic drugs. It primarily affects adolescent females all over the world, however approximately 10% of all afflicted are male. Anorexia nervosa is a complex condition, involving psychological, neurobiological, and sociological components.

Origins
The term anorexia is of Greek origin: an (privation or lack of) and orexis (appetite) thus meaning a lack of desire to eat. A person who is diagnosed with anorexia nervosa is most commonly referred to with the adjectival form anorexic . The noun form, as in 'he is an anorectic', is used less commonly. The term "anorectic" can also refer to any drug that suppresses appetite. " Anorexia nervosa" is frequently shortened to " anorexia " in both the popular media and scientific literature. This is technically incorrect, as strictly speaking " anorexia " refers to the medical symptom of reduced appetite.

Diagnosis
Although biological tests can aid the diagnosis of anorexia , the diagnosis is based on a combination of behaviour, 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.

Presentation
To be diagnosed as having anorexia nervosa a person may display:

Refusal to maintain body weight at or above a minimally normal weight for age and height (eg:, 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).
Intense fear of gaining weight or becoming obese. 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.
In postmenarcheal, premenopausal females (women who have had their first menstrual period but have not yet gone through menopause), amenorrhea (the absence of at least three consecutive menstrual cycles).

Other eating related disorders.
There are a number of features, that although not necessarily diagnostic of anorexia, have been found to be commonly (but not exclusively) present in those with this eating disorder . Physical Anorexia nervosa can put a serious strain on many of the body's organs and physiological resources.

Anorexia puts a particular strain on the structure and function of the heart and cardiovascular system, with slow heart rate (bradycardia) and elongation of the QT interval seen early on.

People with anorexia typically have a disturbed electrolyte balance, particularly low levels of phosphate, which has been linked to heart failure, muscle weakness, immune dysfunction, and ultimately death.

Those who develop anorexia before adulthood may suffer stunted growth and subsequent low levels of essential hormones (including sex hormones) and chronically increased cortisol levels.

Osteoporosis can also develop as a result of anorexia in 38-50% of cases, as poor nutrition leads to the retarded growth of essential bone structure and low bone mineral density.

Anorexia does not harm everyone in the same way. For example, evidence suggests that the results of the disease in adolescents may differ from those in adults. Changes in brain structure and function are early signs of the condition. Enlargement of the ventricles of the brain is thought to be associated with starvation, and is partially reversed when normal weight is regained. 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.

Other effects may include the following:

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 anaemia
Abnormalities of mineral and electrolyte levels in the body
Thinning of the hair
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
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
Emotional Low self-esteem and self-efficacy
Intense fear about becoming overweight
Clinical depression or chronically low mood
Mood swings
Interpersonal and social Withdrawal from previous friendships and other peer-relationships
Deterioration in relationships with the family Denial of basic needs, such as food
Behavioural
Excessive exercise, food restriction
Secretive about eating or exercise behaviour
Fainting
Self-harm, substance abuse or suicide attempts
Very sensitive to references about body weight
Aggressive when forced to eat "forbidden" foods

Cause
It is clear that there is no single cause for anorexia and that it stems from a mixture of social, psychological and biological factors. Current research is commonly focused on explaining existing factors and uncovering new causes. However, there is considerable debate over how much each of the known causes contributes to the development of anorexia . In particular, the contribution of perceived media pressure on women to be thin has been especially contentious. Family and twin studies have suggested that genetic factors contribute to about 50% of the variance for the development of an eating disorder and that anorexia shares a genetic risk with clinical depression. This evidence suggests that genes influencing both eating regulation, and personality and emotion may be important contributing factors. There has been a significant amount of work into psychological factors that suggests how biases in thinking and perception help maintain or contribute to the risk of developing anorexia. Anorexic eating behaviour is thought to originate from feelings of fatness and unattractiveness and is maintained by various cognitive biases that alter how the affected individual evaluates and thinks about their body, food and eating. One of the most well-known findings is that people with anorexia tend to over-estimate the size or fatness of their own bodies. A recent review of research in this area suggests that this is not a perceptual problem, but one of how the perceptual information is evaluated by the affected person. Recent research suggests people with anorexia nervosa may lack a type of overconfidence bias in which the majority of people feel themselves more attractive than others would rate them. In contrast, people with anorexia nervosa seem to more accurately judge their own attractiveness compared to unaffected people, meaning that they potentially lack this self-esteem boosting bias. People with anorexia have been found to have certain personality traits that are thought to predispose them to develop eating disorders. High levels of obsessionality (being subject to intrusive thoughts about food and weight-related issues), restraint (being able to fight temptation), and clinical levels of perfectionism (the pathological pursuit of personal high-standards and the need for control) have been cited as commonly reported factors in research studies. It is often the case that other psychological difficulties and mental illnesses exist alongside anorexia nervosa in the sufferer. Clinical depression , obsessive compulsive disorder , substance abuse and one or more personality disorders are the most likely conditions to be co-morbid with anorexia , and high-levels of anxiety and depression are likely to be present.

Complementary Therapies
Aromatherapy alone is most certainly not enough to help an anorexic but can sometimes be valuable when allied to skilled counselling or psychotherapy. Massage helps to bring the receiver into contact with their own body. This can be important as in many instances the sufferers are alienated from their physical body and develop a strong sense of self loathing. A variety of essential oils can be used in but it depends very much on the individual needs and preferences of the person receiving treatment.

Essential oils which can be used are: Bergamot, Black Pepper , Chamomile Roman , Clary Sage , Fennel, Frankincense , Ginger , Jasmine , Lavender , Lemon , Mandarin , Marjoram , Neroli, Peppermint , Rose , Rosemary , Sage, Thyme , Ylang Ylang . Essential oils which can help alleviate depression , encourage optimism and improve self esteem: Bergamot, Chamomile Roman , Clary Sage , Frankincense , Jasmine , Lavender , Neroli , Rose , Ylang Ylang. Essential oils which can be used to help regulate the appetite: Bergamot, Fennel Fears of growing up and coming to terms with sexuality and adult life: Jasmine , Rose Boosting energy levels and to combat feelings of being run down: Black Pepper, Peppermint , Rosemary , Sage, Thyme Constipation : Black Pepper , Fennel , Ginger , Lemon , Mandarin , Marjoram , Rosemary, Sage

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