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Anorexia Nervosa·Diagnosis, Risks and a More Promising New Treatment

separator http://www.childresearch.net/RESOURCE/NEWS/2001/200104.HTM

Anorexia nervosa is an eating disorder that causes people—the majority of whom are female— to become obsessed with the desire to be thin to the point where they starve themselves. It's a psychiatric that disorder also causes sufferers to see themselves as overweight even when they're frighteningly underweight. It's a fairly rare condition in the population at large, but it's the third most common chronic condition of adolescent girls. It creates a state of semi-starvation in the body, which can lead to:

  • A slowing down of the heart rate and blood pressure, which can lead to heart failure
  • Anemia
  • A slowing in the rate of growth
  • Osteoporosis
  • Infertility
  • Gastrointestinal problems
  • Kidney dysfunction
  • Inability to tolerate the cold
  • Constipation

Anorexia can also lead to anxiety and depression. For a psychiatric illness, it has a high rate of death—6 to 10 percent in adolescents. Research shows that suicide is responsible for about half of all anorexia deaths.

The average age that anorexia begins is 17. There are several criteria a patient must meet to be diagnosed with anorexia:

  • Being under 85 percent of body weight
  • Missing three menstrual periods in a row
  • An extreme fear of weight gain, even when underweight

Common behaviors in an anorexia patient

As a person, usually a teenager, begins to develop symptoms of anorexia, parents and other family members may not be certain, at first, exactly what's happening. Here are some of the common behaviors that people with anorexia may exhibit, in addition to severe weight loss:

  • Exercising compulsively
  • Acting oddly regarding food, including hoarding or hiding it, not eating in public, cutting food into tiny pieces, being extremely interested in diets and counting calories, taking a strong interest in preparing meals for other people, eating only one kind of food
  • Being preoccupied with body image and size
  • Being preoccupied with weight

What are the causes of anorexia?

There's generally not one specific factor that causes someone to develop anorexia. Researchers and other experts typically believe it's likely that several factors can combine and happen at just the right time to trigger the illness. These can include:

  • Family history of anorexia
  • Genetics
  • Traumatic experience, such as sexual abuse
  • An environment that places high importance on being thin
  • A tendency to want to be perfect

What are the risk factors?

  • Being a young woman in her teens
  • Reaching puberty early
  • Having depression
  • Having obsessive-compulsive disorder
  • Being involved in sports or other activities that place importance on having a lean body (dance, gymnastics, figure skating, modeling, acting)
  • History of sexual abuse

Newest treatment—the Maudsley Method

As a rule, people with anorexia take part in a variety of therapies. Their treatment team often consists of the primary care doctor, a dietitian and a mental health provider who specializes in eating disorders. Many patients need to be hospitalized because of the severity of the medical consequences of anorexia. Some are hospitalized to receive feeding through a tube. Some go to long-term residential treatment, away from their homes. Some participate in educational interventions designed to teach them nutrition and symptom management.

The challenge of all treatment for anorexia is that it often is helpful in the beginning, but then patients relapse. Long-term research has shown that 50% to 70% of patients recover from anorexia. The rest do not recover fully. Recovery can take four to seven years, on average. Even when people are considered cured, they may still remain extremely thin.

A new approach to treatment for anorexia is called the Maudsley method. It was created by a team of therapists at the Maudsley Hospital in London in the mid-80s. It's a family-based approach to treatment, in which families are encouraged to take on the role of healthcare providers. Parents learn the method from a Maudsley therapist, and continue working with the therapist through the course of the child's illness. There are many healthcare providers involved, but it's generally the parents who spend time with the adolescent patient at mealtimes.

In the beginning phase of the Maudsley method, which is often called "re-feeding," parents are with their child during the meals and essentially, they insist that the child eat. The Maudsley philosophy is that parents naturally place more importance on their child's well-being than anyone else, and consequently, parents are in the best position to take on the role of care provider. The responsibility lies with the parents to create ways to get their child to do this. The primary goal is to restore the child's health and to help the child become physically stable. This is much easier said than done, of course, which is why parents continuously meet with Maudsley therapists for guidance.

As time progresses and the child with anorexia begins to gain weight and become physically stronger, the emphasis gradually shifts more power to the patient. At that point, when the child is likely to be more ready, therapy to give the child and family insight about the disorder and about how to function in the world as a healthy adolescent can begin.

Studies have shown that 90 percent of patients treated with the Maudsley method either recover or make significant progress. The difficulty is that the Maudsley method is extremely labor- and time-intensive and requires an unflagging commitment on the part of parents. It also is less effective for people older than 18, or for patients who also binge and purge.

If you're interested in learning more about the Maudsley method, you may be interested in visiting the Maudsley Parents Web site: http://www.maudsleyparents.org/

Anorexia needs to be treated early

The most important thing for parents to know about anorexia is that the sooner treatment begins, the higher the chances are for success and the less severe the health consequences are likely to be. Anorexia is not an illness that families are generally able to cope with on their own, and their child's very life can be at stake.

Participants needed for two anorexia studies: genetics and Maudsley method

The National Institute of Mental Health (NIMH) has funded the first-ever government-funded genetic study of anorexia nervosa, to find regions of the human genome that contain genes influencing the risk for anorexia. The researchers are recruiting families that have two or more members, mainly siblings, who have or had anorexia nervosa.

For information about how to participate in the study, call 1-888-895-3886, or visit www.angenetics.org

NIMH is also recruiting patients for a study to compare the Maudsley method with individual supportive psychotherapy. For more information about this trial, visit http://www.clinicaltrials.gov/ct/show/NCT00418977?order=1 or call Rebecca Greif 212-659-8724, rebecca.greif@mssm.edu

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