Anorexia nervosa, also known as simply Anorexia, is an eating disorder characterized by refusal to maintain a healthy body weight and

an obsessive fear of gaining weight. It is often coupled with a distorted self image which may be maintained by various cognitive biases that alter how the affected individual evaluates and thinks about her or his body, food and eating. Persons with anorexia nervosa continue to feel hunger, but deny themselves all but very small quantities of food. The average caloric intake of a person with anorexia nervosa is 600800 calories per day, but there are extreme cases of complete self-starvation. Anorexia most often has its onset in adolescence and is most prevalent among adolescent girls between 13 to 20 years of age. While it can affect men and women of any age, race, and socioeconomic and cultural background, Anorexia nervosa occurs in females 10 times more than in males. Specific characteristic of a child with anorexia nervosa include: Body mass index (BMI) less than 17.5 or less than 85% of expected weight Intense fear of gaining weight or becoming fat even thought underweight Severely distorted body image Amenorrhea (in girl)

Signs and Symptoms include: obsession with calories and fat content preoccupation with food, recipes, or cooking; may cook elaborate dinners for others but not eat themselves] dieting despite being thin or dangerously underweight fear of gaining weight or becoming overweight rituals: cuts food into tiny pieces; refuses to eat around others; hides or discards food purging: uses laxatives, diet pills, ipecac syrup, or water pills; may engage in selfinduced vomiting; may run to the bathroom after eating in order to vomit and quickly get rid of the calories may engage in frequent, strenuous exercise] perception: perceives self to be overweight despite being told by others they are too thin becomes intolerant to cold: frequently complains of being cold due to loss of insulating body fat or poor circulation due to extremely low blood pressure; body temperature lowers (hypothermia) in effort to conserve energy depression: may frequently be in a sad, lethargic state solitude: may avoid friends and family; becomes withdrawn and secretive clothing: some may wear baggy, loose-fitting clothes to cover weight loss if they have been confronted about their health and wish to hide it, while others will

wear baggy clothing to hide what they see as an unattractive and overweight body. Assessment Because of an intense fear of becoming obese, children with anorexia come to perceive food as revolting and nauseating, and refuse to eat or else vomit food immediately after eating. Always ask if the child is using laxative or diuretics or extensively exercising to further lose weight. If the process is allowed to continue without therapy, it can lead to starvation and death. By the time most children are seen at health care facilities, they are already extremely underweight, pale and lethargic. Amenorrhea is commonly present. Often, the childs parents have tried various methods of getting the child to eat, such as threatening, coaxing, and punishing; as a result, parent-child relationship may be strained. Parents may feel guilty for insisting their child lose weight if the girl was once overweight.

Therapeutic Management Planning and outcome identification for a child with anorexia nervosa or binge eating need to be realistic. Remember that, although the condition began as a psychosocial problem, by the time a child is seen for care, physical starvation and its effect have become a second important component. A girl who grows nauseated just looking at food cannot quickly begin to ingest large amount of it. For therapy, typically, oral foods are withheld to prevent vomiting and total parenteral nutrition is initiated to supply needed fat, protein and calories. Children usually accept total parenteral nutrition well because they view it as medicine, not as food. Enteral feedings may also be accepted and used to restore weight. In addition, establishing trust and effective communication are crucial measures to help the child resolve any interpersonal issues that are present. Other therapeutic intervention include: Medications such as antidepressants Identification of emotional triggers Self-monitoring (awareness training) Education about normal nutritional needs

Gradual weight gain is recommended, because rapid gain of weight can cause a child to begin to reduce this weight gain. Weighing once a week is better than every day, to reduce the focus on weight.

Children who had anorexia nervosa need continued follow-up after weight is regained, to be certain that they do not revert to their former dieting pattern. Counseling may need to be continued for 2 to 3 years to be certain that self-image is maintained. With adequate counseling, most girls achieve full recovery with adulthood.