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Ealth Cience Ournal: Contribution of Social and Family Factors in Anorexia Nervosa
Ealth Cience Ournal: Contribution of Social and Family Factors in Anorexia Nervosa
Ealth Cience Ournal: Contribution of Social and Family Factors in Anorexia Nervosa
ABSTRACT
Background: Anorexia nervosa is probably the most substantial eating disorder, with basically unknown
causes, centered on psychological factors and affected by many social, biological and cultural ones. The
aim of this study was to emerge the complex issues regarding the treatment, the early intervention and the
prevention of the anorexia nervosa.
The method f this study included a search of the literature in several databases (Medline, EMBASE and
CINAHL) to identify articles related to anorexia nervosa. Results: Patients with anorexia nervosa develop
a refusal in ingestion of food, maintaining a distorted self-perception of their body, considering themselves
as overweighed. The diagnosis even though is made according international established criteria, varies
among the patients taking into consideration additional factors like family and social environment. As the
patients refuse to admit the seriousness of their condition, they seek for medical assistance when
disorders appear in vital organs, due to de-nutrition. In most cases hospitalization is necessary and
includes a suitable diet program and medication treatment.
Conclusions: Psychological therapy is a basic part of the treatment, in long-term basis and is employed by
behavior therapy and the patient's support. Advising the public and especially parents with children in
adolescence, where usually anorexia nervosa occurs, is necessary as the prevention and the early diagnosis
is the best treatment.
CORRESPONDING AUTHOR
Greta Wozniak, MD, PhD
Applied University of Larissa
Larissa, GREECE,
Phone: +30-2410 684252
Fax: +30-24210 - 72462
E-mail: greta@med.uth.gr
INTRODUCTION
D
isorders in food injection have last years due to the constantly increased
raised the interest of scientists the number, mainly of women, that report
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HEALTH SCIENCE JOURNAL
Volume 6, Issue 2 (April June 2012)
The social conventions and the emphasis mother associated with the occurrence
to external appearance, that influences of the disorder to children and especially
mainly young people, are factors to adolescent females.13
associated with eating disorders in Psychical theory
addition with advertisement and the According to Bruch (1982) the psychical
contribution of mass media projecting factors associated with the appearance of
anorectic models as the only way to the disorder are:
success, the non-acceptance of other 1. Adolescent crisis and new experiences,
values like educational, cultural, social as inclinatory factors
enlarge the problem. The modern society 2. Raising a child that is only ostensibly
enervates family bonds and reduces the "normal". They usually hide behaviors
time spent between parents and children, with lack of recognition, enhancement
setting new priorities, altered from those and confirmation of child's abilities.
of previous generations. 3. The preponderant psychological
Purpose of this study is to highlight the mechanism, which is the complete
complex issues concerning the control of the body, as an effort to
treatment, the early intervention and the maintain a level the dominance over
prevention of the anorexia nervosa. their selves.14
Etiology of anorexia nervosa and Social-Psychological factors
associated factors Many scientists ascribe the disorder to
The causes of anorexia nervosa are multi psychological and social mechanisms.
factored and there are many relative They believe that anorexia nervosa
theories from the scientific community. seems to be a reaction to the demands of
It is supported that the disorder is adolescence for more independence and
caused by a coalescence of biological, increased social and sexual activity. In a
social-cultural and psychological - way, patients through the disorder
psychical factors. There also the view replace the normal adolescent quests
that the causes of anorexia nervosa are with the constant concern of food and
only psychical or that there is no clear control of their body weight. They report
evidence regarding the exact that there are troubled relationships
pathogenesis that induces the disorder. between parents and the anorectic
But all scientists agree at the significant children try to draw their attention. In
role of the family and particularly the patients' family history are mentioned
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Volume 6, Issue 2 (April June 2012)
or with medical history of serious anorexia nervosa are discriminated to
20,21
diseases are at the same risk. medical complications of the disorder,
including hypokalemia,
Progress and prognosis of anorexia bronchopneumonia, cardiac arrhythmia,
nervosa coronary disease, pancreatitis, necrotic
Anorexic patients ask for medical advice colitis and suicides.25
long after the appearance of very serious
symptoms, many of them unwillingly, Symptoms and behavior characteristics
after their family encouragement. The The self-enforcement starvation of the
progress of the disease varies, from patients, who are not having disorders in
immediate recovery after the treatment, appetite, and are visibly obvious, causes
to unsteady progress of weight recovery the symptoms of the disorder by
with recurrences, and to constant fatal behavioral and physical changes.
aggravation. Studies report that the 1/3 Behavior of anorexic
of the patients is cured, at the 1/3 there Anorexic persons have a disorder image
health condition is improved and at 1/3 of the normal weight and shape of the
the disorder becomes chronic.22 body and they consciously chose ways
Generally the prognosis is not good. The for weight loss that gradually lead to
extended duration of the disease, dying. They seem to have obsessive
depression, frequent vomits and the characteristics, high sense of duty and
excess weight loss are negative morality and an inclination to
prognostic points, including hospitalized independence. At the beginning they are
treatment, sensitivity to various diseases, intensively busy preparing their meals,
and family with intense and they avoid high calorie foods, weight
23
psychopathology. As positive at least four times daily, and follow strict
prognostic points are considered the exhausting diets.26 After a while they are
reduction of stress, a strongly supportive entering the second phase, where their
family and friendly environment, and behavior constantly changes, the family
also strongly structured personality.3 begin to realize the problem, although
The mortality of the hospitalized patients patients still deny it and refuse any
is more 10% due to either excess weight conversation about it, as a result there
loss or inanition or to suicide attempts.24 are daily conflicts within family
The causes of death in patients with members, and gradually they become
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combination of behavior therapy and The modern social models idealize
35,36
supportive psychotherapy. It is very women with low body weight, with
important the approaching way of the result the increasing number of incidents
person, in order to develop positive of anorexia nervosa, especially among
behavior. This includes the learning of adolescents. Long-term aim should be
behavior, and then follows de learning the reducing effects of eating disorders
and relearning, without seeking the and the associated risk factors.
causes of the previous pathologic Scientists emphasize the need of
behavior. The aim of this behavior encouraging the patients to seek therapy
treatment is to restore the normal way of and to treat them with understanding,
37
eating. while the goals and limits of treatment
In hospitalized treatment a strict are attainable. Also, they suggest specific
protocol is followed to anorectic patients instructions regarding the level of the
in order to gain a certain weigh daily, needed treatment to psychological and
regarding the intakes and outtakes of behavioral issues that characterize
calories, and there is a close monitoring anorexia nervosa. All the medical
till 2 hour after the meal, to avoid professionals should realize that the
induced vomiting to patients with excess recovery of the disorder is a slow
weight loss. procedure.
The financial cost for this kind of
Conclusions disorders is high and onerous for the
Although there is a significant progress families of the patients. Beside the long
in treatment of anorexia nervosa, the period of time, there are many variations
conclusions, of the few studies during in the force of the disease, and many
the last decade, have showed a times hospitalization is necessary and
wackiness in research, as it seems that treatment is common to engage a
the ways of developing prevention and multidisciplinary team of professionals
treatment programs of anorexia nervosa for the patients and their families.
are not connected with the risk factors Anorexia nervosa is a psychiatric disease
and the necessity of finding a treatment with high mortality rates in young
approach that combines the traditional patients. It is need the state to organize
methods of therapy with new ones, and units for patients with eating disorders
this due to limited knowledge. and to fully cover treatment and
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Kinderpsychiatr, 2005; 54(4): 286- 20.Carter PI, Moss AR. Screening for
302. anorexia and bulimia nervosa in a
13.Izydorczyk B, Czekaj B. Review of college population: Problems and
certain conceptions on eating limitations. Addict Behav, 1984;
disorders. Suggestions on 9(4): 417-419.
psychotherapy for women with 21.Jacobi C, Abascal L, Taylor CB.
anorexia and bulimia nervosa (the Screening for eating disorders and
authors' own experience). high-risk behavior: Caution.
Psychiatr Pol, 2006; 40(1): 65-74. International Journal of Eating
14.Bruch H. Anorexia Nervosa: Disorders, 2004; 36(3): 280 295.
therapy and theory. Am J 22.Neumrker KJ. Mortality and
Psychiatry 1982; 139: 1531-1538. sudden death in anorexia nervosa.
15.McClelland L, Crisp A. Anorexia Intern J Eat Disord, 1998;
nervosa and social class. Intern J 21(3): 205 212.
Eat Disord, 2001; 29(2): 150 156. 23.Golberg R. Practical guide to the
16.Ericsson M, Poston WS 2nd, care of the psychiatric patient.
Foreyt JP. Common biological Mosby, USA, 1995; 15 5: 221-225.
pathways in eating disorders and 24.Palmer R. Death in anorexia
obesity. Addict Behav, 1996; nervosa. The Lancet, 2003;
21(6): 733-43. 361(9368): 1490-1490.
17.Scott DW. Anorexia nervosa in the 25.Stice E, Marti N, Shaw H, O'Neil
male: A review of clinical, K. General and program-specific
epidemiological and biological moderators of two eating disorder
findings. Intern J Eat Disord, 2006; prevention programs. Int J Eat
5(5): 799 819. Disord, 2008; 41(7): 611-7.
18.Bryant R, Bates B. Anorexia 26.Mills IH, Medlicot L. Anorexia
nervosa: a etiological theories and Nervosa as a Compulsive
treatment methods. J Adolesc, Behaviour Disease. Q J Med 1992;
1985; 8(1): 93-103. 83: 507-522.
19.Keating C. Theoretical perspective 27.Pike KM, Walsh BT, Vitousek K,
on anorexia nervosa: The conflict Wilson GT, Bauer J. Cognitive
of reward. Neuroscien Biobehav behavior therapy in the
Rev, 2010; 34(1): 73-79. posthospitalization treatment of
Page | 265
Page | 266
Contribution of social and family factors in anorexia nervosa
HEALTH SCIENCE JOURNAL
Volume 6, Issue 2 (April June 2012)
Adolesc Psychiatr Clin N Am, disorders in children and
2009; 18(1): 147-58. adolescents. Cochrane Database
42.Michler P, Wolter-Flanz A, Linder Syst Rev, 2002; (2): CD002891.
M. Intensive outpatient group 48.American Psychiatric Association
treatment for adolescents with (APA). Diagnostic and statistical
eating disorders. Prax manual of mental disorders DSM-
Kinderpsychol Kinderpsychiatr, IV. 4th edit, Washington,
2007; 56(1): 19-39. American Psychiatric Association,
43.Schmidt U, Lee S, Beecham J, 1994.
Perkins S, Treasure J, Yi I et al. A
randomized controlled trial of
family therapy and cognitive
behavior therapy guided self-care
for adolescents with bulimia
nervosa and related disorders. Am
J Psychiatry, 2007; 164(4): 591-8.
44.Le Grange D, Crosby RD, Rathouz
PJ, Leventhal BL. A randomized
controlled comparison of family-
based treatment and supportive
psychotherapy for adolescent
bulimia nervosa. Arch Gen
Psychiatry, 2007; 64(9): 1049-56.
45.Vandereychen W. Treatment of
Anorexia Nervosa. Eat Disord,
2003; 34(4): 409-422.
46.Varchol L, Cooper H.
Psychotherapy approaches for
adolescents with eating disorders.
Curr Opin Pediatr, 2009; 21(4):
457-64.
47.Pratt BM, Woolfenden SR.
Interventions for preventing eating
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ANNEX
FUNCTIONAL FINDINGS
SYSTEM
Normal TSH*
Decreased serum insulin and RBC insulin bitting GTT flat or diabetic
Deficient ADH
Hematologic Anemias
Leucopenia
Thrombocytopenia
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Table 2. Diagnostic criteria DSM-IV for anorexia nervosa (APA, 1996)
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