Page 82 Complete Your CE Test Online - Click Here ANOREXIA NERVOSA Cathy is 17 years old and a junior in high school. She is a star on the girls’basketball team and hopes to earn an athletic scholarship that will pay her college expenses and allow her to continue her athletic career. Despite her active lifestyle Cathy is a few pounds overweight and admits to a love of desserts. One day after practice her coach casually remarked, “You might want to lose a few pounds, Cathy. That may help you to pick up some speed on the court.” Cathy takes this suggestion seriously. She begins a strict diet and quickly loses 10 pounds. Her running speed does improve, and her friends and family tell her she looks “fantastic.” Convinced that if she continues to lose weight her game will improve even more, Cathy continues to diet. She monitors everything she eats and makes sure to eat no more than 600 calories per day. This meager nutritional intake, compounded by the calories burned during practice and basketball games, leads to a dangerous weight loss. Cathy denies that she is hungry and becomes obsessed with what she eats. She stops menstruating and has trouble sleeping. Her family, friends, teammates, and coach all try to convince her to eat “normally.” Cathy, however, believes that she is “fat” and needs to continue to lose weight, no matter what anyone else tells her. Cathy is displaying signs and symptoms of anorexia nervosa (commonly referred to as anorexia), characterized by a loss of weight greater than 15% of minimally normal weight for age and height[2] . The essential feature of anorexia nervosa is self-induced starvation due to a distorted body image and an extreme, irrational fear of gaining weight[2] . The word “anorexia” may suggest to some people that the client’s weight loss is linked to a loss of appetite. This, however, is quite rare[9] . Anorexia is characterized by clients having[1,2,9] : ● ● A distorted body image. Despite an obviously gaunt, emaciated appearance, the clients still perceive themselves to be fat and unattractive. Even though family, friends, teachers and/or co- workers try to convince clients otherwise, they firmly believe that they must continue to lose weight. They have an unshakable belief that they are fat and see themselves as such no matter what evidence to the contrary is presented to them. ● ● An extreme, irrational fear of gaining weight. This fear makes clients go to extremes to lose weight and to avoid gaining weight. Such extremes include literally starving themselves and, possibly, exercising to the point of exhaustion. Nursing consideration: Anorexia nervosa and bulimia nervosa can occur at the same time. In such cases starvation may occur in conjunction with extreme exercising, laxative abuse, diuretic abuse, and/or self-induced vomiting[9] . It is important to make clients, families, and professional colleagues aware that anorexia nervosa and bulimia nervosa can occur simultaneously. Not everyone is aware of this and it is important that appropriate education and treatment be provided. Incidence and prevalence of anorexia nervosa Anorexia nervosa is found in 5 to 10% of the population. About 95% of those affected are women[9] . Anorexia nervosa usually begins during adolescence or young adulthood and rarely begins prior to puberty or after the age of 40. However, cases of both early (prior to puberty) and late (after the age of 40) onset have been reported[1] . The disease is most prevalent in post-industrialized, high-income countries including the United States, many European countries, Australia, New Zealand, and Japan[1] . In the United States, the prevalence of anorexia nervosa is rather low among Latinos, African-Americans, and Asians. However, it should be noted that the utilization of mental health services among these populations is lower than other groups, which may not accurately reflect the occurrence of the disease[1] . It is estimated that anorexia occurs in 5 to 10% of the population, with most cases occurring in women. However, the occurrence in males is significantly increasing[6,9] . Prognosis varies but is better if clients are diagnosed early and seek help voluntarily. Mortality ranges from 5 to 15%, which is the highest mortality associated with a mental health disorder. One-third of these deaths are due to suicide[9] . Nursing consideration: It is imperative that nurses teach clients and families to monitor for suicidal ideation and actions. Possible causes and risk factors of anorexia nervosa The exact etiology of anorexia nervosa is unknown. Research shows that onset is often linked to a stressful life event, such as leaving home for college[1] . Other examples of such life events include moving, divorce, or the death of a loved one[10] . Other issues have been linked to the development of anorexia nervosa. Risk factors for the development of the disease include the following factors[1,9,10] : ● ● When a person participates in extreme dieting, changes may occur in how the brain and the body’s metabolism work. These changes may predispose someone to the development of an eating disorder. ● ● Genetics may make a person more vulnerable to the development of anorexia nervosa. A family history of eating disorders, obesity, or mood disorder such as anxiety or depression seems to increase the risk of developing the disease. ● ● Certain personality traits, such as low self-esteem, low self- confidence, and/or a drive for perfectionism are linked to anorexia nervosa development. ● ● Some cultural issues seem to play a role in the disease’s development. For example, teenagers and young adults may feel a need to be thin because of peer pressure, societal expectations, and/or media emphasis on what the “ideal” woman (or man) should look like. Cultures that associate being thin with being attractive may help to trigger the disorder. ● ● Other mental health disorders such as obsessive-compulsive disorder, depression, and anxiety have been associated with the development of anorexia nervosa. Nursing consideration: Some experts believe that refusing to eat is an effort to gain or regain control over one’s life. The resulting disease process is a manifestation of that attempt to control[9] . CLINICAL PRESENTATION Clinical presentation of anorexia nervosa can vary depending on the severity of the illness[2] . The most obvious clinical finding is significant weight loss that is self-induced and greater than 15% of minimally acceptable weight for age and height[2] .