Anorexia Nervosa

Overview of Anorexia nervosa

In general, Anorexia nervosa is relatively common condition which may present to almost any clinical specialty with a multitude of presenting complaints.

Moreover, The term ‘anorexia nervosa’ was first used by William Gull in 1874, and his original description of the essence of the condition contains all of the core elements of the diagnostic criteria that we use today.

The ratio of affected females to males is reportedly 10:1.

Lastly, the average age of onset is 15–17 years for females and 12–13 years for males. [1]

Indian epidemiology then other

Causes of Anorexia nervosa

• Cerebral abnormality
• Genetics
• Serotonin dysregulation
• Occasionally, Zinc deficiency
• Childhood upbringing
• Childhood sexual abuse
• Adverse events in early life also home environment
• Occupation
• Societal pressures

Types

Anorexia falls into 2 general types i.e.:

1.Firstly, Restricting type

People with this type of anorexia nervosa place severe restrictions on the quantity and type of food they consume.

2.Secondly, purging type

People with this type of anorexia also place severe restrictions on the food they eat. But this is accompanied by indulging and then purging.

Atypical anorexia nervosa

Atypical anorexia nervosa is a subtype of other specified feeding or eating disorders (in other words, OSFED) in which a person’s body weight is still in the normal weight range despite having significant weight loss from their restricted energy intake.[6]

Risk Factors

• Age i.e.: Eating disorders, including anorexia, are more common in adolescents and young adults, but young children and older adults can still develop anorexia.
• Gender i.e.: Women and girls are more likely to be diagnosed with anorexia. However, it’s important to know that men and boys can have anorexia and may be under-diagnosed due to differences in seeking treatment.
• Family history i.e.: Having a parent or sibling (first-degree relative) with an eating disorder increases your risk of developing an eating disorder, such as anorexia.
• Dieting i.e.: Dieting taken too far can develop into anorexia.
• Changes and trauma i.e.: Big changes in your life, such as going to college, starting a new job or going through a divorce, and/or trauma, such as sexual assault or physical abuse, may trigger the development of anorexia.
• Certain careers and sports i.e.: Eating disorders are especially common amongst models, gymnasts, runners, wrestlers and dancers.[4]

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Pathophysiology of Anorexia nervosa

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Sign & Symptoms of Anorexia nervosa

The main features of anorexia nervosa can be divided into four categories i.e.

1.Firstly, Core psychopathology:

• • Excess concern with shape and weight
  • Distorted body image
  • Low self-esteem

2.Secondly, Pursuit of thinness and low weight

• • Dieting
  • Vomiting
  • Purging
  • Excessive exercise
  • Food preoccupation
  • Indulging

3.Thirdly, Common co-morbidities

• Low mood
• Deliberate self-harm
• Suicidal ideation
• Obsessions and compulsions

4.Lastly, Physical consequences of starvation

          Physical signs relating to malnutrition i.e.

• Emaciation
• Constipation
• Dry skin also brittle nails
• Hypotension also bradycardia
• Cyanosis also hypothermia
• Lanugo
• Hypercarotenemia
• Eroded tooth enamel
• Parotid swelling
• Osteoporosis
• Renal calculi
• Peripheral neuropathy
• Amenorrhoea also infertility
• Reduced libido

         Biochemical abnormalities relating to malnutrition i.e.

• Hypokalemia
• Hypophosphataemia
• Metabolic alkalosis
• Hypoglycaemia
• Hypercortisolaemia
• Either Anemia or a pancytopenia [1]

Physical Examination

Appearance of the patient

• Extreme weight loss
• Stunted growth
• Body mass index less than 17.5 in adults, or 85% of expected weight in children

Vital Signs

Temperature

• Hypothermia

Pulse

Rate

• Bradycardia

Blood Pressure

• Hypotension

Skin

• Growth of lanugo hair over the body
• Dry skin
• Possibly with pallid complexion

Eyes

• Sunken eyes

Extremities

• Creaking joints and bones
• Collection of fluid in ankles during the day and around eyes during the night
• Nails become more brittle
• Tooth decay
• Very dry/chapped lips due to malnutrition

Miscellaneous

Behavioral

• Excessive exercise, food restriction
• Fainting
• Secretive about eating or exercise behavior
• Possible self-harm, substance abuse or suicide attempts
• Very sensitive to references about body weight
• Become very aggressive when forced to eat "forbidden" foods[7]

Diagnosis of Anorexia nervosa

• Body mass index (BMI) < 17.5 whereas ideal body weight (IBW) < 85 per cent of expected value.
• Generally, Intense fear of gaining weight or becoming higher weight.
• The absence of at least three consecutive menstrual cycles (amenorrhoea) in women who have had their first menstrual period but have not yet gone through menopause.
• Disturbance in the way in which either 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. [1]

Differential Diagnosis

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

Investigation

Blood Tests

• Complete blood count (CBC)
• Checks for levels of albumin (a liver protein)
• Measure of electrolytes
• Kidney function tests
• Liver function tests
• Measure of total protein
• Thyroid function tests

Urinalysis

Certain metabolic functions can be measured with a urine test.

Urinalysis also looks at the color and appearance of the urine, its microscopic appearance, and its chemistry.

Other Tests and Procedures

A bone density test may be administered to check for osteoporosis.

An electrocardiogram (ECG) may be ordered to check for problems with the heart such as slow heart rate or abnormal heart rhythm.1

X-rays may be taken to check things like stress fractures or broken bones, lung or heart problems.[8]

Treatment of Anorexia nervosa

• Behavior therapy
• Individual psychotherapy
• Hospitalization, with adequate nursing care for food intake and weight gain
• Drug Therapy: Antipsychotics: for instance Chlorpromazine, Olanzapine Antidepressants: fluoxetine, clomipramine, Cyproheptadine
• Group therapy and family therapy in psycho-education[2]

• Improving general health, nutrition and psychological wellbeing, such as self-esteem and positive body image
• Enhancing media literacy, which provides education on the media’s promotion of unrealistic standards of ‘beauty’. This enables people to critically analyse media messages, thus reducing the risk of developing an eating disorder
• Reducing teasing and bullying, including weight-based teasing[9]

Homeopathic Treatment of Anorexia nervosa

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Anorexia nervosa:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Medicines for Anorexia nervosa:

Arsenicum Alb:

• Extreme fastidiousness especially about germs and dirt.
• Anorexia coupled with fear of being poisoned.
• Fear of getting certain diseases so they start starving.

Carcinosin:

• Specifically for Obsessive compulsive disorder.
• Perfectionism, fear of becoming fat, likewise fear of rejection.
• Etiology-abuse, grief or fears, often related to weight. Additionally chronic insomnia, workaholics.

Hyoscyamas:

• Anorexia plus mania, insanity, besides this fear of being poisoned.
• Could have pathological jealousy, over concern about weight also getting fat.

Ignatia:

• Especially for Perfectionism, fear of becoming fat, fear of rejection.
• Hysteria loss of control of emotions, fainting.
• Etiology-grief or big disappointment, often related to weight.

Natrum mur:

• Most often indicated remedy specifically in anorexia, a lot of guilt.
• Fear of being rejected, hurt easily, also very self-conscious.
• Dry lips, emaciate, and dry skin, constipated, lose appetite.
• Besides this, behind this is perfectionism and fear of becoming fat.

Phosphoric acid:

• Etiology-grief with loss of appetite with emaciation, pinning away from loss of love, second stage they get indifferent to all emotions and food.
• Generally, Deadness inside.

Patina met:

• Obsessed with their appearance, fear of becoming fat.
• Very obsessive and impulsive personality, egocentric and arrogant, all tied up with their sexuality, religious mania.

Pulsatilla:

• Feeling of worthlessness, unloved, loneliness, fixed ideas about.
• Food especially certain foods are bad, than amount of foods that are bad grows, fear of gaining weight, pulsatilla’s gain weight easily, Furthermore, they can eat a pastry and swear they gained weight.
• Puls are constantly weighing themselves.
• Scanty menses.

Sepia:

• Specifically indicated in Anorexia nervosa plus hormonal problems, nausea, sensitivity to smell.
• Disgust for food, worse since childbirth, hormones causes lack of appetite.

Staphysagria:

• Acute of Carcinosin, more visible, visibly upset. Additionally, Carcinosin can control it more, Staph. may it more.
• Deep sense of worthlessness and depression, even suicidal.
• Humiliation, mortified, put down, criticized, especially for zero confidence.
• Fear of becoming fat and neglected by others.

Tarentula:

• Mania could be religious mania.
• Underneath you have a fear of being poisoned.
• Obsessiveness about weight, very restless also hyper energy people, they do everything fast-talk, move.

Thuja occid:

• Fear of being impure, dirty blood, anxiety about health, obsessed with idea of have to clean them out.
• Moreover, Fear of eating more and becoming fat.

Veratrum Alb:

• Religious mania, loquacious, end of world is coming.
• Punish themselves, fast to appease god. Behind this you see guilt. [2]

Nutritional management of Anorexia nervosa

For an anorexic sufferer, gaining weight is an incredibly delicate process. The long periods of starvation could have caused any number of biochemical abnormalities such as deficiencies in proteins, micronutrients and fatty acids.

This usually means that specialist dietary plans must be made in order to correct the imbalances and not cause additional problems. Experts believe that weight should not be gained until these deficiencies have been corrected. Aggressive attempts to boost weight gain during the early stages of treatment could be extremely hazardous.[10]

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References use for Article anorexia nervosa

[1] Psychiatry, Fourth Edition – Oxford Medical Publications

[2] Ahuja – A Short Textbook of Psychiatry, 7th Edition

[3] Full Book Homeopathy in Treatment of Psychological Disorders by Shilpa Harwani

[4]https://www.healthline.com/health/eating-disorders-causes-risk-factors#risk-factorshttps://www.nutritionist-resource.org.uk/articles/anorexia-nervosa.html#treatinganorexia

[5] https://www.msdmanuals.com/en-in/professional/psychiatric-disorders/eating-disorders/anorexia-nervosa#v1027605

[6]https://www.healthdirect.gov.au/anorexia-nervosa

[7]https://www.wikidoc.org/index.php/Anorexia_nervosa_physical_examination

[8]https://www.verywellhealth.com/anorexia-diagnosis-5181747

[9]https://nedc.com.au/eating-disorders/prevention/treatment-2/primary-prevention/

[10]https://my.clevelandclinic.org/health/diseases/9794-anorexia-nervosa

Frequently Asked Questions

What is Anorexia Nervosa?

Anorexia nervosa is a clinical syndrome characterized by low body weight, amenorrhoea, distorted body image, also an intense fear of gaining weight.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Anorexia Nervosa?

• Arsenicum Alb
• Carcinosin
• Hyoscyamas
• Ignatia
• Natrum mur
• Phosphoric acid
• Patina met
• Pulsatilla

What are the symptoms of Anorexia Nervosa?

• Excess concern with shape and weight
• Distorted body image
• Low self-esteem
• Dieting, Vomiting, Purging
• Excessive exercise
• wallowing
• Low mood
• Deliberate self-harm

What are the causes of Anorexia Nervosa?

• Cerebral abnormality
• Genetics
• Serotonin dysregulation
• Occasionally, Zinc deficiency
• Childhood upbringing
• Childhood sexual abuse
• Adverse events in early life and home environment
• Occupation
• Societal pressures