Anorexia Nervosa Or Fear Of Normal Weight

Eating as a behaviour:

Our eating behaviour is controlled by hunger and appetite that are regulated by our brain in the satiety and hunger centers. These centers are part of the hypothalamus, a very important area at the base of the brain which is also responsible for control of other basic bodily functions. Change in appetite can be traced back to many physical and psychological conditions. In depression there is a change in appetite which possibly indicates a link with the serotonin brain system. Serotonin is a chemical secreted by brain cells as a way of communication between those cells in certain areas of the brain. brain cells have a body with long extension called axon which ends at another cell body or shorter extensions called dendrites because they are similar to the branches of a tree. The serotonin system is implicated in sleep, appetite, aggression, sex and mood. Two psychiatric eating disorders have attracted a considerable interest for many years, one involve food avoidance and the other food indulgence: Anorexia Nervosa and Bulimia Nervosa.

Anorexia Nervosa

This condition was first described by Sir William Gull and Charles Laseque in mid-1870. They described anorexia nervosa and recognized its psychological causes.

The condition is diagnosed when certain criteria are fulfilled. These include a significant weight loss or failure of weight gain, which is self-induced. The person is usually a young adult or a teenager and mostly a female avoid fattening foods, induce vomiting, use laxatives in purging, or use excessive exercise; appetite suppressants or diuretics to lose weight. The psychological cause is mainly a fear of fatness and change in body image as the person perceive her body as fat and ugly. There is a widespread hormonal change in anorexia nervosa. There is stop of the period (amenorrhoea) in the majority of cases. There is also a raised growth hormone, raised cortisol level and reduced thyroid hormones. A useful measure of body weight is Quetelet's body-mass index which expresses body weight in relation to the height. BMI or body mass index represents Weight (in kilograms) /divided by Height (in square metres2).

For the diagnosis of Anorexia Nervosa to be made accurately, the following criteria has to be fulfilled:

1. Refusal keep the normal minimal weight (weight is 15% below expected for the age and height)

2. Fear of weight gain or fatness even though the person is underweight.

3. There is abnormal perception of weight, size or shape of the body

4. Loss of menstruation (Amenorrhoea) for a minimum 3 cycles.

In addition anorexic patients also suffer from additional psychiatric conditions. 70% of patients with anorexia are depressed. Obsessional symptoms, particularly centered around food and eating are found in 30% of anorexic patients. 50% of cases fall within the personality disorder categories: avoidant, obsessional and emotionally unstable domains of personality.

Causes of Anorexia:

(1) Social and cultural changes in modern society have glamorized the slim female body and the model female body has seen changes over decades with increasing reduction in the ideal female body weight.

(2) Psychologists such as Minuchin have described a morbid family interaction in Anorexia Nervosa. Rigidity of roles within the family and relationships, very close entangled relationship between mother and daughter (enmeshment), conflict avoidance and over-protection of the anorexic person play an important part in production of the disease.

(3) Developmental causes: Bruch (1970) suggested that early experiences between the child and parents may give poor sense of identity, uncertainty about the relevance and meaning of internal body feelings and an overwhelming sense of ineffectiveness.

(4) Personality factors: low self-esteem and perfectionism characterize the personality of many patients suffering with anorexia.

(5) Conflict relating to sexual maturity: Some studies stressed the avoidance of mature adult sexuality though it is reported that some anorexic patients have been abused sexually. Sexual abuse is reported in 30% of anorexic patients.

(6) Hormonal changes are known to occur in Anorexia. The hypothalamus abnormality is responsible for the excess of serotonin and corticotrophin-releasing hormone.

(7) Genetic factors: Monozygotic twins are those coming from one and the same fertilized egg. Dizygotic twins are those from different eggs like any siblings. There is evidence that anorexia occurs more often in monozygotic twins more than in dizygotic twins. This indicates there is a genetic element in