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Anorexia Nervosa

Anorexia Nervosa

Description

Anorexia nervosa is an emotional disorder characterized by an abnormal preoccupation with, and fear of, being fat. Primarily found in adolescent females (it is extremely rare in males and adult women), anorexia nervosa can create serious social, emotional, educational and physical complications during a critical period of adolescent development. With the increased withdrawal from eating, the cycle of dietary habits may become self-perpetuating and detrimental, due to the body's change in metabolism.

Although a somewhat rare disease, death by malnutrition, dehydration (commonly caused by the abuse of laxatives), or suicide (commonly caused by severe depression) can cause the mortality rate to be as high as 30%.

The onset of anorexia nervosa may be sudden, set off by socially traumatic precipitating factors. When diagnosed, this disease is best treated in a hospital, especially if death by starvation is likely. Individuals with anorexia nervosa usually must be kept under the strict supervision of professionals, where psychotherapy and/or behavior modification can be attempted.

Appetite-stimulating drugs or appetizers may be used in conjunction with the above treatments. While foods, such as aperitifs are believed to stimulate the appetite in simple anorexia, they are not usually helpful in the treatment of anorexia nervosa.

Causes

Primary Factors
The primary cause of anorexia nervosa is unknown.

Predisposing factors
Anorexia nervosa is probably caused by multiple interactions of general disorders in the following areas:

HeredityPhysiology
CultureEducation
NutritionChildhood experiences



Specific theories include:

Fear of becoming an adult woman. The individual rejects her sexuality and is terrified of pregnancy. She suffers from Emotional Amenorrhea, which satisfies her desire to remain a child.

Fear of becoming fat, inspired by a preoccupation with food. The patient may use the refusal to eat as a tool in manipulating parents. This health condition may result from defiance of parental dominance.

The individual desires to regain control of his or her life after a predisposing factor such as:

Moving away from home
Onset of puberty
Severe depression
Loss of self-esteem
Loss of self-confidence
Death of a relative or close friend
Guilt due to an early sexual experience
An undefined disturbance in the hypothalamus

Signs & Symptoms

Typical characteristics of the anorexia nervosa patient are:

Young woman

Child of industrious middle or upper-middle income parents who have high performance standards
Model daughter
Perfectionist
Obedient child
One who is eager to please
One who exhibits an unusual need to be in control of his or her life

Typical symptoms are:

Amenorrhea, often the first symptom
Periods of overactivity
Obsessive exercise in order to lose weight
Voluntary restriction or refusal of food
Spending inordinate amounts of time shopping for food, collecting recipes, preparing meals for others, and calorie counting
Becoming secretive about eating habits
Self-induced vomiting, bulimia: some experts consider bulimia and anorexia nervosa as distinct disorders; others consider bulimia as a variant of anorexia nervosa
Abuse of diuretics and/or laxatives
Withdrawal from friends, school activities, and/or family
Denial of being hungry or ill
Marked weight loss
Non-induced vomiting
Skin becomes dry, scaly, and dirty looking
Skin appears covered with excessive hair although scalp hair may begin to thin
Complaints of being cold and/or constipated
Lowered blood pressure
Lowered respiratory rate
Severe depressive illness
Bones are visible through skin
Yellowing of skin due to carotenemia
Enlarged parotid glands
Edema due to inability of extracellular fluid volume to decrease proportionately with body mass
Anemia
Hypokalemia
Hypoalbuminemia endocrine abnormalities
Leukopenia

Nutritional Supplements

Structure & Function:
        Nutrients for Brain Support &
        Multi Vitamin/Multi Mineral Formulas


---------------------------------
General Supplements
---------------------------------


Zinc*        

Rebuilding a sound nutrient base is, of course, imperative.

* Please refer to the respective topic for specific nutrient amounts.

Note: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.

Dietary Considerations

The nutritional management of a individual suffering from anorexia nervosa frequently takes a team approach in a hospital setting. A psychotherapist can assist the attending physician and dietician in alleviating the individual's fears of food and eating, using the Dietary Goals Diet.

No generalization can be made about the nutritional deficiencies of these individuals. With 96% of patients in one study, no particular dietary technique had been employed. Some ate high quality meals, but at irregular intervals; others ate nutritionally inadequate meals at regular intervals. Some would eat huge amounts of food, and then purge themselves by forced vomiting or taking laxatives. Others would simply fast.

Nutritional therapy must be individualized, with an aim of promoting weight gain and restoring chemical balancing. A diet high in calories should be administered in small and frequent meals. If there is a psychological difficulty in accepting food, it can be offered as high calorie, balanced liquid feedings. In extreme cases of food aversion, it may be necessary to administer nutrients intravenously.

Homeopathic Remedy

1.* Hydrastis canadensis - 15 to 30C
2.* Cinchona officinalis tinct. - 15C
3.* Cina artemisia - 3X to 15C
4.* Nux vomica - 30 to 30C or higher

Advanced , by symptom:

1. Hydrastis canadensis- relieves the imaciations, helps mental condition.
2. Cinchona officinalis tinct.- helps mental and gastrointestinal.
3. Cina artemisia- helps mental aberration and especially digestive abnormalities (nausea, vomiting, pain, hunger)



Treatment Schedule

Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.

Legend

X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency

Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.

References

Boericke, D.E., 1988. Homeopathic Materia Medica.

Coulter, C.R., 1986. Portraits of Homeopathic Medicines.

Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.

Koehler, G., 1989. Handbook of Homeopathy.

Shingale, J.N., 1992. Bedside Prescriber.

Smith, Trevor, 1989. Homeopathic Medicine.

Ullman, Dana, 1991. The One Minute (or so) Healer.

Herbal Approaches

----------
Herbs
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Ginseng
Milk thistle
Valerian root

Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.

Discussion:

Since herbs are calorie free, they should not meet with great resistance. Ginseng, for example, can boost energy, in the short term and also stimulate appetite.

Milk thistle not only cleanses but rebuilds the liver.

Valerian root can be calmative.

Aromatherapy - Essential Oils

Coriander Essence,Marjoram Essence,
Melissa Essence,Rose Essence,
Thyme Essence.


Related Health Conditions

AmenorrheaHypoalbuminemia
AnemiaHypokalemia
BulimiaLeukopenia
ConstipationMenstruation
DepressionVomiting
Edema



Abstracts

References

Alpers, D.H., R.E. Clouse, & W.F. Stenson. 1983. Manual of Nutritional Therapeutics. Little, Brown, and Company, Boston. 457 pp.

Anonymous: Anorexia Nervosa, Vegetarianism and Zinc. Supply, Absorption are Reduced. Nutrition and the MD, June 1993;3.

Anonymous: Psychiatric Symptoms May Signal Brain Damage From Diet Pills. Drug Benefit Trends 1997,9(10):40.

Bakan, R. et al: Dietary Zinc Intake of Vegetarian and Nonvegetarian Patients With Anorexia Nervosa. International Journal of Eating Disorders, 1993;13(2):229-233.

Ballentine, R. 1978. Diet And Nutrition. The Himalayan International Institute Pub., Honesdale, Pennsylvania. 634 pp

Birmingham CL et al., Anorexia nervosa: refeeding and hypophosphatemia. Int J Eat Disord, 1996 Sep, 20:2, 211-3.

Bland, Jeffrey. Medical Applications of Clinical Nutrition. New Canaan, Conn.: Keats, 1983.

Brambilla F et al., Combined cognitive-behavioral, psychopharmacological and nutritional therapy in eating disorders. 1. Anorexia nervosa--restricted type. Neuropsychobiology, 1995, 32:2, 59-63.

Carmichael KA & Carmichael DH Bone metabolism and osteopenia in eating disorders. Medicine (Baltimore), 1995 Sep, 74:5, 254-67.

Eagles, J.A. & M.N. Randall. 1980. Handbook of Normal and Therapeutic Nutrition. Raven Press, New York. 323 pp.

Eckert ED et al., Ten-year follow-up of anorexia nervosa: clinical course and outcome. Psychol Med, 1995 Jan, 25:1, 143-56.

Forbes, G.B., R.E. Kreipe, et al. 1984. Body changes during recovery from anorexia nervosa: comparison of two dietary regimes. Am J Of Clinical Nutrition, 40.

Huse, D.M. & A. R. Lucas. 1984. Dietary patterns of anorexia nervosa. The American Journal Of Clinical Nutrition. vol. 40.

Kopp W et al., Low leptin levels predict amenorrhea in underweight and eating disordered females [see comments]. Mol Psychiatry, 1997 Jul, 2:4, 335-40.

Kunz, J. R. M. 1982. The American Medical Association Family Medical Guide. Random House Pub, New York. 832 pp.

Lask, B. et al: Zinc Deficiency and Child-Onset Anorexia Nervosa. Journal of Clinical Psychiatry February 1993;54:2:63-66.

Milosevic A et al., Dental erosion, oral hygiene, and nutrition in eating disorders. Int J Eat Disord, 1997 Mar, 21:2, 195-9.

Moukaddem M et al., Increase in diet-induced thermogenesis at the start of refeeding in severely malnourished anorexia nervosa patients. Am J Clin Nutr, 1997 Jul, 66:1, 133-40.

Murciano-D et al: Diaphragmatic function in severely malnourished patients with anorexia nervosa. Effects of renutrition. Am-J-Respir-Crit-Care-Med. 1994 Dec; 150(6 Pt 1): 1569-74.

Petersdorf, R. G. & R. D. Adams. 1983. Harrison's Principles Of Internal Medicine. 10th ed. McGraw Hill Pub Co., New York. 2212 pp.

Position of The American Dietetic Association: nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and binge eating. J-Am-Diet-Assoc. 1994 Aug; 94(8): 902-7.

Pryor T & Wiederman MW: Use of the MMPI-2 in the outpatient assessment of women with Anorexia Nervosa or Bulimia Nervosa. J Pers Assess, 66(2):363-73 1996 Apr.

Rigaud D et al., Refeeding improves muscle performance without normalization of muscle mass and oxygen consumption in anorexia nervosa patients. Am J Clin Nutr, 1997 Jun, 65:6, 1845-51.

Rock-CL & Curran-Celentano-J.: Nutritional disorder of anorexia nervosa: a review. Int-J-Eat-Disord. 1994 Mar; 15(2): 187-203.

Schmidt U et al., Is there a specific trauma precipitating anorexia nervosa? Psychol Med, 27(3):523-30 1997 May.

Stoner SA et al., Food preferences and desire to eat in anorexia and bulimia nervosa. Int J Eat Disord, 1996 Jan, 19:1, 13-22.

Subak-Sharpe, G. J. 1984. The Physician's Manual For Patients. Times Books Pub, New York. 607 pp.

van der Ster Wallin G et al., Food selection in anorectics and bulimics: food items, nutrient content and nutrient density. J Am Coll Nutr, 1995 Jun, 14:3, 271-7.

Whisenant SL & Smith BA: Eating disorders: current nutrition therapy and perceived needs in dietetics education and research. J Am Diet Assoc, 1995 Oct, 95:10, 1109-12.

 


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