Out Patient Care: Anorexia Nervosa

Incidences of Anorexia Nervosa have appeared to increase sharply in the USA, UK and western European countries since the beginning of the 60s (Gordon, 2001). The increasing prevalence of the disease has led the World Health Organisation to declare eating disorders a global priority area within adolescent mental health (Becker et al. 2011). Anorexia has in many ways become a modern epidemic (Gordon, 2000) and with a mortality rate of 10% per decade (Gorwood et al. 2003), the highest of any mental disorder (Bulik et al. 2006), it is an epidemic that social and biological scientists have been working tirelessly to understand.

Bulimia nervosa is an eating disorder with psychological, physiological, developmental, and cultural components. The disorder is commonly characterized by binge eating followed by inappropriate compensatory behaviors, such as self-induced vomiting, excessive exercise, fasting, and the misuse of diuretics, laxatives or enemas. Patients properly diagnosed with bulimia nervosa endure many psychological and physiological problems. In order to alleviate these problems for the patient, usually some type of intervention is required. Considering the financial costs to the patient who seeks treatment, it is important to

Anorexia nervosa, otherwise stated as anorexia, is an eating disorder that occurs when an individual restricts themselves from necessary energy intake which leads to significantly low body weight. Other characteristics of this disorder include: intense fear of becoming fat or gaining weight, persistent behavior that interferes with weight gain, and disturbances of perception and experience of their own body weight and shape (DSM V, 2013). Effective treatments are still trying to be researched for this disorder, as there is not a “one size fits all” for people of all age groups, living situations, etc. Since adolescents with anorexia are such a vulnerable population,

‘A psychiatric disorder characterized by an unrealistic fear of weight gain, self-starvation, and conspicuous distortion of body image. The individual is obsessed with becoming increasingly thinner and limits food intake to the point where health is compromised. The disorder may be fatal. The name comes from two Latin words that mean nervous inability to eat.’ Therefore due the physical and medical implications that anorexia nervosa presents, for an individual who experiences the condition, compulsory treatment is often deemed necessary. However this is often grounds for serious ethical debate between many, including medical professionals, those who experience anorexia nervosa and indeed social work practitioners. Thus the following essay will seek to explore the ethical issues that may pertain should the compulsory treatment of anorexia nervosa be utilised. By discussing the principles of ethical treatment, including the rights of the individual and also considering the benefits of allowing the individual to choose their course of treatment, view on the compulsory treatment of anorexia nervosa.

Anorexia Nervosa is usually psychological as well as possibly an eating disorder which is life-threatening well-defined by a tremendously low body weight comparative to stature, great and needless weight loss, fear of gaining weight and distorted discernment of an individual’s self-image and body. There are several clinical factors of this eating disorder, and they are the following: the victim has a tendency of fearing his normal body weight where in this case, a person fears to be fat. In other words, the fear of normal body weight is very common in this eating disorder which is observed as a pathognomonic of the situation. In the case of Joshua, his parents should understand that he fears to get fat such that he already feels that his body

Anorexia nervosa is an eating disorder that consists of self-regulated food restriction in which the person strives for thinness and also involves distortion of the way the person sees his or her own body. An anorexic person weighs less than 85% of their ideal body weight. The prevalence of eating disorders is between .5-1% of women aged 15-40 and about 1/20 of this number occurs in men. Anorexia affects all aspects of an affected person's life including emotional health, physical health, and relationships with others (Shekter-Wolfson et al 5-6). A study completed in 1996 showed that anorexics also tend to possess traits that are obsessive in nature and carry heavy emotional

Paulson-Karlsson, G., & Nevonen, L. (2012). Anorexia nervosa: treatment expectations – a qualitative study. Journal of Multidisciplinary Healthcare, 5, 169–177.

The first article (Goldstein, et al, 2016) aimed to expand the credibility of family-based treatment for anorexia nervosa in a private practice setting. Thirty-four females and three males with either full or partial anorexia nervosa were assessed pre-treatment and post-treatment. The average number of therapy sessions was about fourteen over the duration of a year, with a treatment dropout rate of 27.8%.

The average age was 16.6 years. All women had a diagnosis of Anorexia Nervosa as indicated by DSM-IV and never received FT prior to the study. Patients and family were informed of the study when admitted to impatient care. Unfortunately, the sample size is quite small and there is a gender bias. This study only generalizes its results to females in their teens and early twenties who are hospitalized in inpatient care. Randomization does not occur in the sample selection.

32). By comparing people struggling with anorexia to a group of patients with psychiatric disorders, Zonnevylle-Bender et al. was able to determine that decreased emotional functioning is found not only in patients with anorexia nervosa but many people struggling with a general psychiatric disorder. “Emotional Functioning in Adolescent Anorexia Patients” is directed towards psychiatrists, psychologists, and other professions that play a main role in treating anorexia nervosa patients. By directing this study toward mental health specialists, Zonnevylle-Bender et al. is providing information that can increase the quality of care that is administered to those struggling with eating disorders. Zonnevylle-Bender and her colleagues are reliable because they all have Ph.D.’s in a variety of health science categories. Specifically, Zonnevylle-Bender works at the Rudolph Magnus Institute of Neuroscience and specialize in psychiatry. Overall, Zonnevylle-Bender and his coauthors write in a scientific tone, providing numerous definitions and in-depth data into emotional functioning and how it is

Similar to the form of group therapy in the previous case study, the use of family therapy is a common treatment for coping with an eating disorder. In a controlled study on the effects of family therapy as a source of treatment for adolescents with anorexia nervosa, an observational study was conducted comparing two forms of family therapy. In addition to observing the patients in treatment they also examined the five-year follow-up of 40 patients who utilized conjoined group family therapy and separate family therapy (Eisler, Simic, Russell and Dare. 2007). The study included interviewing 40 patients who received either separate or conjoint family therapy. In addition to the interviews with the families, all participants also took part in 6-question surveys. The data collected measured the relationship between symptomatic outcome and psychosocial

Fairborn (2005) points out that there is a range of treatment options and a variety of treatment settings for anorexia nervosa, however there is inadequate empirical support for this abundance of options as what minimal research on the treatment has been inconclusive. One reasoning behind this is that anorexia nervosa has been an uncommon disorder and sample sizes for studies have been low. Furthermore, the lack of evidence based treatment research can be attributed to the individual’s avoidance of treatment and dropping out of treatment. Many individuals with anorexia nervosa are unwilling to change as their identity and self-worth are intertwined with their distorted body image; they tend to deny that anything is wrong with their weight and are ambivalent on changing (Abbate-Daga, Amianto, Delsedime, De-Bacco & Fassino,

Self-esteem is reliant upon body shape and weight. Physical implications may include disruption of the menstrual cycle also known as amenorrhea, signs of starvation, thinning of hair or hair loss, bloated, yellowish palms/soles of feet, dry and pasty skin. The risks that people take while indulging in anorexia can also become physiologically and mentally damaging. There are several effective treatments. One of which is hospitalization, this occurs when the weight loss is greater than 30% in 3 months time. Some other effects to be taken into consideration when hospitalizing a patient are the risk of suicide and depression, severe binging and purging, and serious metabolic disturbance. Therapy and counseling is used to help the patients with depression and family complications that may have led to the state they’re in. Clinical studies have not yet identified a medication that could improve the core symptoms of anorexia.

People suffering from eating disorders cannot solely help themselves. Although they may be able to stop for a short time, in the long run they will be back in the same path of self-destruction. Kirkpatrick & Caldwell (2001) state, "Because eating disorders are a complicated mix of physical and psychological abnormalities, successful treatment always includes treatment of psychological issues as well as restoration of a healthy diet" (p. 131). Trained therapists should treat eating disorders. The severity of the disorders will determine the need for outpatient therapy or an in-hospital program (Matthews, 2001, p. 178). There are many goals of therapy but the return to normalcy is the main goal. The eating disorder sufferer needs to restore and maintain a normal weight as well as develop normal eating and exercise routines. Kirkpatrick and Caldwell (2001) state,

Anorexia nervosa is listed in DSM-5 as a Feeding and Eating Disorder alongside bulimia nervosa and binge-eating disorder (American Psychiatric Association [APA], 2013). AN is characterised by symptoms that include dangerously low body weight, intense fear of fat or weight gain, abnormal cognitions that lead to an over-evaluation of the importance of body weight, shape and size, indifference about the disorders seriousness (APA, 2013). It is a multi-determined psychiatric disorder with an interplay between sociocultural, biological, physical and mental factors that make it extremely difficult to treat successfully (Chang & Bazarova, 2016; Boraska et al., 2014). AN affects approximately 3.7% of NZ population, the average duration is five years, with the highest prevalent rate (10%) in teenage females (M = 17 years). While predominantly a young white middle-upper class female disorder, recent research shows a significant increase in diagnosis of males,