Key Terms

Amenorrhea—Absence of menstrual periods.

o Anemia—Condition that results when there is a < deficiency of oxygen in the blood. Can cause fatigue and impair mental functions.

False-positive—A test result that is positive for a specific condition or disorder, but this result is inaccurate.

Lanugo—Downy hair, usually associated with infants, that sometimes develops on the face and back of people affected by anorexia nervosa.

Specialists in family therapy have demonstrated that dysfunctional family relationships and impaired family interaction can contribute to the development of AN. Mothers of persons with AN tend to be intrusive, perfectionistic, overprotective, and have a fear of separation. Fathers of AN-affected individuals are often described as passive, withdrawn, moody, emotionally constricted, obsessional, and ineffective. Sociocultural factors include the messages given by society and the culture about women's roles and the thinness ideal for women's bodies. Developmental causes can include adolescent "acting out" or fear of adulthood transition. In addition, there appears to be a genetic correlation since AN occurs more commonly in biological relatives of persons who have this disorder.

Precipitating factors are often related to the developmental transitions common in adolescence. The onset of menarche (first menstrual cycle) may be threatening in that it represents maturation or growing up. During this time in development, females gain weight as part of the developmental process, and this gain may cause a decrease in self-esteem. Development of AN could be a way that the adolescent retreats back to childhood so as not to be burdened by maturity and physical concerns. Autonomy and independence struggles during adolescence may be acted out by developing AN. Some adolescents may develop AN because of their ambivalence about adulthood or because of loneliness, isolation, and abandonment they feel.

Symptoms

Most of the physical symptoms associated with AN are secondary to starvation. The brain is affected— there is evidence to suggest alterations in brain size, neuro-transmitter balance, and hormonal secretion signals originating from the brain. Neurotransmitters are the chem icals in the brain that transmit messages from nerve cell to nerve cell. Hormonal secretion signals modulate sex organ activity. Thus, when these signals are not functioning properly, the sex organs are affected. Significant weight loss (and loss in body fat, in particular) inhibits the production of estrogen, which is necessary for menstruation. AN patients experience a loss of menstrual periods, known as amenorrhea. Additionally, other physiologic systems are affected by the starvation. AN patients often suffer from electrolyte (sodium and potassium ion) imbalance and blood cell abnormalities affecting both white and red blood cells. Heart function is also compromised and a person affected with AN may develop congestive heart failure (a chronic weakening of the heart due to work overload), slow heart rate (bradycar-dia), and abnormal rates and rhythms (arrhythmias). The gastrointestinal tract is also affected, and a person with AN usually exhibits diminished gastric motility (movement) and delayed gastric emptying. These abnormalities may cause symptoms of bloating and constipation. In addition, bone growth is affected by starvation, and over the long term, AN patients can develop osteoporosis, a bone loss disease.

Physically, people with AN can exhibit cold hands and feet, dry skin, hair loss, headaches, fainting, dizziness, and lethargy (loss of energy). Individuals with AN may also develop lanugo (a fine downy hair normally seen in infants) on the face or back. Psychologically, these people may have an inability to concentrate, due to the problems with cognitive functioning caused by starvation. Additionally, they may be irritable, depressed, and socially withdrawn, and they obsessively avoid food. People affected with AN may also suffer from lowered body temperature (hypothermia), and lowered blood pressure, heart rate, glucose and white blood cells (cells that help fight against infection). They may also have a loss of muscle mass.

In order to diagnose AN, a patient's symptoms must meet the symptom criteria established in the professional's handbook, the Diagnostic and Statistical Manual of Mental Disorders, also called the DSM. These symptoms include:

• Refusal to maintain normal body weight, resulting in a weight that is less than 85% of the expected weight.

• Even though the affected person is underweight, he or she has an intense fear of gaining weight.

• Distorted body image, obsession with body weight as key factor in self-evaluation, or denial of the seriousness of the low body weight.

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