Anorexia Nervosa as an Eating Disorder - Case Study Example

Running Head: EATING DISORDER Anorexia Nervosa Outline I Introduction II. Body A. Anorexia Nervosa Definition 2. Body Distortion 3. Causes B. Case Study 1. The Case 2. Mental Status Exam 3. DSM-IV Multiaxial Evaluation C. Treatment 1. Pharmacological Treatment 2. Generics and Trade Names 3. Side Effects II Summary A. Stress B. Relationship to Practice C. Summary Anorexia Nervosa Introduction The study of anorexia nervosa has revealed that it is far more than self starvation. The disorder involves primarily women with issues of body satisfaction being central to the manifestation of the illness. The case study of Kara provides insight into how the disease affects an individual. With the use of refocused energies, the individual can release some of the pressure that has placed them in a situation to control their eating. There are little recourses that involve medications that are affective in working with the disorder. However, some co-morbidity such as depression can be treated through drug therapies, helping to ease the instigating factors of the illness. Anorexia nervosa is a disorder that is born of culture and part of obsessive compulsive control issues that relieve stress in an individual’s life. Anorexia Nervosa Anorexia Nervosa, according to Hall and Ostroff (1999), is “self-starvation” (p. 17). This description, however, does not embrace the full extent of the complexity of this eating disorder. From the outside people who are diagnosed as anorexic can be described as “stubborn, vain, appearance-obsessed people who simply do not know when to stop dieting” (Hall & Ostroff, 1999, p. 17). The truth is much more complicated and far more tragic. Anorexia nervosa involves an obsession with controlling food intake. Anorexia is about control for the person who suffers from the disorder, their life consumed by their need to have some sort of order in what feels like chaos where they have no control. They may have a distorted view of their own body, identifying fat where there is no excess or possibly any fat to be seen. They will experience a series of problems from being malnourished. Anorexia will have co-morbidity with depression in 64%, 35% presenting with social phobias, and with 26% appearing with obsessive-compulsive disorders (Sadock, Kaplan, & Sadock, V. A., 2007). A person with anorexia may not appear to be suffering from the disorder as often they learn to hide their dysfunction with food. When the disorder becomes apparent to family and friends, the illness has come to a point where physical manifestations are past the point of return. Death can often come from the prolonged malnutrition that affects the organs and the proper function of the body. The illness can get to a point where nutrition can no longer be processed within the body. Karen Carpenter is not only famous for having been a part of popular music, but for having died from complications from anorexia nervosa. Most of those who suffer from Anorexia Nervosa suffer from body distortion disorders in which they cannot see themselves in the mirror without seeing themselves as fat. Body distortion manifests differently between different sufferers with some having a completely deluded view of themselves as they look in the mirror, others seeing a distorted image but knowing they are not fat, and still others not having a distorted image of their body at all (Lask & Frampton, 2011). This may be an extension of cultural importance as it is put on women. Ogden (2011) concluded that at least 55% of all women were dissatisfied with their weight with 57% dissatisfied with their waist size. More than 90% of all those who suffer from anorexia are women (Carlson, Eisenstat, & Ziporyn, 2004). There are a great many causes for the development of anorexia, but the family dynamics is often central to the reasons that a person seeks to control their food in an obsessive manner. Most individuals who develop the disorder seek to be perfect, their idea of perfection centered on the lowest possible weight. Often the parents are too involved in the individual’s life, creating pressures for the need to be perfect in balance with a feeling that the individual is not in control of their own path. In order to fulfill the need to be perfect and at the same time rebel against imposed pressures, the individual begins to control food. These families put a great deal of emphasis on looks and performance. Often the disorder is triggered by new circumstances where the environment is uncertain. Simple activities such as going to a sleep away camp or a new school will create an unknown in regard to how someone will feel about their appearance, triggering the need to obsess about food control (Alexander-Mott & Lumsden, 2008). Case Study A case study presented by Halloran & Lowenstein (2000) describes a 22 year old Caucasian woman who is 5’9” tall and weighs 89 pounds and presents with hypotension, malnutrition, and amenorrhea. Her physical symptoms were so severe that she was hospitalized for three weeks in order to regulate her nutrition and attend to her other problems. Kara was diagnosed with the disease at the age of 17 and was hospitalized when she was 18 for complications from weight loss. After having moved to campus to study in college during her 22nd year, she went from weighing 118 to 89 pounds, her weight at 118 already too low for her height. Her entry into the hospital occurred as she passed out during a hot shower and an ambulance was called to the scene. Kara does not discuss any leisure activities in her life, but only reports that she spends her time studying. Her only social interaction seems to be studying with classmates. She has spent her summers working at a camp for disabled children, keeping up correspondence with them as she has become close to several. Because of her control over eating, however, she is currently having difficulty concentrating and is fatigued often. She is having memory loss in that she cannot remember much from the classes that she is taking and fears that she will not be able to take the final exams. In giving the Mental Status Exam to Kara, the first observation is that she appears gaunt and thin, her physical problems deteriorating her energy. While she is coherent, her speech is slowed with her fatigue. Her mental state is worried, the tension creating further physical problems as she is in continued stress. Her intellectual capacity is high, even though she is having some short term memory problems. Kara is well aware of her surroundings, knowing where and where she is and having a grasp on reality. Her DSM-IV Multiaxial Evaluation, Axis 1-5 suggests that she fits Criteria A as her body weight is well below what is healthy. She fits B in that she seems to have a fear of gaining weight. She fits into Criteria C as she has a distorted view of the importance of her body weight. The final Criterion for the specific diagnosis is amenorrhea, which she has presented. The fifth axis, the global assessment, is not necessary if the first four criteria are fulfilled (Dziegielewski, 2010). Treatment Pharmacological treatments for anorexia nervosa include the use of an antidepressant, but no real drug therapies work in regard to the disorder (Plotnik, & Kouyoumjian, 2011). The best pharmacological treatment has been found through olanzapine, which can be found by the trade name Zyprexa, which helps to raise the BMI and to dampen obsessive tendencies. The drug is an atypical anti-psychotic. Common side effects may be “back pain; constipation; cough; diarrhea; dizziness; drowsiness; dry mouth; headache; increased appetite; lightheadedness; nausea; pain, redness, or swelling at the injection site; sore throat; stuffy nose; tiredness; vomiting; and weight gain” (Drugs.com, 2011). More severe side effects will include severe allergic reactions; abnormal thoughts; chest pain; confusion; decreased urination; disorientation; fainting; fast, slow, or irregular heartbeat; fever, chills, or persistent sore throat; increased sweating; memory loss; menstrual changes; muscle pain, weakness, or stiffness; new or worsening mental or mood changes; one-sided weakness; seizures; severe or prolonged drowsiness, dizziness, or headache; shortness of breath; suicidal thoughts or actions; swelling of the hands, legs, or feet; symptoms of high blood sugar; symptoms of high prolactin levels; tremor; trouble concentrating, speaking, or swallowing; trouble sitting still; trouble walking or standing; uncontrolled muscle movements; unusual bruising; vision changes; yellowing of the skin or eyes (Drugs.com, 2011). Treatment is best done with someone who specializes in obsessive compulsive disorders as they relate to eating disorders. The success rate is not high and often it is a matter of struggling with the issues through continued work in which there are some good times and some bad. Conclusion Stress is a primary cause of the disorder as it manifests. As shown in the example of Kara, her increased pressure from school provided the reason for which her illness worsened. Her lifestyle was centered on service to others as well as focus on her studies, a great deal of stress put on her through her own drives. In practice, it can be seen through the dynamic of the family which allows for a further need to understand how pressures from parents affect their children. Kara’s family made the decision for her that she would not be returning to campus and would live at home. While this is a wise medical decision, it might be part of the pressure that Kara experiences as her parents assert their decisions on her rather than letting her make her own decisions, even though they did allow her to go live on campus from the beginning. Understanding boundaries is an important concept in treatment and in practice this insight would be invaluable. The illness is one of the disorders that is from the obsessive compulsive forms of disorders, most often affecting women, and driven by a need to be perfect within the expectations of society. Resources Alexander-Mott, L. & Lumsden, D. B. (2008). Understanding eating disorders: Anorexia nervosa, bulimia nervosa, and obesity. New York: Taylor and Francis, Inc. Carlson, K. J., Eisenstat, S. A., & Ziporyn, T. D. (2004). The new Harvard guide to womens health. Cambridge, Mass: Harvard University Press. Drugs.com (2011). Olanzapine Side Effects. Drugs.com. Retrieved from http://ww w.drugs.com/sfx/olanzapine-side-effects.html Dziegielewski, S. F. (2010). DSM-IV-TR in action. Hoboken, N.J: John Wiley & Sons. Hall, L., & Ostroff, M. (1999). Anorexia nervosa: A guide to recovery. Carlsbad, Calif: Gürze Books. Halloran, P., & Lowenstein, N. A. (2000). Case studies through the healthcare continuum: A workbook for the occupational therapy student. Thorofare, N.J: SLACK. Lask, B., & Frampton, I. (2011). Eating disorders and the brain. Chichester, West Sussex: John Wiley Sons. Ogden, Jane. (2011). The Psychology of Eating: From Healthy to Disordered Behavior. New York: Wiley – Blackwell. Plotnik, R., & Kouyoumjian, H. (2011). Introduction to psychology. Belmont, CA: Wadsworth/Cengage Learning. Sadock, B. J., Kaplan, H. I., & Sadock, V. A. (2007). Kaplan & Sadocks synopsis of psychiatry: Behavioral sciences/clinical psychiatry. Philadelphia: Wolter Kluwer/Lippincott Williams & Wilkins. Swain, P. I. (2006). Anorexia nervosa and bulimia nervosa: New research. New York: Nova Science Publishers. Read More