Anorexia Nervosa and Force Feeding

- life threatening eating disorder often characterised by self-starvation or excessive weight

loss
- has two types, Binge Eating(Purging Type) and Restricting Type
Symptoms
• Inadequate food intake leading to a weight that is clearly too low.
• Intense fear of weight gain, obsession with weight and persistent behavior to prevent
weight gain.
• Self-esteem overly related to body image.
• Inability to appreciate the severity of the situation.
• Binge-Eating/Purging Type involves binge eating and/or purging behaviors during the
last three months.
• Restricting Type does not involve binge eating or purging.
Eating disorders experts have found that prompt intensive treatment significantly improves
the chances of recovery. Therefore, it is important to be aware of some of the warning
signs of anorexia nervosa.
Warning Signs
• Dramatic weight loss.
• Preoccupation with weight, food, calories, fat grams, and dieting.
• Refusal to eat certain foods, progressing to restrictions against whole categories of food
(e.g. no carbohydrates, etc.).
• Frequent comments about feeling “fat” or overweight despite weight loss.
• Anxiety about gaining weight or being “fat.”
• Denial of hunger.
• Development of food rituals (e.g. eating foods in certain orders, excessive chewing,
rearranging food on a plate).
• Consistent excuses to avoid mealtimes or situations involving food.
• Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury, the need
to “burn off” calories taken in.
• Withdrawal from usual friends and activities.
• In general, behaviors and attitudes indicating that weight loss, dieting, and control of food
are becoming primary concerns.
Health Consequences of Anorexia Nervosa
Anorexia nervosa involves self-starvation.; The body is denied the essential nutrients it
needs to function normally, so it is forced to slow down all of its processes to
conserve energy. This “slowing down” can have serious medical consequences:
• Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is
changing. The risk for heart failure rises as heart rate and blood pressure levels sink
lower and lower.
• Reduction of bone density (osteoporosis), which results in dry, brittle bones.
• Muscle loss and weakness.
• Severe dehydration, which can result in kidney failure.
• Fainting, fatigue, and overall weakness.
• Dry hair and skin, hair loss is common.
• Growth of a downy layer of hair called lanugo all over the body, including the face, in an
effort to keep the body warm.
About Anorexia Nervosa
• Approximately 90-95% of anorexia nervosa sufferers are girls and women.
• Between 0.5–1% of American women suffer from anorexia nervosa.
• Anorexia nervosa is one of the most common psychiatric diagnoses in young
women.
• Between 5-20% of individuals struggling with anorexia nervosa will die. The probabilities
of death increases within that range depending on the length of the condition.
• Anorexia nervosa has one of the highest death rates of any mental health condition.
• Anorexia nervosa typically appears in early to mid-adolescence.
Psychological Treatments
- mostly psychological treatments, sometimes nutrition management is used
- is force feeding a treatment?
• Behavioural therapy
• Cognitive analytic therapy
• Cognitive behavioural therapy
• Ego-oriented therapy-adolescent focused individual therapy (for children and
adolescents)
• Focal psychodynamic therapy
• Family interventions focused explicitly on eating disorders
• Maudsley family-based treatment (for children and adolescents)
• Interpersonal psychotherapy
• Specialist supportive clinical management
Is force feeding used and is it bad?
- Red Cross characterises force feeding as “concerning torture and other cruel, inhuman,
and degrading treatment”
- force feeding is used in Guantanamo Bay when the prison detainees go on a hunger
strike
- in 2006, UN authorised force feeding Vojislav Seselj (Serbian paramilitary leader
waiting for trial). In response to protests, the U. N. noted that the European court of
human rights had declared that force-feeding is not torture or inhuman if it is
medically necessary and “if the manner in which the detainee is force-fed is not
inhuman or degrading.”
- Advocates of force-feeding point out that medical tube feeding is an uncomfortable
process, but not a torturous one.
- In the past, people were force fed through cranking the mouth open(sometimes making
the gums bleed) and tying them to a “restraint chair”
- Currently the procedure used in Guantanamo Bay is through the naso-gastric tube
where it is inserted into the nose. This reduces the danger of damaging the mouth and
biting but may severely injure the nose as the nose is a delicate structure. But still,
restraint chairs are still used and if the person struggles, nosebleeds or damage to the
nose can still happen
- Lubricant is applied to the naso-gastric tube and pain-killers are given after the force feed
- Misplacement of the naso-gastric tube can lead to serious injuries like pneumonia(if
food gets into the lungs) or damage the windpipe etc…
- Force feeding is only done for people that has been starving for days
- “Refeeding syndrome” can happen and causes the body's insulin to be produced at a
very fast rate, snapping the glucose levels, IV drops are given to overcome this
- After force feeding, they will be put into a “dry room” to monitor them and those that
try to make themselves vomit will be tied to the restraint chair until the food digests
- Some people have involuntary vomitting as soon as the tube is pulled out after force
feeding
- There's no end date to when force feed will be stopped. An Indian woman (Irom
Sharmila) has been force fed for over a decade when she decided to go on a hunger
strike in protest of the Indian military killing 10 people at a bus stop
- Force feeding is a long, painful and humiliating process
- Debates usually revolve around the medical ethics of force feeding, medical ethics vs a
person's choice/dignity