 anorexia nervosain adolescent
• Anorexia nervosa (AN), a form of self-starvation, is an
eating disorder characterized by low body weight, a
distorted body image, amenorrhea (absence of at
least three consecutive menstrual cycles when
otherwise expected to occur in women), and an
intense fear of gaining weight. Anorexia nervosa is
sometimes referred to as anorexia.
• Anorexia nervosa (AN) is a psychiatric disorder with
severe physiologic consequences, characterized by
the inability or refusal to maintain a minimally
normal weight. Patients have a profoundly disturbed
body image as well as an intense fear of weight gain
despite being moderately to severely underweight.
Causes of anorexia nervosa
• Anorexia nervosa has often been seen as an
escape from the emotional problems of
adolescence and a regression into childhood.
Perfectionism and low self-esteem are common
antecedents. Survivors of childhood sexual abuse
are at risk of developing an eating disorder, usually
anorexia nervosa, in adolescence.
• Anorexia nervosa occurs most often in girls,
usually at puberty or during adolescent between
13-20 years of age
• The disorder may be manifested as severe
weight restriction controlling by limited food intake,
be excessive exercise or by binge eating or
purging.
Biological causes
• anorexia may run in families. If a girl has a
sibling with anorexia, she is 10 to 20 times more
likely than the general population to develop
anorexia herself. People with anorexia tend to
have high levels of cortisol, the brain hormone
most related to stress, and decreased levels of
serotonin and norepinephrine, which are
associated with feelings of well-being.
Psychological causes
• Low self-esteem
• Feelings of ineffectiveness
• Poor body image
• Depression
• Difficulty expressing feelings
• Rigid thinking patterns
• Need for control
• Perfectionism
• Physical or sexual abuse
• Avoidance of conflict with others
• Need to feel special or
Unique
Family and social pressures causes
• participation in an activity that demands
slenderness, such as ballet, gymnastics, or
modeling. It also includes having parents who are
overly controlling, put a lot of emphasis on looks,
diet themselves, or criticize their children’s bodies
and appearance. Stressful life eventssuch as the
onset of puberty, a breakup, or going away to
school can also trigger anorexia.
Cultural causes
• Being extremely thin is the standard of beauty
for women and represents success, happiness, and
self-control. Women are bombarded with messages
from the media that they must diet to meet this
standard. This conflict leaves most women very
dissatisfied with their body weight and shape.
• more frequent in white populations than in
people of other races
• Other causes
• Delayed psychosexual development
• Almost starved appearance
• Girls do not appear as sexually developed or as
old as their chronologic age
Risk factor
• Being female. Anorexia is more common in
girls and women.
• A young age. Anorexia is more common
among teenagers. Teenagers may be more
susceptible because of all of the changes their
bodies go through during puberty. They also may
face increased peer pressure and may be more
sensitive to criticism or even casual comments
about weight or body shape.
• Weight changes. When people lose or gain
weight on purpose or unintentionally those
changes may be reinforced by positive comments
from others if weight was lost, or by negative
comments if there was a weight gain.
• Transitions. Whether it's a new school, home
or job, a relationship breakup, or the death or
illness of a loved one, change can bring emotional
distress and increase the riskof anorexia nervosa.
• Sports, work and artistic
activities. Athletes, actors and television
personalities, dancers, and models are at higher
risk of anorexia.
• Media and society. The media, such as
television and fashion magazines, frequently
feature a parade of skinny models and actors. But
 whether the media merely reflect social values or
actually drive them isn't
clear-cut. In any case, these images may seem
to equate thinness with success and popularity.
pathophysiology
 Anorexia nervosa is the result of a complex
interplay between biological, psychological, and
social factors, which tend to affect women more
than men, and adolescents more than older
women.
 The onset of the disorder during puberty has
led to the theory that, by exerting control over food
intake and body weight, adolescents are
attempting to compensate for a lack of autonomy
and selfhood. Individuals with anorexia nervosa
maintain a lifelong increased incidence
of anxiety, depressive disorders, andobsessive-
compulsive disorder.
• The patient's altered body image results in a
perception of fatness despite being normal or
underweight. Attempts to correct this flaw through
food restriction or purging lead to progressive
malnutrition and eventually starvation.
• Neuroendocrine disturbances result in delayed
puberty, amenorrhea, anovulation, low estrogen
states, increased growth hormone, decreased
antidiuretic hormone, hypercarotenemia, and
hypothermia.10 Decreased gonadotropin levels and
hypogonadism may occur among males who are
affected.
Signs and symptoms
• Loss of menstrual periods
• Lack of energy and weakness
• Feeling cold all the time
• Dry, yellowish skin
• Constipation and abdominal pain
• Restlessness and insomnia
• Dizziness, fainting, and headaches
• Growth of fine hair all over the body and face
• Dieting despite being thin
• Obsession with calories, fat grams, and
nutrition
• Preoccupation with food – Eats very little
• Feeling fat, despite being underweight
• Fixation on body image – Obsessed with
weight, body shape, or clothing size
• Harshly critical of appearance – Spends a lot of
time in front of the mirror checking for flaws.
• Denies being too thin
• Using diet pills, laxatives, or diuretics
• Throwing up after eating
• Compulsive exercising
nursing management
• A team approach to care ”combining medical
management, nutritional counseling, and
individual, group, or family psychotherapy or
behavior modification therapy” is the best
approach. Treatment is difficult, and results may
be discouraging
• Nutritional therapy- a nutritionist or dietician
teaches the patient about healthy eating, proper
nutrition, and balanced meals.
• Counseling and therapy- Its goals are to
identify the negative thoughts and feelings about
weight and the self that are behind the anorexic
behaviors, and to replace them with healthier and
less distorted attitudes. Teach how to deal with
difficult emotions, relationship problems, and
stress in a productive, rather than a self-
destructive, way.
• Reestablish adequate/appropriate nutritional
intake.
• Correct fluid and electrolyte imbalance.
• Assist client to develop realistic body
image/improve self-esteem.
• Coordinate total treatment program with other
disciplines.
• Provide information about disease, prognosis,
and treatment.
medication
• Antidepressant
• Antipsychotic Drugs
 The most common form of this drug
which is administered to AN patients is
chlorpromazine. If prescribed, it is usually given to
severely obsessive-compulsive, anxious, and
agitated AN patients.
• “A therapist must win the cooperation of the
patient by emphasizing that treatment can free the
patient from the obsessive thoughts about food
and body weight that have become the sole focus
of the patient's life.”
• 2000-3000 kilocalories- normal
• Weight every morning
• .5 to 2 pounds every week