Support Groups

Eating Disorder support groups exist primarily to offer people a space to share personal experiences and to promote listening and relating to the experiences of others in the group.  They also provide a space for education and advocacy about Eating Disorders.  There are two types of support groups: self help and professionally operated.  Self help support groups consist of members who are the organizers of the group.  Professionally operated support groups are facilitated by a professional (psychologist, social worker, therapist).  Within these two types a support group can also be closed or open.  A closed support group means there are specific criterion for participation and not everyone is allowed to participate in the group.  Open support groups are available for anyone to participate in.  One resource that I found for finding Eating Disorder support groups is an organization called the Emily Program.  They are located in Seattle and in addition to offering in patient treatment they also facilitate a variety of support groups.  There is one group for adolescents that meets three days a week  to discuss topics like identity expression and cultural influences on body image.  They also work on developing skills to look at disordered eating and explore its affect on relationships.  They also provide a group to introduce people to treatment where they create a space for discussion of the treatment and recovery process.  They offer other groups as well that support people in all walks of their anorexia diagnosis.  For a complete list and explanation of the groups click here.  The Emily program also offers family and friends support groups.  One of the unique things about these groups is that they are lead by trained parent facilitators.  The facilitator is trained and knowledgable but also able to relate to what the people in the group are going through.

attend_support_group [online image]. (n.d).  Retrieved from http://www.annegiles.com/wp-content/uploads/2015/02/attend_support_group.jpg 

Apps

The majority of Apps related to anorexia are marketed more towards people recovering from anorexia.  There are apps to help track eating habits and increase caloric intake.  There are also apps designed to help battle mental illness.  One app I found was aimed more towards educating about anorexia was called Anorexia Study.  It has information about Anorexia, body image, and mental disorders all of which are helpful to understand when treating a patient with anorexia.  The app also has pictures aid in the understanding of the material.

Anorexia Study on the App Store  [online image].  (2010).  Retrieved November 5 2015 from http://a2.mzstatic.com/us/r30/Purple/v4/c3/71/91/c37191e5-07b3-f491-2e69-0b33a20321d0/screen320x480.jpeg

Nursing Care

Nursing care for individuals with anorexia at first requires a lot monitoring of the patient.  Nurses are responsible for monitoring nutritional status.  In an inpatient setting this involves constant observation of patients especially before and after meal times.  Nurses look for unhealthy behaviors like excessive exercise before or after eating, and vomiting or abusing laxatives after eating.  If the patient is receiving treatment in an outpatient setting the role of the nurse becomes more of an educator.  The nurse is then responsible for teaching parents to monitor their child's behaviors.   Nurses can also contribute positively to treatment by building non judgmental trusting relationships with patients.  These relationships can be effective in facilitating discussion with the patient about eating patterns and giving the patient space to voice concerns.

An article called Effective Nursing Care for Adolescents Diagnosed with Anorexia Nervosa: the Patient's Perspective provides a unique understanding of these nursing intervention and how the patients perceive them as effective in the treatment process.  The article looks at an inpatient facility and breaks treatment there into 3 phases.  The nursing interventions in the first phase are focused on monitoring and teaching the patient.  In this phase the nurse is very involved in the patients decisions and eating behaviors, dictating when the patient will eat, what the patient will eat, and how much the patient will eat.  In retrospect patients viewed these behaviors as helpful as they recognized that at that part of their lives they simply did not know how to eat anymore.  The nurses constant presence forced them to follow guidelines to build healthier eating behaviors.  The second phase of treatment involved the nurses giving more space to patients in order for them to begin to make healthy choices for themselves.  The nurses were then involved in evaluating the patients decisions and helping them make better choices or encouraging them in the good choices they were making.  During this phase the patients also saw the nurse as a role model for eating behaviors, This also served as a positive factor in treatment.  The third phase involved the nurse facilitating reintegration into normal life.  To accomplish this the nurses helped patients practice managing difficult life situations.  During this phase the patients recognized that one of the factors that helped them rebuild self esteem was the trust the nurses placed in them.

van Ommen, J., Meerwijk, E. L., Kars, M., van Elburg, A., & van Meijel, B. (2009). Effective nursing care of adolescents diagnosed with anorexia nervosa: The patients' perspective. Journal Of Clinical Nursing, 18(20), 2801-2808. doi:10.1111/j.1365-2702.2009.02821.x

The main focus of dietary treatment for anorexia is not centered around eating specific foods but rather developing a more healthy relationship with food in general.  Nutritional therapy is an aspect of treatment that focuses on a person's thoughts and feelings about food.   Nutritional therapy works to overcome unhealthy thoughts and behavioral patterns related to food in addition to encouraging positive thoughts and behaviors.  Nutritional therapy focuses on a variety of food related topics.  It includes education about carbohydrates, proteins, and fats and how much your body needs of each of these nutrients.  It seeks to understand the factors that contributed to a person's unhealthy relationship with food in order to work through these problems.  It helps people develop a meal plan in order to get the nutrients they need to recover physically from the damage anorexia has done to their body.  It also helps educate about portion control and how to eat a balanced diet.

The actual nutritional component to treatment includes gradually increasing caloric intake back to a healthy level.  Generally patients will start with a 1,200 calorie diet and increase the amount of calories eaten by 200 every other day.  Starting small and gradually increasing caloric intake reduces a patients risk of suffering from referring syndrome.

Tips to Stop Restricting [online image]. (n.d.) Retrieved from http://24.media.tumblr.com/tumblr_lx93qoAQb11r3trhwo1_r1_500.jpg

Treatment

Treatment for Anorexia is a team effort.  It involves doctors, specialist nurses, psychologists, and dietitians.  The two key elements of treatment are therapy and safe weight gain.  There are many different types of therapies that are based on different theories of what causes anorexia.  The Cognitive Analytic Therapy (CAT) is rooted in the belief that anorexia is caused by unhealthy patterns that were developed in a persons past.  This type of therapy focuses on recalling past events that may have contributed to the development of unhealthy patterns, recognizing how those unhealthy patterns contributed to developing anorexia, and finding strategies to break free from these patterns.  Another type of the ray is Cognitive Behavioral Therapy.  This therapy seeks to undo the kind of cyclical thinking that says how we think about a situation determines how we act, and that how we act in turn affects how we think and feel.  CBT attempts to show how anorexia is related to unrealistic thoughts and beliefs and then encourages patients to substitute old thinking patterns for healthier thought processes.  Interpersonal Therapy is grounded in the idea that mental health is strongly related to our relationships with other people.  IPT seeks to resolve interpersonal relationships in order to deal with anorexia. Another therapy more common in teens is family interventions which seek to involve the whole family in the healing process.

Gaining weight is also necessary for treating anorexia.  It is recommended that people recovering from anorexia gain about 1 pound per week.  There can be complications associated with returning to healthier eating patters.  One of these complications is called "re-feeding syndrome." This occurs when a patient starts eating aging and the body starts secreting more insulin which causes the synthesis of glycogen, fat, and protein, which requires phosphate.  Phosphate stores, however, have been depleted during starvation.  This lack of p;phosphate leads to muscle weakness, confusion, delirium, convulsions, and cardiac failure.  One study showed that this occurred in about 27.5% of patients.

For more information about treatment click here.

 Anorexia nervosa - Treatment . (n.d.). Retrieved October 19, 2015. 

Symptoms

Anorexia is characterized by an unhealthy relationship with food and gaining weight.  Early symptoms of the disease reflect this relationship and include more psychological factors that can be difficult for friends and family to detect at first.  These symptoms include a strong fear of gaining weight, a driven desire to be thin, a distorted self perception characterized by low self esteem, and a preoccupation with food.  These symptoms contribute to the physical symptoms of low body weight, thin hair that breaks or falls out, lack of menstruation, fatigue, and dry or yellowish skin   As an anorexic person continues to starve his or her body of the nutrients it needs more serious complications develop.  The heart begins to lose muscle mass, the walls of the heart thin out and the chambers enlarge.  This causes a lower heart rate and blood pressure.  This means that not as much blood is being pumped out to the body’s other organs.  This can contribute to failure of the body’s organs.  Additionally the heart may also have an irregular rhythm, or a mitral valve prolapse (which means that the valve between the two left chambers doesn’t close completely.  Anorexia damages the heart during disease progression but many of these heart problems can persist even after a person receives treatment.  A person may still suffer from heart failure years after a successful recovery from Anorexia.  For more information on Anorexia’s effect on the heart click here.

Anorexia Diagram [online image]. Retrieved October 8 from http://ygraph.com/graphs/anorexiadiagram-20120605T004542-t8uynbc.jpeg

Bunch, T. Jared. (2015).  Anorexia's Hidden Toll: The Heart Fails.  Retrieved from http://www.everydayhealth.com/columns/jared-bunch-rhythm-of-life/for-both-men-and-women-anorexia-nervosa-is-increasing-and-the-effects-on-the-heart-can-be-severe/

Diagnosis Process

Anorexia is a difficult disease to diagnose because it can be very challenging to admit that you or someone you love suffers from it.  An article called Adolescents with a diagnosisof anorexia nervosa: Parents’experience of recognition anddeciding to seek help describes the experiences of parents as they went through the diagnosis process with their child.  The article describes themes that are common to the diagnosis process.  The first theme is normalization of the illness, where the parent attributes weight changes and altered eating patterns to the normal developmental process.  Sometimes they even see these changes as good or beneficial for their child.  After normalization there is a period of ambivalence or ambiguity where the parent is beginning to realize that their child's eating and weight loss patterns are not healthy but they are not sure what to do about it and don't necessarily realize or are afraid to admit the seriousness of what their child is going through.  Next there is the decision point for seeking help.

After the individual or family decides to seek professional help there are tests done to confirm the diagnosis.  Physical exams involve checking height, weight, and vitals. Lab tests are done to check blood counts and organ function.  Other tests may be done to determine bone density and heart function.  Psychological examinations are also completed to understand the patients thoughts and feelings better especially in relation to their eating habits and beliefs about food.  Part of what makes Anorexia so dangerous is the way it is so easily normalized and can go unnoticed for a long period of time.  Much of the responsibility for diagnosis rests on the family and the family's ability to admit that there is a problem.    

  

Thomson, S., Marriott, M., Telford, K., Law, H., McLaughlin, J., & Sayal, K. (2014). Adolescents with a diagnosis of anorexia nervosa: Parents’ experience of recognition and deciding to seek help. Clinical Child Psychology & Psychiatry, 19(1), 43-57. doi:10.1177/1359104512465741

tumblr_mhtopnALve1rxcmmyo1_400.jpg [online image].  Retrieved October 2 2015 from http://slow-and-graceful.tumblr.com/post/42461781576

Anorexia Etiology and Disease Progression

The exact cause of Anorexia is unknown but it is probably rooted in a variety of factors.  Western culture has a huge influence on the way people perceive beauty and thinness.  Since anorexia is more common in Western countries it is likely that the self esteem issues and the distorted views of beauty that Western culture promotes are probably factors.  Another suspected cause of Anorexia are certain personality traits.  People who have more perfectionist and obsessive compulsive tendencies are more at risk for developing anorexia.  Additionally people who experience high levels of anxiety are more at risk for using anorexia as a coping mechanism.

Anorexia can go unnoticed at first.  Eventually it leads to significant weight loss which can cause a variety of health problems.  The weight loss caused by unhealthy eating patterns and excessive exercise can lead to decreased blood pressure and heart rate, anemia, kidney problems, gastrointestinal problems. and bone loss (among other things).  These problems are all caused by the malnutrition that results from this disease.  The main life threatening complication that people with anorexia experience is heart failure.  When the body runs out of fat to burn it turns to muscle for energy as a last resort.  Eventually the body starts to use cardiac muscle of the heart for energy making the heart weaker and more susceptible to failure.  A lot of this damage is irreversible and can still cause problems and even lead to death after an anorexic person has received treatment and has recovered.

To show how deeply flawed our self perceptions can be I've included a video that, while not directly relating to Anorexia, does a great job of showing how people find it difficult to see beauty in themselves.

Dove United States.  (2013, April 14).  Dove Real Beauty Sketches  [video file].  Retrieved from https://www.youtube.com/watch?v=XpaOjMXyJGk 

Anorexia Epidemiology

1.2 million Americans suffer from Anorexia and following the trend of the past 25 years this number will only continue to grow.  The vast majority of these people are women.  The male to female ratio for those suffering from anorexia is 1:20.  The main age group of people affected are between the ages of 15-19.  Forty percent of identified cases in females fell between this age group.  Anorexia is more common in western countries.  It more commonly affects white women who are of higher socioeconomic status.  Additionally those who participate in activities or professions that demand thinness (modeling, athletics) are at a higher risk for developing Anorexia.   A follow up study researched how well patients were recovering after treatment and found that only 50% of patients with anorexia recovered.  26% reported a poor outcome after treatment, and 21% reported an intermediate outcome.  The study also found Anorexia had a 9.8% mortality rate.  This is the highest mortality rate of any mental illness.  

The-Reality-of-Eating Disorders. (2013).  Retrieved from https://advocateglobalhealth.files.wordpress.com/2014/04/49p8c6-facts-statistics-465pxwide.jpg

Anorexia: an Introduction

Anorexia is an eating disorder, but the name can be misleading.  Anorexia is an avenue of coping with emotional struggles that manifests itself in an unhealthy relationship with food.  People suffering from Anorexia experience a strong fear of weight gain which leads to eating patterns that cause a decrease in body weight.  Anorexia is often thought of as a "women's disease" and this is true in that the majority of people who are anorexic are women, however 10% of people with anorexia are men and this stigma of having a "women's disease" is a factor that keeps many of them from seeking treatment.  Common treatment options for those who choose to pursue them include a combination of psychotherapy and consultations with mental health professionals and dietitians.

Anorexia-in-the-mirror.  (2014).  Retrieved from http://nursejournal.org/files/2014/07/Anorexia-in-the-mirror.jpg