Research Paper: Anorexia Nervosa Is a Serious

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[. . .] In younger patients, a family assessment can be critical to treatment planning, as the patient will typically have extensive contact with family members while she is in treatment and attempting to regain weight and recovered from her disordered eating habits (Keel & McCormick, 2010).

The patient's environment and family experiences, in fact, are often heavily factored in the etiology of anorexia. Many experts suggest that family dynamics may play a key role in the development of anorexia. A person needing to individuate from family members or maintain a sense of control over her environment may develop disordered eating habits. Environmental factors are, however not the only possible cause of anorexia. Current studies indicate that there may be a myriad of biological factors, such as brain chemistry and genetics, which contribute to anorexia. Studies have indicated that anorexics tend to have higher levels of cortisol, the hormone related to stress, and lower levels of serotonin, which is related to feelings of well being. Imbalances in brain chemistry may result in obsessive-compulsive behaviors and mood disorders, both of which are highly associated with anorexia. Cultural factors also play a role, as the media and society in general promote thinness as a measure of beauty and desirability. A young person with a weak self-concept and a predisposition to perfectionism or obsessive behavior may be highly influenced by these social cues. In fact, groups such as dancers, models, and media personalities have some of the highest rates of anorexia and other eating disorders because so much emphasis is placed on their physical appearance and body weight (Smith et. al., 2011). Each individual may have different factors contributing to the development of anorexia, and treatment teams must investigate the causes in order to develop the most promising treatment plan.


Treatments for anorexia include medical, nutritional, and psychological interventions. The patient's weight and vital signs help a treatment team determine the appropriate treatment setting. Patients who are severely underweight, show evidence of metabolic or cardiac abnormalities, or display an inability to care for themselves due to their physical or psychological state, may require treatment in a hospital setting. Hospital treatment may include the use of a feeding tube and intravenous fluids, and patients typically gain an average of 2 to 3 pounds a week. Hospitalization normally lasts as long as the patient has serious health risks due to low weight or associated health issues (Franco, 2011).

Nutritional therapies for anorexia are designed to return the patient to a healthy weight. These interventions may require careful monitoring of the patient and the use of positive reinforcement and restrictions from exercise. Regular weigh-ins, thorough physical exams, and monitoring of urine output and bowel movements are critical for the charting of patient progress. It has been repeatedly noted that many patients treated for anorexia in hospital or outpatient settings may be very ambivalent about their treatment, and in many cases this can lead to treatment resistance. Some patients report that they feel coerced into treatment and deny the presence of health issues related to their weight. These cases may be very difficult to treat, as the patient may engage in behaviors that directly undermine the effectiveness or success of treatment (Franco, 2011)

Psychological interventions for eating disorders include interpersonal and cognitive behavioral therapies with the aim of changing the patient's attitudes and behaviors towards food and enhancing both social and interpersonal functioning. These therapies are used in both in-patient and outpatient settings. Cognitive behavioral techniques are combined with nutrition planning, and often use strategies such as meal planning, stress management techniques, and gradually increasing exposure to different foods. A main theme of these psychosocial approaches is to help a patient develop coping skills to manage anxiety and fear regarding food and increasing body weight. In addition, many approaches directly address issues of low self-esteem or distorted thinking that often precipitates food-restricting behaviors. In addition, depending on the needs of the patient, family or marital therapy may be implemented to address any dysfunctional patterns that may have contributed to development of the eating disorder (Smith et al., 2011).

Many forms of group therapy and support are available to individuals with anorexia. Some of these are clinically based therapy groups run by mental health professionals. The participants learn communication skills, and use the group as a source of feedback regarding treatment progress. Some support groups, such as Overeaters Anonymous, are peer-based groups that are primarily used to prevent relapse once a patient has recovered to a healthy weight. Overeaters Anonymous and related 12-Step programs approach the treatment of eating disorders from a physical, emotional, and spiritual perspective, and many aspects of the program's counseling and steps format incorporate a spiritual emphasis that integrates quite directly with Christian counseling methods, that is, incorporating a spiritual approach to emotional and physical recovery (Franco, 2011).

Physiatrists often prescribe psychotropic medications once patients have regained a significant amount of weight. Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat depressive symptoms and control anxiety and obsessive-compulsive behaviors. In addition, anti-psychotic medications may be prescribed to treat issues of severe agitation or psychotic thinking that may result from nutritional deficiencies or, during recovery, increases in food intake. In addition, fast-acting anti-anxiety medications, such as benzodiazepines can be used to treat extreme episodes of anxiety or panic that may result from the reintroduction of food or the limitation of exercise.


The prognosis for an anorexic patient may vary widely depending on the severity of her symptoms at the time of diagnosis. A variety of studies indicate that an estimated 10% of cases end in death. Physical complications, such as kidney damage, heart irregularities, and weakened bones, and thyroid malfunction may also result in long-term medical issues, and up to 20% of patients suffer from ongoing medical issues. A prognosis may be more promising for a patient who shows very few signs of comorbid disorders, such as personality or substance abuse disorders. Outcomes are also typically better for patients who respond to SSRI medications for the treatment of anxiety or depressive symptoms. Patients with comorbid disorders and duel diagnosis may respond to medical treatments and behavioral therapies, but their risk of relapse may be higher due to multiple risk factors (Halse et al., 2008).

Patients who are treated at a younger age and earlier in the progression of the disease have a higher chance of full recovery. Likewise patients with families or support systems, such as significant others, church groups, or spiritual leaders who are directly involved in the recovery process, have a better rate of recovery compared to patients who lack strong support system or report highly dysfunctional or conflict filled home environments (Franco, K., 2011).

Overall the diagnosis, assessment, and treatment of anorexia nervosa presents many and varied challenges for researchers and providers. This disorder continues to have a complex relationship with both biological and psychological factors, and can be present with a wide variety of comormid and extremely complicated conditions, such as substance abuse disorders and personality disorders. As such, treatment plans and prognosis much be highly individualized, and researchers must continue to study how these complexities guide or determine specific treatment strategies.


American Psychiatric Association. Treatment of patients with eating disorders, third edition. American Psychiatric Association. Am J. Psychiatry. 2006;163(7 Suppl):4-54.

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th Ed.) United States of America: American Psychiatric Association.

Franco, K. 2011."Eating Disorders." Center for Continuing Education, Cleveland Clinic. Foundation, Cleveland Ohio. Retrieved from 2, March. 2011

Halse, C.,Honey, A.,Boughtwood, D. 2008. "Inside anorexia: the experiences of girls and their families." Jessica Kingsley Publishers. Philidephia, Pennsylvania.

Keel, P., McCormick, L. 2010, "Diagnosis, Assessment and Treatment Planning for Anorexia Nervosa" from "The Treatment of Eating Disorders," Guilford, New York, New York

Keski-Rahkonen, A. et al. 2007. "Epidemiology and Course of Anorexia Nervosa in the Community." Am J. Psychiatry. 164:1259-1265.

Knoll, S. Bulik, C. Hebebrand, J. 2010. "Do the currently proposed DSM-5 criteria for anorexia nervosa adequately consider developmental aspects in children and adolescents?" European Child & Adolescent Psychiaty. 20: 95-101.

McIntosh VV, Jordan J, Carter F, Luty, McKenzie JM, Bulik C, Frampton C, Joyce P. 2005. "Three psychotherapies for anorexia nervosa: a randomized, controlled trial." Am J. Psychiatry; 162:741 -- 747. Retrieved from

Pritts, S. Susman, J. 2003. "Diagnosis of Eating Disorders in Primary Care" Am Fam Physician. 2003 Jan 15;67(2):297-304.

Smith, M., Kovatch, S..Segal, J. 2011 "Anorexia nervosa: Signs, Symptoms, Causes, and Treatment." Helpguide. Retrieved from, 2, March. 2011.

Walsh, A. 2009. "Beahvioral management for anorexia… [END OF PREVIEW]

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Anorexia Nervosa Is a Serious.  (2011, March 4).  Retrieved July 18, 2019, from

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