Dr. Ahmed
Extreme Anorexia Nervosa or severe anorexia nervosa is a medical condition defined as a person with an eating disorder and a BMI of less than 15 kg/m².
Patients with anorexia nervosa perceive themselves as if they are overweight and fear the idea of gaining a slight weight.
What is Anorexia Nervosa?
“Anorexia nervosa” consists of two words, Anorexia means “without appetite(hunger) ” and Nervosa means “nervous”.
Anorexia nervosa — frequently called anorexia — is a disorder related to eating indicated by very low and decreasing body weight, an extreme fear of an increase in weight, and a wrong impression about weight.
The ones suffering from anorexia are extremely stressed about controlling their weight and shape, doing many efforts to reduce it, despite being underweight, thus damaging their lives.
To reduce the chances of weight gain or to get fitter, ones with anorexia always decrease the food intake that they were previously taking.
Anorexics do vomiting and control food intake after eating or by abusing or overusing such medicines to clean their bowels or cause diarrhea.
People with anorexia try their best to unreasonably shed pounds by working out and doing hard exercises. Despite how much weight is lost, they continue to fear weight gain and in this manner attempt more to get thinner.
Anorexia isn’t precisely about food. It is a disease. It’s an inconceivably unwanted and hazardous approach to managing everyday schedule issues and intense emotional matters. Right when you have anorexia, you habitually contrast slimness and confidence or self-love.
It, in the same way as other dietary issues, has some control over your life and can be extremely difficult to get by. Extreme anorexia is an extreme condition.
As a person starts losing weight with unhealthy methods, they become anorexic and later may have extreme anorexia when their body sheds lots of pounds and their BMI falls to less than 15.
With proper treatment, you can have a predominant sensation of what your personality is, return to better dietary examples, and can also reverse very serious problems and complications caused by it.
Causes of Anorexia and Extreme Anorexia Nervosa:
We don’t know the exact cause of anorexia and extreme anorexia to date but it can be a combination of many factors as many diseases are. The factors can be
- Environmental
- Hereditary
- Psychological
Environmental factors of Anorexia and Extreme Anorexia:
Modern society demands a perfect figure and lean body, so it pressurizes the youngsters and they stop eating and start doing hard exercises to keep them fit.
Instead of keeping them fit, they end up being very weak.
Sense of Perfection:
The NEDA has said that many people who have experienced the ill effects of anorexia experienced conduct resoluteness growing up — that they felt like they by and large expected to follow the “rules” and complete work in the right order.
There is a type of rigid nature in an individual’s personality that makes him wish to be perfect, tense, and lose self-esteem.
These psychological issues centered around control can cause an increase in the chances of individuals adopting and experiencing long-term eating disorders.
Harassment/ Bullying:
The people who experience the failure to talk or communicate with other people or those who are introverted and talk less are bullied or harassed by their friends and fellows.
This bullying could be in the form of taunting, face-to-face insults, or remarks about a person’s appearance.
Harassing is such a critical risk factor in dietary problems that it has acquired significant consideration in the previous ten years.
NEDA states that 60% of those impacted by dietary problems revealed that harassment straightforwardly has caused and enhanced their dietary problems causing anorexia.
Minority Communities:
Those from racial and minority ethnic gatherings are especially in danger of encountering social challenges.
This is because of the way that they are supposed to adjust to the social “standard,” (which is in many cases Western excellence beliefs).
At the point when an individual’s body show doesn’t line up with what is “expected,” social problems begin to occur.
These people might experience difficulty in fitting clothes according to their body, see essentially fewer individuals who appear as them in the media, and have many chances to be bullied or be named as “other.”
These outcomes might make people hate themselves and think badly about their bodies, which then leads to eating disorders.
To give proof of this, a survey was held in Fiji, where ladies were introduced to western TV programs [Ref].
After three years, ladies who were previously being told OK with their bodies started facing serious issues.
Of the ladies, “74% felt excessively fat; 69% slimmed down to get in shape by severe dieting; 11% did self-induced vomiting;29% were in danger of clinical dietary problems” (NEDA).
Depression and Loneliness:
Social problems, for example, a failure to form or create contacts or social networks with people, fewer social events, and less or no support from society.
This absence of collaboration, companionships and the sensation of being distant from everyone else are indications of anorexia.
Various individuals who have anorexia report having fewer partners than common, less well-disposed activities to participate in, and less cordial assistance.
This absence of help is displayed to keep up with, and possibly deteriorate, dietary problems and ways of behaving in people.
It is essential to note here that these eating disorders are like a vicious cycle. Dietary problems might make people disconnect: they probably shouldn’t go to get-togethers regarding food, wish to not be considered inferior to others, and try hard that those around them shouldn’t realize what is happening.
This results in even more loneliness, which might make an individual further confine and restrict to his home and thus result in eating disorders due to depression [Ref]
Hereditary causes of Anorexia and Extreme Anorexia Nervosa:
Even though the idea is a mental issue, the dietary problem “anorexia nervosa” frequently runs in families, recommending that it has a hereditary part.
Presently analysts have found two qualities that assist with deciding the risk of getting this disease. The outcomes recommend that the changes in genes associated with mood and hunger can seriously cause anorexia in people.
Individuals with anorexia, normally ladies, have a bad self-perception, starve themselves, and try to be perfect.
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Research throughout the past ten years has proposed that genes also have a part in causing it.
The possibilities of becoming anorexic are about a portion of a percent in everybody. However, the risk of having anorexia nervosa in a close relative makes you more prone to developing the condition. The risk is thought to increase by 11 times.
Psychological causes of Extreme Anorexia:
Certain individuals with anorexia might have such personality and habitual character that makes it easier for them to adhere to severe and strict diet plans and they stop themselves from eating regardless of how hungry they might be.
They might have an extreme desire for being perfect, which makes them believe they’re never fit and capable of looking good.
Also, they might have a very high degree of depression and do a very strict diet to reduce depression.
Who is at Risk of Developing Extreme Anorexia:
Anorexia is a more normal problem among young ladies. Young fellows have dynamically advanced dietary issues, possibly associated with creating social issues.
Anorexia is in a manner more ordinary among youngsters. Anyway, people, everything being equal, can have this dietary issue, nonetheless, it’s exceptional in those over 40.
Teens and young adults are more prone to develop anorexia as they have the most body changes during a shorter time.
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In addition, they are more sensitive to issues related to self-esteem, comments about their weight or body shape, and may have marked peer pressure.
The following factors may add fuel to the fire and exacerbate the things:
Genetic Predisposition:
Changes in qualities of specific nature could put explicit people at a higher opportunity of anorexia.
The risk of developing anorexia is much greater if a person in a family or a close relative have the same issue.
Starvation and Dieting
Starvation and taking meals either less frequently or in a minute amount are the main dietary habits of anorexic patients.
Starvation impacts the psyche and affects demeanor changes, the strength of reasoning, disquiet, and a loss of appetite.
Starvation and weight decrease could modify the psychological functions of frail individuals. This results in limiting diet and meal intake.
Change in place
A change in an environment can sometimes bring about a huge change in the dietary habits of a person. A change in the environment can be another school, home, or workplace.
It could be a change in relationship or partition from a relative or a friend.
How to treat Extreme Anorexia:
Treatment of it is for the most part done by teamwork, which contains specialists, psychological experts, and dietitians, all with experience in dietary problems.
Continuous treatment and useful education about nutrition are essential for treatment.
Here is a look at what’s normally expected for treating people with extreme anorexia:
Being hospitalized
People who are extremely anorexic, become bedbound, have severe electrolyte disturbances, and have psychological distress may need to be hospitalized.
Hospitalization may be normal for startling issues, outrageous mental issues, extreme absence of sound sustenance, or proceeded demonstration of declining to eat food.
Some of the clinics have practical experience in treating individuals with dietary issues. They might offer day programs or some days residential programs rather than complete hospitalization.
Specific dietary problem projects might offer more-careful treatment over longer timeframes.
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Clinical consideration or medical care
Due to many problems anorexia causes, you might require a continuous look after essential signs, water levels, salts levels, and other conditions which are concerning their bodies.
In cases of extreme anorexia, doctors may pass a feeding tube that is placed in their nose and goes to the stomach (nasogastric tube).
Along with dietary management, patients are monitored for weight gain and electrolyte abnormalities. Psychotherapists and physicians are all involved in the care of the patient on a daily basis.
Regaining a healthy weight
The principal objective of treatment is getting back to a sound weight. Anorexia can’t be recuperated without recovering weight and finding out about sound sustenance. The people who play out this treatment are:
- Your primary specialist can give clinical consideration and observe your food requirement and gain of weight.
- A doctor or other therapist can help you to find strategies and plans to regain weight and become healthy.
- A dietitian can provide certain healthy diet plans and nutritious meals that assist you with meeting your weight objectives.
- Your family will monitor and make you follow healthy eating habits and give moral support and motivate you to eat and engage yourself in healthy activities.
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Psychotherapy for extreme anorexia:
Psychotherapy is an important step in the treatment of patients with extreme anorexia.
Family-related cure or treatment.
This is the main evidence-based treatment for youngsters with anorexia. Since youngsters with anorexia can’t utilize good instincts about eating and can’t arrive at great conclusions about themselves, this treatment centers around their family to help their kids in eating quality food and make him/her take on beneficial routines of activity and adjust diet and back them ethically.
Individual treatment. For adults, mental social treatment — expressly further developed mental direct treatment — has been shown to help.
The essential goal is to normalize eating models and approaches to acting to assist with weight gain.
The auxiliary goal is to assist with wrongful convictions and considerations which keep them from eating and which cause them to do hard activities and ultimately cause anorexia.
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Drugs
No meds are found to treat anorexia since none has been found to have the commendable capability.
Notwithstanding, antidepressants or other mental medications can help with treating other close-to-home issues you may similarly have, similar to sadness or anxiety.
Medicines to correct electrolytes, high protein, and a high-calorie diet to build muscles, fluid administration orally or intravenously to correct dehydration and ketosis, and antidepressants are all required by most patients with extreme anorexia.
Among the SSRIs, Paroxetine is associated with the most weight gain and may be effective in some ways.
Treatment challenges in anorexia
Perhaps the biggest challenge in treating anorexia is that individuals don’t want treatment. The problems in treatment might include:
- The thought of not requiring treatment.
- Not believe anorexia to be an infection but rather an approach to everyday life.
- Fear of gaining weight.
- The ones suffering from anorexia can be normal and healthy again. However, there is a danger that they might fall back again and suffer from anorexia when having depression or anxiety. Thus psychiatric therapy sessions are essential to deal with depression.
