SOCIETAL pressure, mainly in the form of social media, seems to be at its peak. The idea of attaining an ideal body type, which is slim, is thrust upon us on a daily basis via social and print media.

Recently, former Miss Universe Alicia Machado opened up about her struggles with the disorder post winning her crown. It is even more important in today’s day and age that we are aware of anorexia nervosa and its implications.

Anorexia nervosa is an eating disorder that is potentially life-threatening. It is characterised by an inability to maintain a healthy body weight, a devastating fear of weight gain, and a misinterpretation of what normal body weight should be. It is most common in the adolescent female population and is more often seen in the higher socioeconomic group.

However, it can affect anyone at risk. In Jamaica the disorder affects mostly people in the urban setting and is most prevalent in the student population.

CAUSE

Anorexia nervosa may be due to genetic, psychological and social factors. A family history of the condition is a significant risk factor. Imbalance of chemicals, known as neurotransmitters, in the brain have also been implicated.

People with a history of sexual or physical abuse, a perfectionistic personality and low self-esteem are especially predisposed to this illness. It is commonly seen in occupations which place a great emphasis on body shape and weight such as modelling, acting and competitive sports.

Purging and refusal of food is seen as a way to gain some sense of control of an otherwise chaotic life. People suffering from the disorder are usually subject to harsh and extreme criticism coming in their direction from family members and friends.

SIGNS AND SYMPTOMS

Anorexia nervosa can affect different systems of the body and can result in dry skin, brittle nail and hair, imbalance in essential vitamins and minerals, and severe weight loss. In females, the disorder can result in amenorrhea and anovulation. Severe dehydration and low blood counts can result and, if untreated, the condition can even lead to death.

Patients who induce vomiting develop dental erosions, inflammation of the food pipe and even fits from electrolyte imbalance due to persistent vomiting and loss of fluids. Efforts to minimise body weight may be done either via vomiting and purging, excessive exercise or just refusal to eat.

MANAGEMENT

Anorexia should be approached in a systematic manner and involves a multidisciplinary team comprising psychiatry, general medicine, dietitian and a psychologist at the least. Management should begin by taking a comprehensive history from the patient.

On many occasions, information needs to be gathered by close relatives and friends as the patient may not believe that their actions are wrong and may even justify their eating abnormalities. A thorough physical exam needs to be conducted looking for any complications arising from the illness followed by blood investigations.

Hospital admission may be needed for people who are extremely ill. Most people are admitted for purpose of refeeding. Vitamin and mineral replacement is of utmost priority. There is some evidence that antidepressants have shown efficacy in the treatment of anorexia nervosa.

Psychological intervention needs to go hand in hand with any drug therapy and includes psychoeducation, identifying any negative thoughts that the patient may have and attempting to address negative emotions. Family therapy involves the family and attempts to correct any family dysfunction that may be contributing to the illness. It is important to remember that eating disorders are highly comorbid with other psychiatric disorders such as major depressive disorder and anxiety disorders and these need to be managed appropriately.

Dr Ashish Sarangi MBBS is a resident in psychiatry at the University Hospital of the West Indies. He may be contacted via email at aks_sarangi@hotmail.com