Anorexia nervosa is a serious eating disorder that results from an individual's intense preoccupation with body weight. Individuals with anorexia have difficulty maintaining a normal body mass index score, and frequently make continued efforts to lose weight even if their weight is abnormally low. The psychological factors that precipitate anorexia can be quite complex, and as a result the diagnosis and treatment of the disorder often require thorough psychological assessment, differential diagnosis, and long-term therapy. This paper will explore current research on anorexia and investigate how medical and mental health professionals are using this research to inform their work with anorexic patients (Smith et. al, 2011).
Diagnosis?
According to the American Psychiatrics DSM-IV-TR (American Pyschiatric Association [APA], 1994) a diagnosis of anorexia requires the following criteria:
"Refusal to maintain body weight at or above a minimally normal weight for age and height, for example, weight loss leading to maintenance of body weight less than 85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected.
Intense fear of gaining weight or becoming fat, even though underweight.
Disturbance in the way one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
In postmenarcheal females, amenorrhea, i.e., the absence of at least 3 consecutive menstrual cycles. A woman having periods only while on hormone medication (e.g. estrogen) still qualifies as having amenorrhea.
Types:
Restricting Type: During the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (self-induced vomiting or misuse of laxatives, diuretics, or enemas).
Binge Eating/Purging Type: During the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior."
While the diagnostic criteria have been clearly outlined for mental health clinicians, many professionals note that it can be quite difficult to make a definitive diagnosis in patients due to factors such as resistance to treatment and denial of the disorder. According to Halse, Honey and Boughtwood (2008), many patients with anorexia will blame their lack of appetite and weight loss on stomach pains, or intolerance to certain foods. In addition, criterion such as amenorrhea require patient disclosure, and an individual who is struggling with the compulsion to lose weight many not be willing to disclose this information to a medical provider.
When a patient's physical symptoms lead medical professionals towards a diagnosis other than anorexia, such as a food allergy, the individual may ultimately use this misdiagnosis to justify her inadequate food consumption. In addition, patients with anorexia may engage in purging behaviors, such as excessive exercise that they explain as athletic training for s specific sport or event. For example, an anorexic patient may eat adequate calories, but if she engages in a running workout for excessive distance or time periods, she may burn far more calories than she consumes. Thus, patients can use seemingly reasonable explanations to prevent diagnosis, and this often occurs, as patients typically have a deep psychological need to control and reduce their weight. The potential resistance, evasive behaviors, and lack of proper diagnosis of anorexic individuals may also be complicated by their age. In the United States, patients who are over the age of 18 can make their own medical decisions, meaning that family members cannot compel them to seek a proper diagnosis or treatment. In some cases individuals may live with the disease for years and avoid any contact with mental health or medical professionals (Halse, Honey, & Boughtwood, 2008).
In addition to these diagnostic difficulties, many professionals note that the current DSM-IV criteria for Anorexia Nervosa (AN) have some significant classification problems that make a proper diagnosis very difficult. First, there is no reference provided for the weight criteria, so clinicians can have difficulty knowing if a patient's weight falls within the criterion. Secondly, the subtypes of anorexia are not particularly useful for the diagnosis of younger patients because these individuals typically exhibit resistricting behavior. As a result, many young patients are diagnosed with Eating Disorder Not Otherwise Specified (EDNOS) rather than AN, which often blocks proper treatment and research. Many clinicians have called for a revision of the diagnostic criteria in the DSM-V, which will be released in 2012 (Knoll, Bulik, & Hebebrand, 2010).
According to Keski-Rahkonen, et al., (2007), delays in diagnosis and misdiagnosis of anorexia can have serious consequences. A patient's weight may fall to a dangerously low level, and this may often result in electrolyte imbalances, heart irregularities, kidney damage, seizures, and extreme...
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