h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Entry: Anorexia Nervosa - A3802303
Author: DrMatt - U739774

In response to a challenge... here it is! I should probably do a Bulimia one to go with it, but see what you think of this one first.

Matt

This is very good, DrMatt. Its a serious topic, treated very sensitively. Well done.

"but nonetheless it is a well-known problem throughout the Western world – for instance, a famous sufferer of anorexia is the singer Karen Carpenter." - are there other well known sufferers, as the "for instance" doesn't really substatiate well enough the "well-known problem" bit?

Also, can you provide some additional external links? Approved or well known organisations in the US or Britain who work with AN sufferers?

Excellent!

I've added a couple of links, and reworded the first paragraph. Before the debate starts, I should mention that I'm not too sure how many "famous people who have/had..." discussion I should put in, not least that most eating disorder talk is hearsay and women's magazines stuff at best, rather than documented evidence. For instance, I want to keep whichever Olsen is supposed to have anorexia out of this if I possibly can (not least because in 5 years time, people will say "who?").

What do others think?

Matt

I think famous people is a no no for something like this. I've had anorexia and still have problems with it and I really DON'T care which famous people have had it. It's annoying.

"Anorexia almost exclusively affects adolescent and young adult women living in Western cultures. Females outnumber males by twenty to one."

I'm not very happy with this bit. I think it may alienate people who have it but fall outside those catagories. You could say it's most COMMONLY in those...

Also the first sentence of Treatment is a bit garbled and could do with a bit of a prod.
Actually on the treatment front...currently it sounds scary and as if you won't get any help until you're dying. Can you change that, show friendlier ways that people get help, who they can go to if they or someone else has anorexia, how people can help sufferers just in everyday life etc? I know that anorexia is a very isolating experience for the sufferer and people who care about them.

Kat

Fair call - I wanted to talk about watershed weight and how therapy doesn't work in the very starved. But it sounds a bit gloomy to lead off with that, particularly when there are so many success stories.

Does it read a bit better, Kat?

Matt

I would like to say that this is a good entry, both the psychiatric and biological implications are handled very well.

You may or may not wish to mention that anorexia can lead to various nasty bone problems due to lack of calcium, phosphate, and energy for bone cells. Indeed, serious anorexics can break bones simply by falling over.

Did you know that there are even a number of pro-anorexic websites? These treat anorexia as a mere lifestyle choice, and often refer to it as 'ana'. They also give tips for losing mass faster, eg sitting in a cold room and shivering.

Just

Uhm, that piece of information about twins is very interesting. A friend of mine is part of a twin. Contrary to her healty, voloptuous, beautiful and popular sister, my friend was suffering from anorexia. She is healed, but it was a very painful path.
It had a lot to do with her dad who was known as a charmer to the outside world but would treat her as the runt of the family and every bad mood he took out on her. He would humilate her in front of the rest of the five kids of the family.
There is also the ambiguous mum, who complained a lot about daddy behind his back to the kids , but never in his presence stood up either for herself or for the girl. In fact, later during a session of psychotherapy the mum denied everything my friend said about the verbal and physical abuse by her dad.

I think this is excellent! A couple of comments:

I think I agree with Kat about famous sufferers not being relevent. I suppose it might sometimes be okay to mention a celebrity in an entry on an illness or condition if that celebrity was closely linked with public awareness of the condition - e.g. Tim Howard (Man Utd and USA goalkeeper) and Tourette's Syndrome. But anorexia seems somehow different, but I'm not quite sure why I think that....

Onto the rest of the entry...

"The ICD-10 and DSM-IV2" - probably best to explain what these are in the body of the entry rather than as a footnote. It's difficult to follow the sentence without knowing what they are.

"where an identical twin of a sufferer was much more likely to get the disorder"

I would say 'develop the disorder' rather than 'get' it. Getting a disease sounds very much like catching a disease. Of course external factors do have an impact, but I would use 'get' for a disease that was mainly caused by an external factor, and 'develop' for one that originated within the body/mind of the person. Do you see what I mean?

Would it be to scientific to explain that twin studoes are about identical vs non-identical twins, so the level of shared environment is the same and only the genetic differences are counted?

I haven't read the entry yet - but my daugther has an eating disorder that started with anorexia - she is still being treated for it.

I was going to suggest you linked to the EDA but then I saw you have as 'UK equivalent'

I think it would look better if you named the association, perhaps in a bullet pointed such as

National Eating Disorders Association - a USA-based non-profit organisation advocating for those with eating disorders.

Eating Disorders Association - a UK based charity for both carers and sufferers of eating disorders.

Or something like that

Ok, here's my :

I'd take out the bit about Karen Carpenter in the beginning -- I think people either know who she was (in which case they generally know she was anorexic as well), or they have no idea who she was (in which case the reference is completely unhelpful).

The phrase "psychiatric eating disorder" is rather redundant.

In the first paragraph, you appear to define Anorexia as "excessive exercise and purging", when that's not how it's defined at all -- the true hallmark of the disorder is an unhealthy weight restriction prompted by an inaccurate body image. Excessive exercise and purging are two ways that those with anorexia can restrict their weight, but they are far from the only ways and are not required for anorexia to be diagnosed.

I'm in general against using the word "sufferers" to describe any medical or psychological condition - it's patronizing and demeaning.

There are several things you describe or say, in which you give the impression that they are true for *all* people with anorexia, when they would not be. Hiding food would be one -- it may be common, but it's not universal.

I would emphasize that growth as well as sexual development can be stunted. And it's not only an issue during the early phases of adolescence -- even for someone who develops an eating disorder during later years, the secondary sexual characteristics are often the first to go for a woman. And stunting of growth and sexual maturation can even be an issue for those who are in the later stages of puberty -- if any sort of development is still happening, weight restriction can hamper that development.

There are also several ways in which you word things that can come across as blaming the individual for their disorder. I'd suggest rewording such things as "punishing exercise programmes" and "They tend to put too much emphasis on their body shape to determine their self-esteem (discounting their other, non-physical qualities)."

Actually, excessive exercise falls into the same subgroup as those with other forms of purging. It's basically "restriction only" on one hand, and "excessive ways of getting rid of calories" on the other. This entry as a whole pretty much ignores the "restriction only" variation.

It's not just unheard of for men to have anorexic symptoms, men can also develop the actual disorder -- and as the rates of men have been jumping rather markedly over the last decade, I would not downplay it to the degree you have here.

You describe ammenhorrhea as a *cause* of the disorder rather than as a *symptom*, which is incorrect. Yes, it is a symptom which can actually worsen the disorder -- but it is not an actual cause.

You haven't mentioned that ballet dancers and gymnasts (for women) and wrestlers and jockeys (for men) are at far greater risk for developing anorexia, in large part because of the emphasis these disciplines place on body weight, especially at the elite levels.

I would probably also mention that while eating disorders used to be seen as restricted to whites, this is no longer the case - there have been significant rises in diagnoses across other racial and ethnic groups in recent years.

The genetic role seems to be largely mediated by personality type, perhaps even more so than via anxiety disorders, etc. As opposed to other eating disorders, anorexia is more likely to affect those with perfectionist tendencies, and those who are not assertive in everyday life.

You seem to completely ignore the effects on the body of anorexia -- the cardiovascular effects are incredibly important, and I would probably mention things like body hair growth and head hair loss as well.

Rather than focusing the treatment section on type of psychotherapy used, I'd probably divide it by: inpatient treatment (often focused on stabilization of medical symptoms and tube feeding), day treatment (intensive outpatient), outpatient counseling (often used in the long-term as maintenance, and including both nutritional counseling and psychotherapy), and medications (including, but not limited to, psychotropics).

The bit on watershed weights seems to rather miss the point, to me. The main thing is that having an extremely low body weight actually has a significant impact on the brain and thought processes, and this does not come through clearly. It's after reaching this "watershed" weight that a patient is able to think more clearly, and decide whether to participate more fully and intentionally in treatment.

I would probably also add that in many treatment settings, it's possible for an unhealthy competition to arise between those with anorexia - centres that specialise in this are generally well aware of this potential and take steps to prevent it from happening.

This is great! I studied Anorexia in my Psychology A - level last year, so most of this is pretty familiar to me.

Great entry, I can't think of any changes you need to make, except some of those which have already been mentioned.

Sorry, I am reading this in dribs and drabs as it is a bit of a trigger subject for me.

You don't mention Body mass Index (BMI) This is often used to see if a person is underweight according to their body size and shape.
http://www.edauk.com/bmi.htm

Not only do the muscles become atrophied - ie waste away due to lack of nourishment, the body actually starts to use them as a source of nourishment. The heart, as Mikey says, is at particular risk.

As well as the soft downy hair growth on the body and face, the skin can become dry and scaley.

Osteoporosis occurrs in both men and women. Women may have fertility problems if they have been ill for a long time.

I would say that the low numbers of men in studies is, in part, perhaps due to the reluctance of men to admit to having what is mistakingly seen as a 'womens illness'

What source was your 1 in 20 anorexics are men from? May be worth stating it. The UK figure is 1 in 10 men (EDA) admit to ED's and I doubt that only 50% of that number is of men admitting to anorexia, but that is just my feeling.

Personally if you are going to mention a study on twins I would like to see a link to it or at least a source.

"when their abdominal muscles atrophy due to starvation, they sometimes see the resulting sticking-out abdomen as fatty"

"sticking-out abdomen" could be phrased better I think. Bloatedness is another common sympton of anorexia too, so the abdominal distension is not just due to weakened abdominal walls.

(My apologies if I have repeated what someone else has said as I hate when that happens to me - i feel ignored !)

Thats just my thoughts for the moment anyhow

The BBC site lists it as 10% for the Uk too

http://www.bbc.co.uk/health/conditions/anorexia1.shtml

Otto, in regard to your comment about not being in favour of mentioning famous people but not being quite sure why you think it's different with anorexia: beauty, as advertised in female magazines and on television and in movies is still very much linked with slender bodies and expensive clothes.
It might be of importance to know how many women are victimized by this 'official concept of beauty' that is advertised by the media. Many famous women might have suffered anorexia because of it.
Even if females themselves are not very interested in their appearances, it still can be top priority for others to point out to them: 'not a pretty face, old loon, stinking dress' are just a few of the comments I encountered on this site made to myself. Now as an adult, one has achieved the wisdom of old age. I for one regard the people who make these kind of remarks as shallow. An insecure sixteen year old might be devastated.

I think that all that can be said is that

"Many famous women with a *predisposition* to anorexia might have developed it"

"Many famous women with a 'predisposition' to anorexia might have developed it", that is like saying nothing at all. Many ex-marines from the Falkland war who kept their boots on the second shelf of the cupboard in their cellars might have developed an obsession with window cleaning.

Not really. If what you are saying is true about the media and body image is true (and I don't doubt that it is one of the overall triggers for the illness) then everybody would suffer it. Not everyone who is bullied commits suicide - not every soldier suffers PTSD not every abuse victim develops anxiety disorders.

Everybody has characteristics that are part themselves which are involved in how they respond or react to situations.

Media coverage is simply one of the drops in the overflowing bucket that contributes to the development of anorexia.

However that is a discusion more about the subject than the submitted entry.