INTRODUCTION

The increased prevalence of anorexia nervosa (AN) in societies has encouraged many developments western and

theimplementation of new approaches in the treatment of the disorder. Many patients are hospitalized in psychiatric departments where they often adopt others’ symptoms and frequently relapse following discharge from the hospital. Foster care can be an alternative to hospitalization. It is a professional treatment

resource which is as close as possible to the normalcy of typical home surroundings, and one used widely in the psychiatric domain. It can provide the appropriate environment for diminishing the anorexic experience, especially when it is available to the narrative approach. The narrative approach assumes that our lives are constituted through narrative. To deconstruct the stories which persons narrat their lives by, Michael White has proposed to do this deconstructing through objectification of the problem [3].

Objectification engages the individual in an externalizing of conversations relevant to his or her problem, rather than in internalizing conversations. Externalizing conversations are crucial so that the patient may experience an identity distinct from his or

her view of himself or herself in order to clear the way for distinguishing areas in the patient’s life not co-opted by this view, thus exploring alternative, positive versions of who he or she might be. Externalizing conversations encourage persons to verbalize how the problem impacts on his or her life (including emotional states, relationships, social and work spheres and the like) with emphasis on how the problem has affected his or her “view” of himself or herself and his or her relationships. The individual is then invited to “map” the influence this view or perception has on his or her live. Using the narrative approach in treating AN enables patients to separate themselves from the “totalizing” stories that are

constitutive of their lives and to orient themselves toward those aspects contradicting these perceptions. This approach helps the patient to engage in change rather than guilt or blame, which are often the dominant feelings among patients with anorexia nervosa. The foster family setting serves as an therapeutic environment in which intensive externalizing talks can occur; the “normal”

behavior of family members serves as a counter behavior to the anorectic one, as well as a model of healthy attitudes toward food and eating. The containing and holding environment and the presence of caregivers with therapeutic backgrounds (a clinical

dietitian, in the present case) gives the patient an opportunity to change maladaptive patterns of interaction. The following is a case study of a 17-year-old girl with severe anorexia nervosa, of the restricted type. After a threemonth hospitalization, she was transferred to a foster family for a period of two months. The process of her recovery will be described. People who have anorexia have problems with eating. They are very anxious about their weight. They keep it as low as possible, by strictly controlling and limiting what they eat. They starve themselves to lose weight because they: • Think they are fat or overweight. • Have a very strong fear of being fat. • Want to be thin. Even if they are already very thin and underweight, they continue to want to lose weight. People with anorexia are obsessed with food, eating and calories. Sometimes they try to get rid of food from their body, for example, by making themselves vomit. Anorexia means 'loss of appetite'. People can lose their appetite because of other conditions, such as cancer. Doctors may use the medical term anorexia to describe this. However, it is not the same as the

condition anorexia nervosa. People with anorexia nervosa do not usually lose their appetite. Anorexia can affect anyone. It is much more common in developed countries such as the UK than developing countries. Anorexia is more common in women and girls. It can also affect men and boys, and some experts think that this is increasing. Anorexia usually develops over time. It most commonly starts in the mid-teens. In teenagers and young adults, the condition affects about 1 in 250 females and 1 in 2000 males. It can be very difficult to understand why someone close to you has problems with eating. Anorexia can be very upsetting, both for the person affected and everyone close to them. Supporting each other is very important. It can play a key part in helping the person to recover. Anorexia can be a serious condition. Starving yourself affects every part of your body and can lead to health problems. If anorexia is not treated, these problems can become severe and even life-threatening. Sometimes people can have anorexia for years before seeking help. Anorexia can be treated, usually with a combination of: • Psychological treatment.

• Advice, help and support on gaining weight safely and healthy eating. Treatment also aims to reduce the symptoms of medical problems caused by the anorexia. Some people make a full recovery from anorexia, and others can improve their condition. However, anorexia can also become a chronic condition.

MEANING AND DEFINITION
Amenorrhea: Absence of menstrual periods. Binge eating: A pattern of eating large quantities of food in a short period of time. Purging: The use of vomiting or other techniques to empty the stomach of food. Anorexia is a psychiatric illness that describes an eating disorder characterized by extremely low body weight and body image distortion with an obsessive fear of gaining weight. Individuals with anorexia are known to control body weight commonly through the means of voluntary starvation, purging, excessive exercise or other weight control measures such as diet pills or diuretic drugs. While the condition primarily affects adolescent females approximately 10% of people with the diagnosis are male[1]. Anorexia nervosa, involving neurobiological,

psychological, and sociological components[2] is a complex condition that can lead to death in severe cases. Anorexia nervosa is an eating disorder that occurs primarily among girls and women. It is characterized by a fear of gaining weight, self-starvation, and a distorted view of body image. The condition is usually brought on by emotional disorders that lead a

person to worry excessively about the appearance of his or her body. There are generally two types of anorexia: one is characterized by strict dieting and exercising; the other type includes binging and purging. Binging is the act of eating abnormally large amounts of food in a short period of time. Purging is the use of vomiting or other methods, such as laxatives, to empty the stomach. An individual who suffers from anorexia is called anorexic. Anorexia is a serious psychological disorder. It is a condition that goes well beyond out-of-control dieting. The person with anorexia, most often a girl or young woman, initially begins dieting to lose weight. Over time, the weight loss becomes a sign of mastery and control. The drive to become thinner is thought to be secondary to concerns about control and fears relating to one's body. The individual continues the endless cycle of restrictive eating, often to a point close to starvation. This becomes an obsession and is similar to an addiction to a drug. Anorexia can be life-threatening. Anorexia is characterized by a significant weight loss resulting from excessive dieting. Most women and an increasing number of men are motivated by the strong desire to be thin and a fear of becoming obese. Anorexics consider themselves to be fat, no matter what their actual weight is. Often anorexics do not recognize they are

underweight and may still "feel fat" at 80 lbs. Anorexics close to death will show you on their bodies where they feel they need to lose weight. In their attempts to become even thinner, the anorexic will avoid food and taking in calories at all costs, which can result in death. An estimated 10 to 20% will eventually die from complications related to it. Anorexics usually strive for perfection. They set very high standards for themselves and feel they always have to prove their competence. They usually always put the needs of others ahead of their own needs. A person with anorexia may also feel the only control they have in their lives is in the area of food and weight. If they can't control what is happening around them, they can control their weight. Each morning the number on the scale will determine whether or not they have succeeded or failed in their goal for thinness. They feel powerful and in control when they can make themselves lose weight. Sometimes focusing on calories and losing weight is their way of blocking out feelings and emotions. For them, it's easier to diet then it is to deal with their problems directly. Anorexics usually have low self-esteem and sometimes feel they don't deserve to eat. The anorexics usually deny that anything is wrong. Hunger is strongly denied. They usually resist any attempts

to help them because the idea of therapy is seen only as a way to force them to eat. Once they admit they have a problem and are willing to seek help, they can be treated effectively through a combination of psychological, nutritional and medical care. Bulimia is characterized by a cycle of binge eating followed by purging to try and rid the body of unwanted calories. A binge is different for all individuals. For one person a binge may range from 1000 to 10000 calories, for another, one cookie may be considered a binge. Purging methods usually involve vomiting and laxative abuse. Other forms of purging can involve excessive exercise, fasting, use of diuretics, diet pills and enemas. Bulimics are usually people that do not feel secure about their own self worth. They usually strive for the approval of others. They tend to do whatever they can to please others, while hiding their own feelings. Food becomes their only source of comfort. Bulimia also serves as a function for blocking or letting out feelings. Unlike anorexics, bulimics do realize they have a problem and are more likely to seek help. Compulsive overeating is characterized by uncontrollable eating and consequent weight gain. Compulsive overeaters use food as a way to cope with stress, emotional conflicts and daily problems. The food

can block out feelings and emotions. Compulsive overeaters usually feel out of control and are aware their eating patterns are abnormal. Like bulimics, compulsive overeaters do recognize they have a problem. Compulsive overeating usually starts in early childhood when eating patterns are formed. Most people who become compulsive eaters are people who never learned the proper way to deal with stressful situations and used food instead as a way of coping. Fat can also serve as a protective function for them, especially in people that have been victims of sexual abuse. They sometimes feel that being overweight will keep others at a distance and make them less attractive. Unlike anorexia and bulimia, there is a high proportion of male overeaters. The more weight that is gained, the harder they try to diet and dieting is usually what leads to the next binge, which can be followed by feelings of powerlessness, guilt, shame and failure. Dieting and bingeing can go on forever if the emotional reasons for the bingeing is not dealt with. In today's society, compulsive overeating is not yet taken seriously enough. Instead of being treated for the serious problem they have, they are instead directed to diet centers and health spas. Like

anorexia and bulimia, compulsive overeating is a serious problem and can result in death. With the proper treatment, which should include therapy, medical and nutritional counseling, it can be overcome.

SYMPTOMS
The symptoms of anorexia nervosa have a wide range. Extreme weight loss leads to many secondary symptoms. Note that the physical, mental, and behavioral worlds of a person struggling with anorexia overlap: Each area has the potential to affect the other two. Physical Symptoms of Anorexia Nervosa The most visible symptom of anorexia nervosa is weight loss, which is often clear to the casual observer. But the body of a person with anorexia changes in many ways: • Weight loss (achieved via restricting food or purging it): A person with anorexia will lose weight because, by definition, she refuses to maintain or achieve a body weight of 85% of the expected weight for her age and height. Amenorrhea (interruption of the menstrual cycle): Amenorrhea is present if there is an absence of at least three consecutive menstrual cycles, or if the person needs to take estrogen for her normal cycle to occur. Amenorrhea is a menstrual condition characterized by absent menstrual periods for more

than three monthly menstrual cycles. Amenorrhea may be classified as primary or secondary.

Primary amenorrhea - from the beginning and usually lifelong; menstruation never begins at puberty.

secondary amenorrhea - due to some physical cause and usually of later onset; a condition in which menstrual periods which were at one time normal and regular become increasing abnormal and irregular or absent.

Bone loss (osteoporosis or osteopenia)- Osteoporosis, or a condition of porous bone, is a disease in which bones become more fragile. Left untreated, osteoporosis can progress silently until a bone breaks. In many cases, early prevention and treatment can make a big difference.

Bone is living, growing tissue constantly being formed and broken down. Early in life, more bone tissue is formed than broken down, allowing the skeleton to grow. By about age 30 your bones are at your lifetime best, or your "peak bone mass." After this peak, bone maintains an equilibrium until about age 50 in women and 60 in men. Then, bone breaks down faster than it forms. The resulting bone loss affects both men and women. Bone loss can lead to osteoporosis.

Today, osteoporosis is a major health threat for 44 million Americans, 80 percent of whom are women. In the United States, 10 million individuals already have the disease and 34 million more have low bone density, placing them at increased risk for osteoporosis and bone fractures. Osteoporosis is the most common cause of hip fractures, a tragedy that can result in permanent disability, loss of independence or death. A woman's risk of a hip fracture is equal to her combined risk of breast, uterine and ovarian cancer.

Extra sensitivity to cold- There is much variation in the sensitivity to cold experienced by different people, with some putting on many layers of clothing while others in the same environment feel comfortable in one layer.Cold sensitivity may be a symptom of

hypothyroidism, anemia, or vasoconstriction (according to article Sauna). There may also be differences in people in the expression of uncoupling proteins, thus affecting their amount of thermogenesis.

• Bloated stomach after eating (since the stomach loses its ability to deal with a normal quantity of food at one sitting)

Lanugo--a fine hair that grows on the skin in response to the body's need for warmth Downy hair on the body of the fetus and newborn baby. It is the first hair to be produced by the fetal hair follicles, usually appearing on the fetus at about five months of gestation. It is very fine, soft, and usually unpigmented. Although lanugo is normally shed before birth around seven or eight months of gestation, it is sometimes present at birth. This is not a cause for concern: lanugo will disappear within a few days or weeks of its own accord.

• Yellowed skin (often from getting too much vitamin A as a result of eating only certain foods, like carrots) • Thinning hair

Mental and Behavioral Symptoms of Anorexia Nervosa In addition to physical changes, friends and family may notice changes to the person's thoughts and behaviors: • Distortion of body image or excessive importance placed on body composition or shape • Denial of seriousness of low weight • Intense fear of gaining weight or becoming fat, even if the person is considered underweight • Confused thinking (since the brain needs fuel to function properly) • Ritualistic eating (including cutting food into a planned number of bites) • Spitting out food before swallowing • Much more attention paid to nutrition labels • Major increase in exercise output, even when exhausted • Hatred for foods that used to be favorites • Refusal to eat with others

Binge eating (for the binge eating/purging subtype of anorexia)

Increased or unnecessary use of laxatives, or vomiting after eating (for the binge eating/purging subtype of anorexia)

FOOD AVOIDANCE
Retrospective and longitudinal study was carried out on all children and adolescents who presented to a child psychiatry service over a period of 26 years to identify the nature, course, and outcome of cases meeting criteria for anorexia nervosa (n = 27). Two groups of the same age were identified for comparison, firstly those with food avoidance and emotional disorders (n = 23), and secondly those with emotional disorders but no symptoms associated with eating (n = 22). The results confirm previous reports that early onset anorexia nervosa shows a similar nature, course, and outcome to the adult disease. Being tall at presentation seems to be associated with a poor outcome. Self starvation of early onset may result in short stature in some cases. There seem to be more boys among the group in whom the disease was of early onset than would be predicted from the sex ratio among adult patients. In addition boys with anorexia nervosa may have a better prognosis than girls. Children with food avoidance emotional disorders seem to have a worse prognosis than expected for childhood emotional disorders. They may represent a middle group between those with anorexia

nervosa and those with emotional disorders but no symptoms associated with eating. Scientists have identified a new eating disorder which affects children - fear of food. Researchers from the Institute of Child Health and Great Ormond Street Hospital have dubbed the disease Food Avoidance Emotional Disorder (FAED). Children with the illness want to get better and gain weight, but are afraid to eat - unlike those with anorexia nervosa who are scared of putting on weight. The researchers said FAED children tended to be younger than those with anorexia nervosa and were more likely to be boys and of non-British origin. Anorexia nervosa mainly affects young girls with a poor self image. Most are aged around 13-and-ahalf. Stunted growth The average age of children with FAED is just under 12 years old. The researchers found that the young age of onset of the illness could lead to "significant stunting". But they said that this could be reversed if children received proper treatment. Dr Dasha Nicholls of the Institute of Child Health said she saw around 60 children a year with eating disorders. Half had anorexia nervosa, but as many as a quarter were simply afraid to eat. Twice as many girls had the

disorder as boys, but nine times as many girls had anorexia nervosa as boys. A large proportion of the children from ethnic minorities with the fear were Asian. Dr Nicholls said this could be to do with the way Asian families interpret eating disorders. They might, for example, be less likely to put an eating disorder down to fear of putting on weight. Fear of choking She said there were many reasons a child might become afraid to eat. The children she saw were aged between seven and 15. Most had grown normally until suddenly something went wrong and they began to avoid food. Some were worried they would choke or be sick if they ate. Some complained of stomach pains. Dr Nicholls said one reason for the disease could be an earlier illness which caused a child to have a bad experience with food. "They may have felt anxious and their throat tightened and they were unable to swallow and they linked this feeling to food," she said. The research team also found that children with the disorder tended to go to doctors because of physical rather than psychological problems associated with the illness. "Losing weight is always abnormal for children as they are growing," said Dr Nicholls. She added that doctors often felt the reason for food avoidance was solely physical and began lots

of investigations. She said they should consider that the problem may also be psychological. She added that children with FAED might also have a physical problem which caused their fear. Extremely thin Some of the children she has seen are thinner than children with anorexia because doctors have spent so much time investigating the cause rather than treating the disease. At Great Ormond Street Hospital, treatment includes parental counselling. This is tailored to each individual child and involves looking at what the fear is and how much food the child needs to eat and when. Some children are afraid to eat because they feel full very quickly and they should eat small meals regularly rather than big meals.

MEDICAL COMPLICATIONS
Medical complications can frequently be a result of eating disorders. Individuals with eating disorders who use drugs to stimulate vomiting, bowel movements, or urination may be in considerable danger, as this practice increases the risk of heart failure. In patients with anorexia, starvation can damage vital organs such as the heart and brain. To protect itself, the body shifts into "slow gear": monthly menstrual periods stop, breathing, pulse, and blood pressure rates drop, and thyroid function slows. Nails and hair become brittle; the skin dries, yellows, and becomes covered with soft hair called lanugo. Excessive thirst and frequent urination may occur. Dehydration contributes to constipation, and reduced body fat leads to lowered body temperature and the inability to withstand cold. Mild anemia, swollen joints, reduced muscle mass, and lightheadedness also commonly occur in anorexia. If the disorder becomes severe, patients may lose calcium from their bones, making them brittle and prone to breakage. They may also

experience irregular heart rhythms and heart failure. In some patients, the brain shrinks, causing personality changes.

Fortunately, this condition can be reversed when normal weight is reestablished. In NIMH-supported research, scientists have found that many patients with anorexia also suffer from other psychiatric illnesses. While the majority have co-occurring clinical depression, others suffer from anxiety, personality or substance abuse disorders, and many are at risk for suicide. Obsessive-compulsive disorder (OCD), an illness characterized by repetitive bouts and behaviors, can also accompany anorexia. Individuals with anorexia are typically compliant in personality but may have sudden

outbursts of hostility and anger or become socially withdrawn. Bulimia nervosa patients -- even those of normal weight -- can severely damage their bodies by frequent binge eating and purging. In rare instances, binge eating causes the stomach to rupture; purging may result in heart failure due to loss of vital minerals, such as potassium. Vomiting causes other less deadly, but serious, problems -- the acid in vomit wears down the outer layer of the teeth and can cause scarring on the backs of hands when fingers are pushed down the throat to induce vomiting.

Further, the esophagus becomes inflamed and glands near the cheeks become swollen. As in anorexia, bulimia may lead to irregular menstrual periods. Interest in sex may also diminish. Some individuals with bulimia struggle with addictions, including abuse of drugs and alcohol, and compulsive stealing. Like individuals with anorexia, many people with bulimia suffer from clinical depression, anxiety, OCD, and other psychiatric illnesses. These problems, combined with their impulsive tendencies, place them at increased risk for suicidal behavior. People with binge eating disorder are usually overweight, so they are prone to the serious medical problems associated with obesity, such as high cholesterol, high blood pressure, and diabetes. Obese individuals also have a higher risk for gallbladder disease, heart disease, and some types of cancer. Research at NIMH and elsewhere has shown that individuals with binge eating disorder have high rates of co-occurring psychiatric illnesses -- especially depression. Anorexia is an extremely dangerous illness with a shockingly high mortality rate. A person with anorexia starves herself to dangerously thin levels, at least 15% below what would be considered normal body weight. Although men can and do

struggle with anorexia, it is far more prevalent in women. Because the body needs food to function correctly, starving takes a significant toll on a woman’s health. The medical impact of anorexia is huge and includes: Amenorrhea - Loss of Menstrual Cycle - This occurs in nearly all women with anorexia. The body simply shuts down its reproductive capacity because it is finding it difficult to sustain one life, let alone, two. Although a woman’s ability to bare children usually returns once sufficient weight is gained, that is not always the case. Anorexia, if engaged in long enough or at a critical time during adolescence, can contribute to infertility. Anemia -Without sufficient nutrition, the blood is affected and anemia results. Fortunately, this condition is only temporary; blood health returns once food is reintroduced. Dry Skin and Hair Loss- Dehydration causes the skin to drastically dry out and become flaky. The woman’s scalp, starved for protein and nutrients, often becomes bald or patchy. Paradoxically, extremely fine hair growth often occurs on other parts of the torso; this is an attempt by the body to keep itself warm.

Feeling Cold-Without protective fat stores to keep them warm, those with anorexia are usually cold. In fact, their body temperature is rarely at a healthy 98 degrees; it’s typically a couple of degrees less that normal. Slowness of Thought/Brain Shrinkage -Although retardation of thought is temporary, due to lack of fuel to keep the brain functioning well, actual brain shrinkage, due to prolonged starvation, is not. Studies show a drop in actual IQ, which does not always return once the woman gets well. Osteopenia/Osteoporosis- These degenerative bone conditions result from lack of calcium and other dietary deficiencies. Most bone loss is permanent, leaving even young women at severe risk of bone fractures and spinal curvature. Heart Rhythm Abnormalities, Heart Attacks - Electrolyte abnormalities often trigger arrhythmias in the heart. This is a significant indication that the heart is undergoing stress. When a body is starving, it starts attacking its own muscle tissue in an effort to stay alive. The heart is a muscle and is not immune to this attack. In the case of extreme starvation, the heart simply stops. Many of these medical complications can improve once a person recovers from the disorder. And for those that don't

resolve, the sooner a person seeks treatment, the less severe the complication will be.

PSYCHOLOGICAL FACTORS
A number of theories have been advanced to explain the psychological factors of the disorder. No single explanation covers all cases. Anorexia nervosa has been interpreted as: • A rejection of female sexual maturity. This rejection is variously interpreted as a desire to remain a child, or as a desire to resemble men as closely as possible. • A reaction to sexual abuse or assault. • A desire to appear as fragile and nonthreatening as possible. This hypothesis reflects the idea that female passivity and weakness are attractive to men.

Overemphasis on control, autonomy, and independence. Some anorexics come from achievement-oriented families that stress physical fitness and dieting. Many anorexics are perfectionistic and "driven" about schoolwork and other matters in addition to weight control.

• Evidence of family dysfunction. In some families, a daughter's eating disorder serves as a distraction from marital discord or other family tensions.

• Inability to interpret the body's hunger signals accurately due to early experiences of inappropriate feeding. Although anorexia nervosa is still considered a disorder that largely affects women, its incidence in the male population is rising. Less is known about the causes of anorexia in males, but some risk factors are the same as for females. These include certain occupational goals and increasing media emphasis on external appearance in men. Moreover, homosexual males are under pressure to conform to an ideal body weight that is about 20 pounds lighter than the standard "attractive" weight for heterosexual males.

BODY OF FIGURE CONSCIOUSNESS
Contemporary culture increasingly suffers from problems of

attention, over-stimulation, and stress, and a variety of personal and social discontents generated by deceptive body images. This book argues that improved body consciousness can relieve these problems and enhance one’s knowledge, performance, and

pleasure. The body is our basic medium of perception and action, but focused attention to its feelings and movements has long been criticised as a damaging distraction that also ethically corrupts through self-absorption. In Body Consciousness, Richard

Shusterman refutes such charges by engaging the most influential twentieth-century somatic philosophers and incorporating insights from both Western and Asian disciplines of body-mind awareness. Rather than rehashing intractable ontological debates on the mindbody relation, Shusterman reorients study of this crucial nexus towards a more fruitful, pragmatic direction that reinforces important but neglected connections between philosophy of mind, ethics, politics, and the pervasive aesthetic dimensions of everyday life.

Many kids — particularly teens — are concerned about how they look and can feel self-conscious about their bodies. This can be especially true when they are going through puberty, and undergo dramatic physical changes and face new social pressures. Unfortunately, for a growing proportion of kids and teens, that concern can grow into an obsession that can become an eating disorder. Eating disorders such as anorexia nervosa or bulimia nervosa cause dramatic weight fluctuation, interfere with normal daily life, and damage vital body functions. Parents can help prevent kids from developing an eating disorder by nurturing their self-esteem, and encouraging healthy attitudes about nutrition and appearance. Also, if you are worried that your child may be developing an eating disorder, it's important to intervene and seek proper medical care. This is also true if there is any family history of eating disorders. Generally, eating disorders involve self-critical, negative thoughts and feelings about body weight and food, and eating habits that disrupt normal body function and daily activities. While more common among girls, eating disorders can affect boys, too. They're so common in the U.S. that 1 or 2 out of every 100 kids

will struggle with one, most commonly anorexia or bulimia. Unfortunately, many kids and teens successfully hide eating disorders from their families for months or even years. People with anorexia have an extreme fear of weight gain and a distorted view of their body size and shape. As a result, they strive to maintain a very low body weight. Some restrict their food intake by dieting, fasting, or excessive exercise. They hardly eat at all and often try to eat as few calories as possible, frequently obsessing over food intake. The small amount of food they do eat becomes an obsession. Bulimia is characterized by habitual binge eating and purging. Someone with bulimia may undergo weight fluctuations, but rarely experiences the low weight associated with anorexia. Both disorders can involve compulsive exercise or other forms of purging food they have eaten, such as by self-induced vomiting or laxative use. Although anorexia and bulimia are very similar, people with anorexia are usually very thin and underweight but those with bulimia may be a normal weight or even overweight. Binge eating disorders, food phobia, and body image disorders are also becoming increasingly common in adolescence.

It's important to remember that eating disorders can easily get out of hand and are difficult habits to break. Eating disorders are serious clinical problems that require professional treatment by doctors, therapists, and nutritionists. If you suspect your child has an eating disorder, it's important to intervene and help your child get diagnosed and treated. Kids with eating disorders often react defensively and angrily when confronted for the first time. Many have trouble admitting, even to themselves, that they have a problem. Sometimes getting a family member or friend who has been through treatment for an eating disorder can help encourage someone to get help. Trying to help when someone doesn't think he or she needs it can be hard. As hard as it might be, getting the professional assistance needed, even if your child resists, is the best help you can give as a parent. Approach your child in a loving, supportive, and nonthreatening way when your child feels comfortable and relaxed and there are no distractions. Your child may be more receptive to a conversation if you focus on your own concerns, and use "I" statements, rather than "you" statements. For example, steer clear of statements like "you have an

eating disorder" or "you're obsessed with food," which may only prompt anger and denial. Instead, try "I imagine that it's very stressful to count calories of everything you eat" or "I'm worried that you have lost so much weight so quickly." Cite specific things your child has said or done that have made you worry, and explain that you want your child to see a doctor to put your own mind at ease. If you still encounter resistance, talk with your doctor or a mental health care professional about other approaches. Treatment focuses on helping kids cope with their disordered eating behaviors and establish new patterns of thinking about and approaching food. This can involve medical supervision, nutritional counseling, and therapy. The professionals will address a child's perception about his or her body size, shape, eating, and food. Kids who are severely malnourished may require hospitalization and ongoing care after their medical condition stabilizes. Generally, the earlier the intervention (ideally, before malnutrition or a continual binge-purge cycle starts), the shorter the treatment required. You can play a powerful role in your child's development of healthy attitudes about food and nutrition.

Your own body image can influence your kids. If you constantly say "I'm fat," complain about exercise, and practice "yo-yo" dieting, your kids might feel that a distorted body image is normal and acceptable. At a time of great societal concern about obesity, it can be tricky for parents to talk with their kids about their eating habits. It's best to emphasize health, rather than weight. Make sure your kids know you love them for who they are, not how they look. It's OK to appreciate attractiveness in celebrities — if your kids (and you!) feel OK about how they look, it won't prompt them to try to change to be like someone else. Getting the message that they're great as they are and that their bodies are healthy and strong is a wonderful gift that parents can give their kids. Try to avoid power struggles regarding food — if your teen wants to "go vegetarian," be supportive even if you're an avid meat-eater. Teens frequently go through "faddy" eating periods, so try to set good limits, encourage healthy eating, and avoid fighting over food issues. Kids can catch on pretty quickly if their parents panic over one skipped meal. Try to gain perspective and talk to your kids about what's going on if they don't want to eat with the family.

Finally, take an active role in creating a healthy lifestyle for your family. Involve your kids in the preparation of healthy, nutritious meals. Let them know that it's OK to eat when hungry and refuse food when they're not. Also, make exercise a fun, rewarding, and regular family activity. Developing your own healthy attitudes about food and exercise will set an excellent example for your kids.

TREATMENT OF ANOREXIA
There are a number of treatments used for anorexia nervosa. A treatment plan is developed to address the specific needs of the individual. It usually includes treating any serious medical problems first and then focusing on weight gain and addressing the psychological issues that have led to the development and maintenance of the anorexia nervosa. Regaining weight is a key part of any treatment plan since improvements in mood, personality, and interpersonal relationships cannot be sustained without it. Factors that determine the types of treatments are: • The person's age • Current living arrangements • How long the person has had anorexia nervosa

• Overall medical condition, including weight

Other eating disorder symptoms, such as binge eating, vomiting, or laxative abuse

• Poor results with previous treatments • Severity of other associated psychological symptoms, such as depression, problems controlling impulses, and personality problems The overall goals of treatment are to: • Treat medical complications • Gradually gain weight to a level that allows normal menstrual periods to begin • Normalize eating • Eliminate inappropriate weight control behaviors • Help the person cope with changes in eating and weight • Deal with psychological and family problems that have caused the disorder or have led to it being maintained over time The types of treatments that may be used for anorexia nervosa include:
• •

Psychotherapy Support groups

• •

Medication Hospitalization

Psychotherapy

Individual psychotherapy is the cornerstone of treatment for anorexia nervosa, especially for people who are beyond adolescence and who are not living at home. Individual therapy provides a safe place to learn how to identify concerns, solve problems, overcome fears, and test new skills. There are many types of individual therapy. Cognitive behavioral approaches can help to develop healthy ways of thinking and patterns of behavior, particularly with food and relationships. Other kinds of therapy emphasize important interpersonal relationships and psychological issues, such as self-esteem.

Family therapy is almost always used as part of treatment when the person with anorexia nervosa is young or living at home. Family therapy can be useful to provide information about anorexia nervosa, assess the impact of the disorder on the family, help members overcome guilt, improve

communication and decision-making skills, develop strategies

for coping, and develop practical strategies for overcoming the disorder.

Marital therapy is almost always valuable when the person with anorexia nervosa is married. The primary goal of marital therapy is to strengthen the relationship. It can provide practical suggestions on how to deal with the disorder. It may also help identify and resolve communication problems.

Group therapy can play an important role as part of hospital treatment, partial hospitalization or intensive day treatment. There are many different types of groups, each with different goals and orientations. Some groups are "task-oriented" and may focus on food, eating, body image, interpersonal skills, and vocational training. Other groups are aimed at

understanding the psychological factors that may have led to the development and maintenance of the disorder. Groups can assist in dealing with other associated emotional symptoms, such as anxiety, depression and anger. Sharing experiences with others in a group can be very effective in helping reduce guilt, shame, and isolation, and can lead to important insights regarding strategies for recovery. Support Groups

Support groups led by non-professionals may be helpful under certain circumstances; however, it is usually best to have groups facilitated by a professional. Support groups can provide people with anorexia nervosa and their families with mutual support and advice about how to cope with the disorder. They can also prepare someone for therapy who is afraid of it. Support groups can be counterproductive if they foster an "anorexic identity" or provide peer-group support for maintaining eating disorder behaviors. Medication Many medications have been tried in treating anorexia nervosa. It is generally agreed that medication alone is not effective. Because depression and other emotional problems are often a result of starvation, it is best to focus on weight gain rather than medication. In addition, the effects of starvation decrease the effectiveness of antidepressants and worsen the side effects. However, occasionally, medication may be required to deal with overwhelming anxiety, obsessions, depression, or gastric discomfort following meals. Hospitalization Hospitalization is rarely sufficient to cure anorexia nervosa. However, it may be required to:

• Interrupt steady weight loss or promote weight gain if there has been a failure to gain weight in outpatient care • Interrupt bingeing and vomiting • Control weight gain that is occurring too rapidly • Evaluate and treat physical complications • Address other serious psychological problems reflected by severe depression, suicidal behavior, self-destructive behavior, or substance abuse One of the advantages of hospital treatment is that it provides a safe environment where food and weight can be carefully monitored while psychological concerns are explored. There are various settings in which hospitalization can occur, including general hospitals, psychiatric hospitals, and specialized eating disorders programs. Although there are advantages and disadvantages to each of these settings, they can all lead to treatment success. While in the hospital, a variety of types of treatment may be used, such as family meetings, individual therapy, group therapy, occupational therapy, and occasionally medication.

Partial care programs share many features with inpatient programs. Patients receive similar therapeutic services; however, the major difference is that they do not stay overnight. Partial hospitalization has economic and clinical advantages over inpatient treatment. Partial programs usually provide enough structure around meal times, plus the possibility for intensive therapy, that is sufficient for most patients to make behavioral changes, without requiring them to be totally disengaged from the supports and the therapeutic challenges outside of the hospital. Nutritional therapy A dietitian offers guidance on a healthy diet. A dietitian can provide specific meal plans and calorie requirements to help meet weight goals. In severe cases, people with anorexia may require feeding through a tube that's placed in their nose and goes to the stomach (nasogastric tube). Treatment challenges in anorexia Anorexia occurs on a continuum. Some cases are much more severe than others. Less severe cases may take less time for treatment and recovery. But one of the biggest challenges in treating anorexia is that people may not want treatment or think they don't need it. In fact, some people with anorexia promote it as a lifestyle choice.

They don't consider it an illness. Pro-anorexia Web sites are proliferating, even offering tips on which foods to avoid and how to fight hunger pangs. Even if you do want to get better, the pull of anorexia can be difficult to overcome. Anorexia is often an ongoing, lifelong battle. It may wax or wane. Even if symptoms subside, you remain vulnerable and may have a relapse during periods of high stress or during triggering situations. For some women, for instance, anorexia symptoms may subside during pregnancy but return after pregnancy. Ongoing therapy or periodic appointments during times of stress may be helpful.

CONCLUSION
There is a lot of blame surrounding anorexia and other eating disorders.There are two very sensitive issues involved. The first is that 'mental illness' carries enormous stigma. The fact that research on anorexia nervosa continues to assert that eating disorders are psychiatric illnesses means that they, too, carry a stigma. The second is that parents are highly sensitive to any criticism of their parenting skills. Regarding the first issue background is in psychology, philosophy and social anthropology. Like to question and uncomfortable with the idea of statics such as 'mental illness.'

It is my belief that there is no such thing. There are simply healthy and unhealthy ways of thinking. Having recovered from anorexia, ountable. I, as a parent, am fully aware of how the slightest criticism can be painful. I am far more aware, however, of my need to continually grow as a person in order to be the best parent . Honestly put your hand on yours heart and say that you are able to put your son first, and give him the love and integrity he deserves, We are in an age of enlightenment. Gone are the days when we can be content with the image we portray to others. The human race has taken huge leaps and bounds in terms of our consciousness and our awareness of where it can take us. If we are to help those suffering from anorexia - whether they are our children, our partners, our students, or our friends, we must stop looking for who is to blame. We must stop depending on research on anorexia that is stagnant and misleading. We must stop being scared and understand that eating disorders are simply about low self esteem and that the remedy is available to us all, as parents, as families, as educators and as friends. Low self esteem and depression are endemic in western society, and are rapidly rising. Yet more than ever we have access to ways to build self esteem in ourselves and our children. If we are to truly

prevent anymore anorexia in teenage girls, and all forms of depression in our children and our society, we must access those ways.

COUNSELING IMPLICATIONS
It is also a means to sustain and nourish our bodies. But to someone suffering from anorexia, food is the enemy. Anorexia is a true medical condition in which someone will literally starve themselves to death in an attempt to stay dangerously thin. While all of us diet from time to time, an anorexic is continually obsessed with their body weight, which is closely linked to their self-image and esteem level. The thinner they are, the better they believe they will look. However, what they find is thin is never thin enough. According to the Journal of the American Academy of Child and Adolescent Psychiatry, the prevalence of eating disorders has doubled in the last 40 years. Alarmingly, doctors now see children as young as seven with symptoms of anorexia. Even more disturbing is the fact that 40 percent of all nine-year-old girls have already dieted. It is further estimated that up to 3.7 percent of all females between the ages of 15 and 35 currently suffer from anorexia. The National Institute of Mental Health (NIMH) states that the mortality rate among anorexics is 12 times higher than the annual death rate for all causes of death in females between the

ages of 15 and 24. This translates to almost 18 percent of all anorexics, a death rate that is actually higher than some cancers. The good news is that anorexia can be cured. While the first step is to ensure healthy weight gain, therapy and counseling is an essential and highly effective component to a full recovery. There is no one specific reason why someone will develop an eating disorder but researchers have found that certain people are at higher risk than others. According to a review in the International Journal of Eating Disorders, 90 percent of all anorexics are females, 40 percent of which are young adolescents between the ages of 15 and 19.

Generally, it is believed that anorexia stems from a combination of psychological, social and biological factors. From a psychological standpoint, if you suffer from anorexia, typically you will have selfesteem issues, which manifest as an intense fear of gaining weight or becoming fat, poor coping skills and difficulty making and keeping close relationships. Additionally, most anorexics tend to be extreme perfectionists. People with anorexia see their bodies much differently than the rest of us. Where most of us may see ourselves as more attractive than others might actually rate us, anorexics,

according to one study published in the British Journal of Clinical Psychology, tend to lack what is termed a self-esteem boosting bias. Simply put, if you are anorexic, you will see yourself in a less flattering light than the rest of us and as such, no matter what your weight, you will consistently believe you are obese. This, in part, accounts for why so many anorexics are also highly anxious and clinically depressed.

Social contributors such as inappropriate family dynamics play a big part in any eating disorder. For instance, almost half of all anorexics admitted to hospital have been sexually abused,

according to the Department of Psychiatry at Toronto General Hospital. As well, the media constantly portrays perfect, skinny women as the ideal image. “You can’t be too thin” is a common motto among models, dancers and celebrities. Young girls quickly become obsessed, looking to unrealistic role models for an image they will never realistically obtain.

For people who don’t suffer from an eating disorder, it is often hard to understand why someone would purposely starve themselves to death. But we now understand that much of anorexia has a

biological component. Recent studies conducted at Michigan State University show that more than 50 percent of anorexia cases have a genetic basis. As well, according to the University of Pittsburgh, anorexia is further linked to abnormal levels of the

neurotransmitter serotonin. What this means is that if you are anorexic, you do in fact suffer from a true medical condition. Eating disorders have the highest mortality rate of all the psychiatric disorders. When you starve yourself of food, you are essentially slowly killing every organ in your body. Most deaths among anorexics result from heart failure. Typically, anorexics weigh only 85 percent of what is considered within healthy limits. Poor nutrition results in reduced immune system

functioning and white blood cell count, poor circulation, creaking bones, amenorrhea (stopped menstruation), low blood pressure and fainting spells, hypothermia, slowed heart rate and nerve damage just to name a few of the many negative implications of this disorder. Psychologically, anorexia creates intense emotional

turmoil, compounding already low self-esteem with feelings of guilt and shame, which ultimately put you at further risk for such things as alcohol and drug abuse. Anorexia is a life-threatening illness, but you can get help. Because anorexia is such a complex

condition, often both individual and family counseling are effective. The sooner anorexia is treated, the better chance you have for a full physical and emotional recovery. Fear is the most common first response to the idea of treatment for anorexia. “Help” and “health” are heard as gaining weight and becoming fat. A feeling of being out of control can take hold. The first step to recovery in counselling treatment is understanding what anorexia is, and why you have embarked on this relentless pursuit for thinness. Anorexia may appear on the surface to be about body size, however your slowly disappearing body is telling a story of what you are feeling and believing about yourself and your place in this world. Unless you are at a life threatening stage, this first step encompasses a process of time to allow you to understand your pursuit of thinness, and then for the steps of learning new and healthier coping skills to replace your pursuit that is slowly killing you. Change is an important yet difficult element in recovery from anorexia. It is unavoidable, and often just understanding its natural results and affect on us can ease a good portion of our fear of recovery. Recovery from anorexia is really about recovery of a self that has become lost beneath the “voice” and the “demands” of anorexia. It is a step to choosing such things as life over death, the

restoration of your self-worth and your emotions, and reclaiming positive attitudes and belief’s, which make for a truly better life.

PAST STUDY
Anorexia nervosa is a psychiatric illness that describes an eating disorder characterized by extremely low body weight and body image distortion with an obsessive fear of gaining weight.

Individuals with anorexia are known to control body weight commonly through the means of voluntary starvation, purging, excessive exercise or other weight control measures such as diet pills or diuretic drugs. While the condition primarily affects adolescent females approximately 10% of people with the diagnosis are male[1]. Anorexia nervosa, involving neurobiological,

psychological, and sociological components[2] is a complex condition that can lead to death in severe cases. The term anorexia is of Greek origin: a (α, prefix of negation), n (ν, link between two vowels) and orexis (ορεξις, appetite), thus meaning a lack of desire to eat.[3] "Anorexia nervosa" is frequently shortened to "anorexia" in the popular media. This is technically incorrect as the term "anorexia" may be misinterpreted as a symptom of reduced appetite while the medical condition is technically called anorexia nervosa. There is no

definition to "nervosa" in the English language. Bulimia nervosa is a related condition to anorexia nervosa. Orthorexia nervosa may be added to the DSM, but is currently a psychological illness that has been coined by Steven Bratman, a Colorado MD. .[4] Argyreia nervosa, Mahonia nervosa, Utricularia nervosa and Lettsomia nervosa are all unrelated genus and species names for plants. Established by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the World Health Organization's

International Statistical Classification of Diseases and Related Health Problems (ICD). Although biological tests can aid the diagnosis of anorexia, the diagnosis is based on a combination of behavior, reported beliefs and experiences, and physical characteristics of the patient. Anorexia is typically diagnosed by a clinical psychologist,

psychiatrist or other suitably qualified clinician. Notably, diagnostic criteria are intended to assist clinicians, and are not intended to be representative of what an individual sufferer feels or experiences in living with the illness. The full ICD-10 diagnostic criteria for anorexia nervosa can be found here, and the DSM-IV-TR criteria can be found here.

be diagnosed as having anorexia nervosa, according to the DSM-IVTR, a person must display:
1. Refusal to maintain body weight at or above a minimally

normal weight for age and height (e.g., 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).
2. Intense fear of gaining weight or becoming obese

3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on selfevaluation, or denial of the seriousness of the current low body weight.
4. The absence of at least three consecutive menstrual cycles

(amenorrhea) in women who have had their first menstrual period but have not yet gone through menopause

(postmenarcheal, premenopausal females). Furthermore, the DSM-IV-TR specifies two subtypes:

Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (that is, self-induced vomiting, overexercise or the misuse of laxatives, diuretics, or enemas)

Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating OR purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas).

The ICD-10 criteria are similar, but in addition, specifically mention 1. The ways that individuals might induce weight-loss or maintain low body weight (avoiding fattening foods, selfinduced vomiting, self-induced purging, excessive exercise, excessive use of appetite suppressants or diuretics).
2. Certain

physiological disorder

features,

including

"widespread

endocrine

involving

hypothalamic-pituitary-gonadal

axis is manifest in women as amenorrhoea and in men as loss of sexual interest and potency. There may also be elevated levels of growth hormones, raised cortisol levels, changes in the peripheral metabolism of thyroid hormone and abnormalities of insulin secretion". 3. If onset is before puberty, that development is delayed or arrested. Changes in brain structure and function are early signs often to be associated with starvation, and is partially reversed when normal

weight is regained.[6] Anorexia is also linked to reduced blood flow in the temporal lobes, although since this finding does not correlate with current weight, it is possible that it is a risk trait rather than an effect of starvation. • Extreme weight loss

Body mass index less than 17.5 in adults, or 85% of expected weight in children

• Stunted growth

Endocrine disorder, leading to cessation of periods in girls (amenorrhoea)

• •

Decreased libido; impotence in males Starvation symptoms, such as reduced metabolism, slow heart rate (bradycardia), hypotension, hypothermia and anemia

Abnormalities of mineral and electrolyte levels in the body

• Thinning of the hair

Growth of lanugo hair over the body

• Constantly feeling cold
• • • •

Zinc deficiency Reduction in white blood cell count Reduced immune system function Pallid complexion and sunken eyes

• Creaking joints and bones • Collection of fluid in ankles during the day and around eyes during the night
• •

Tooth decay Constipation

• Dry skin • Dry or chapped lips • Poor circulation, resulting in common attacks of 'pins and needles' and purple extremities

In

cases of extreme weight

loss, there

can be

nerve

deterioration, leading to difficulty in moving the feet
• • •

Headaches Brittle fingernails Bruising easily

• Fragile appearance; frail body image • Slowing of the rate of growth of breasts • drastic changes in blood pressure upon standing Psychological

Distorted body image

• Poor insight

• Self-evaluation largely, or even exclusively, in terms of their shape and weight • Pre-occupation or obsessive thoughts about food and weight
• •

Perfectionism Obsessive compulsive disorder (OCD)

• Belief that control over food/body is synonymous with being in control of one's life • Refusal to accept that one's weight is dangerously low even when it could be deadly • Refusal to accept that one's weight is normal, or healthy Emotional
• • • •

Low self-esteem and self-efficacy Phobia of becoming overweight Clinical depression or chronically low mood Mood swings

Behavioral • Excessive exercise, food restriction • Secretive about eating or exercise behavior

Self-harm, substance abuse or suicide attempts

• Very sensitive to references about body weight

• Aggressive when forced to eat "forbidden" foods • social withdraw or being anti-social • body checking Diagnostic issues and controversies The distinction between the diagnoses of anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified (EDNOS) is often difficult to make in practice and there is considerable overlap between patients diagnosed with these conditions. Furthermore, seemingly minor changes in a patient's overall behavior or attitude (such as reported feeling of 'control' over any binging behavior) can change a diagnosis from 'anorexia: binge-eating type' to bulimia nervosa. It is not unusual for a person with an eating disorder to 'move through' various diagnoses as his or her behavior and beliefs change over time. Additionally, it is important to note that an individual may still suffer from a health- or life-threatening eating disorder (e.g., subclinical anorexia nervosa or EDNOS) even if one diagnostic sign or symptom is still present. For example, a substantial number of patients diagnosed with EDNOS meet all criteria for diagnosis of

anorexia nervosa, but lack the three consecutive missed menstrual cycles needed for a diagnosis of anorexia.[2] Feminist writers such as Susie Orbach and Naomi Wolf have criticized the medicalization of extreme dieting and weight-loss as locating the problem within the affected women, rather than in a society that imposes concepts of unreasonable and unhealthy thinness as a measure of female beauty. A vigorous debate exists on the topic of whether eating disorders are a choice or a biological illness. In 2006, Dr. Thomas Insel, director of the US National Institute of Mental Health, wrote an open letter to the National Eating Disorder Association stating

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