ANOREXIA NERVOSA IN ADOLESCENTS
Prepared by: Amandeep Singh sidhu, Anupama parajuli, Kajal Sapra and
Oshadi Puhabhugoda Arachchigedo
Introduction
Anorexia nervosa is a psychological illness that has disastrous physical and mental consequences. Anorexia nervosa is characterised by
low body weight and body image distortion with an obsessive fear of gaining weight, which is apparent through the body as the
amount of food consumed is extremely low. The focus of this poster is to actively explore causative factors of anorexia nervosa within
the age frame of 15-24 which is classified of groups teenagers and adolescents including factors like evidence regarding ways to
address the issue, mental health services available and other relevant issues arising upon the topic anorexia nervosa.
Define and Diagnosis
Anorexia nervosa does not have a specific underlying cause. However, it is identified with a wide range of components. These
elements are labelled as being either predisposing, precipitating, and perpetuating factors which makes individuals hopeless and
vulnerable. Individuals with anorexia nervosa begins the journey as wanting to be fit or eating healthier. Unfortunately, this leads to
extremely unsafe practices of not eating which causes to lose weight in an unbelievable manner.
The diagnostic process of anorexia nervosa is extremely Challenging as the diagnostic stage involves understanding individuals'
thoughts and ideas where denial plays a huge role. Individuals with anorexia nervosa tends to go into a denial stage due to the
inability to understand that something is wrong. To diagnose an individual with anorexia nervosa doctors and medical experts
undertake test including blood tests to figure out the underlying cause of losing weight, according to findings individuals are referred
to mental specialists as although anorexia nervosa is visible through the physical appearance it is mainly occurs due to the mental
processes of individuals.
There are 3 basic features of anorexia nervosa. Persistent energy intake restriction, intense fear of gaining weight or becoming fat, or persistent
behaviour that interferes with weight gain and disturbance in self perceived weight or shape. The individual keeps up a weight that is under an
ordinary level for age sex, and actual wellbeing. Individuals body weights meet the following criteria due to significant weight losses mostly among
teenagers. There may on the other hand be inability to make expected weight gain or to keep up a typical direction rather than weight reduction.
Individuals with this disorder typically has an intense fear of gaining weight or of becoming fat (criterion B). This extreme dread of turning out to be
fat is generally not weakened by weight reduction. In fact, the worry about weight gain may increment even as weight falls. Younger individuals
majorly teenagers and adolescents with anorexia nervosa, may not perceive or recognize a fear of weight gain.
The experience and significance of body weight and shape are distorted in these people (measure C). some individuals feel globally overweight
whereas others understand that they are thin however are as yet worried that specific body parts, especially the mid-region, backside, and thighs are
'excessively fat'. They may utilize an assortment of methods to assess their body size or weight, including the use of constantly checking themselves
through a mirror. The confidence of people with anorexia nervosa is exceptionally subject to their view of body shape and weight. weight reduction is
frequently seen as an amazing accomplishment and an indication of remarkable self-restraint, while weight gain is seen as an unsatisfactory
disappointment of discretion. however, some people with this issue may recognize being slim, they frequently do not perceive the genuine clinical
ramifications of their malnourished state.
Critical Analysis
Anorexia nervosa can begin at any age, upon research it is to be concluded that following asthma and obesity, anorexia is the third most common
chronic disorder amongst females aged 15 to 24 years (National Eating Disorders collaboration (NEDC0, 2019). Evidence demonstrates that anorexia is
most prevalent mainly in the female population of 0.5-1.0% (Tafa et al., 2017). With evidence it is evident that risks associated in anorexia nervosa in
females are anaemia, disturbance to menstruation, and infertility. Anorexia nervosa is also highly evident in this age group due to having a mental idea
of wanting to be perfect and change the appearance which is influenced now a days with the use of social media.
The initial point of treatment of eating disorders are often the nurses who play a key role in initiating the foundation for recovery, especially with
consumers who do not perceive that there is any problem (bakker et al., 2011). Nurses play a vital role in addressing the complicated issue of anorexia
nervosa as with many individuals, for them to understand that there is an issue is usually the process which is complex as changing the ideas and
thoughts are difficult. Nurses partake in the treatment process, beginning with comprehensive initial assessment which includes collecting the past
medical history of the consumer, looking for any medical complications and assessing their level of risk, observing the consumer for any psychiatric
comorbidities, assessing changes in the cognitive behaviour of the consumer due to starvation and addressing any emotional difficulties (Royal
Australian and New Zealand College of Psychiatrists (RANZCP), 2014). The recovery stage proceeds the assessments, which includes stabilizing the
condition of the consumer with medications and helping support the consumer towards setting their own recovery goals (RANZCP, 2014). Nurses play a
vital role in assisting individuals to get back to normal eating patterns and understanding individuals emotional state to work well and working towards a
holistic approach towards recovery ( Davis & Bacon, 2016). Other ways to address the issue include the use of psychological intervention such as
cognitive behavioural therapy and family base therapy (Stice, South & Shaw, 2012)
(Oldershaw et al., 2019)
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Consumers’ and carers’ perspectives and lived experience
Adolescents suffering from anorexia nervosa defined the condition as their “friend” and as well as their “enemy”. They reported that
anorexia nervosa gave them positive feeling of self-control while at the same time they also felt destroyed and betrayed because of
the illusion of control created by the disease. Moreover, young adults diagnosed with anorexia nervosa also mentioned that people
often judge them based on physical appearance. Also, they described family relations as painful because they find themselves as a
source of distress for the whole family (Sibeoni et al., 2017). Furthermore, they went on and talked about their feelings of sadness,
frustration, guilt, loneliness, emotional distress, and solitude experienced while suffering from anorexia nervosa (Koruth et al., 2011).
During recovery process, some adolescents found peer relationships useful in recovery as they felt supported and accepted by peers
with similar difficulties. On the other hand, some adults highlighted negative impacts of peer involvement such as acquiring negative
coping strategies from peers like self-harm (Bezance & Holliday, 2013). Also, patients highlighted some most successful nursing
interventions which includes having an open caring environment and involving them in their own care and progress (Stavarski et al.,
2019).
Parents of certain adolescents reported that anorexia nervosa is altering their child’s behaviour and emotions impacting their social
and family relationships (Sibeoni et al., 2017). Some parents associated their child’s anorexia nervosa with family conflicts,
communication difficulties while others highlighted psychosocial impacts such as emotional frustration and always remained
concerned about their child’s progress. Also, most of the parents reported that general practitioners they have reached out to get
help from were unaware of the treatment options available for anorexia nervosa (McCormack & McCann, 2015).
Healthcare professionals explained the anorexia nervosa through a biomedical theory. They labelled anorexia nervosa as a disease or
a disorder that needs treatment and they also differentiated the patient and actual disease (Couturier et al., 2012). On the other
hand, adolescents rejected their beliefs of separation between the disease and themselves (Sibeoni et al., 2017). Also, therapists have
seen both negative and positive emotions experienced by patients involved in cognitive remediation therapy (CRT). Therapists
outlined anxiety as the most common negative emotion seen in patients while some patients expressed feeling of losing control,
feeling of being judged, fear of making mistakes, feeling of sadness and frustration. On the other hand, positive emotions seen in
some patients include feeling of safety, improvement in confidence and self-esteem (Easter & Tchanturia, 2011). Moreover, nurses
think family involvement in the treatment of their child is very important as family members are the source of information for nurses
and other health professionals to understand patient in depth (Bakker et al., 2011).
Current/future mental health development and research
 
There are various treatment options for eating disorder. Multidisciplinary team take part in the proper management and treatment.
Multidisciplinary treatment for eating disorder includes the following:
Psychotherapy: Psychotherapy uses various of methods to manage and treat someone with an eating disorder. Thoughts, emotions,
behaviours, patterns of thinking, motivations and relationships are important aspects of psychotherapy. Models such as Cognitive
Analytic Therapy, Cognitive Behavioural Therapy and Dialectical Behavioural Therapy can be included. Psychotherapy will be normally
provided by psychologist and can also be provided by psychiatrists, psychotherapist or councillors.
Family approaches: These are most common approaches when dealing with young adults or adolescent patient. The main aim of
family approach is to include the family in treatment process for eating disorder and also to educate the whole family regarding caring
for the patient with eating disorder.
Self-help approaches: Self-help approaches can be done with the patient themselves. It can be more useful, when combined with
other treatment approaches that are offered by the professionals and clinicians. If only self-help approach is adapted patient can
ignore or reject other types of medical treatment as a result of which they cannot be treated and can also have a relapse.
Nutritional management: Nutritional management are carried out by nutritionist or GP. This approach helps to make sure that the
patient is receiving balanced diet with right level of vitamins and minerals throughout the treatment so that the patent can have good
eating habit.
Medication: Medications can be prescribed by psychiatrist or GP. Medication management is best when patient have other disorders
present i.e.: anxiety, depression, psychosis etc. The patient of more than one disorder is called comorbidity (The butterfly
foundation,2020).
Mental health community support services are a part of Victoria’s state-funded specialist mental health service system. Medical and
specialist mental health inpatient services within tertiary facilities are also part of the continuum of more intensive treatment
responses.
Many helplines and web-based supports are found to support early help seeking and engagement of the people with eating disorder
in the community. The Eating Disorders Victoria helpline team provides support in phone and internet-based helplines and people can
also visit for support during the week. The Butterfly Foundation also provides a national support line and web-based counselling
services, and e-headspace is also a youth-friendly point of contact. Multidisciplinary teams help the management and treatment of
eating disorder in private providers which includes GPs, health professionals funded through the Commonwealth’s Medicare Benefits
Schedule and private hospitals. (State of Victoria, Department of health,2014) It is very important that patients with eating disorder
get early treatment that helps them to get the treatment that includes various services and supports. According to the National Eating
Disorders Collaboration, ‘the only safe way to respond to eating disorders is to address all of the features of the disorder, which
includes both physical and mental illness, and the environmental condition in which the disorder occurs’ (National Eating Disorder
Collaboration 2012, p. 7).
The current research evidence tells that a particular form of family-based therapy (FBT) is the most efficient approach for younger
patients. Even though many types of other approaches are applied in the present-day scenario like cognitive behaviour therapy,
cognitive analytic therapy nutritional counselling and family-based therapy etc existing randomised controlled trails are limited
(Dahlgren,Ro,2014)
Conclusion
In conclusion, Anorexia nervosa is a psychological disorder that mainly affects adolescents and can be managed by early intervention
and treatment. This disorder affects both the mind and body in multiple ways. It requires multidisciplinary medical team who covers
both medical and psychological aspect for the management of this disorder. So, during the treatment for anorexia nervosa in
adolescents its very important to build therapeutic relationship with the patient throughout their journey. The focus should be on
patient’s eating pattern, their psychosocial needs and their personal struggle towards recovery. Individualised treatment approach for
patient and support for his family members would be advantageous (Beukers et al., 2015).