ANOREXIA NERVOSA

ELMEIDA EFFENDY

What is eating disorders?

• Eating disorders are disorders of eating behavior overvalued desire of weight loss functional medical, psychological, and social impairment.

• Gangguan makan adalah gangguan makan keinginan perilaku dinilai terlalu tinggi dari penurunan berat badan gangguan fungsional medis, psikologis, dan sosial

Pathways to Eating Disorders

Types of eating disorders

• Anorexia Nervosa

• Bulimia Nervosa

• Binge-eating disorder

“MAJOR TYPES”

ANOREXIA NERVOSA?

• The term anorexia nervosa is derived from the Greek term means “loss of appetite”.

• 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.

• Para anoreksia nervosa Istilah ini berasal dari istilah Yunani berarti "hilangnya nafsu makan".Anorexia nervosa adalah penyakit jiwa yang menggambarkan gangguan makan yang ditandai dengan berat badan sangat rendah dan distorsi citra tubuh dengan ketakutan obsesif untuk mendapatkan berat badan.

Epidemiology

• Lifetime prevalence of anorexia nervosa is less than 1% and is 10 times more frequent in women than in men.

• Peaks occur at early and late teen years.

• Lifetime prevalensi anoreksia nervosa kurang dari 1% dan 10 kali lebih sering pada wanita dibandingkan pada pria.Puncak terjadi pada masa remaja awal dan akhir.

Three essential criteria!!

1. Behavior self-induced starvation to a significant degree.

2. Psychopathology strong drive for thinness and/or a morbid fear of fatness.

3. Physiological symptomatology the presence of medical signs and symptoms resulting from starvation.

• Perilaku disebabkan oleh diri sendiri kelaparan sampai tingkat yang signifikan.Psikopatologi drive yang kuat untuk ketipisan dan / atau rasa takut mengerikan dari kegemukan.Fisiologis simtomatologi adanya tanda-tanda medis dan gejala akibat kelaparan.

Types of anorexia nervosa

• Restricting type loses weight by severely limiting the amount of food consumed.

• Binge-eating-purging type engages in binges (large amount of food consumed) following by purging (vomiting or use of laxatives).

• Membatasi jenis kehilangan berat badan dengan sangat membatasi jumlah makanan yang dikonsumsi.Pesta-makan-membersihkan jenis bergerak di binges (sejumlah besar makanan yang dikonsumsi) berikut dengan membersihkan (muntah atau menggunakan obat pencahar).

Etiology

1. Physiological factors : Genetic factors Neurobiological factors Nutritional factors

2. Psychological factors

3. Social and environmental factors

• Fisiologis faktor:  faktor genetik  neurobiologis faktor  gizi faktor2. faktor psikologis3. Sosial dan faktor lingkungan

CLINICAL FEATURES

• Physical features :• 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 • Constantly feeling cold • Zinc deficiency • Constipation • Dry skin • In cases of extreme weight loss, there can be nerve deterioration, leading to

difficulty in moving the feet • Fragile appearance; frail body image • Slowing of the rate of growth of breasts • Drastic changes in blood pressure upon standing • Dizzyness and fainting • Etc.

• Fisik fitur:Ekstrim berat badanIndeks massa tubuh kurang dari 17,5 pada orang dewasa, atau 85% dari berat yang diharapkan pada anak-anakterhambat pertumbuhanEndokrin gangguan, yang menyebabkan penghentian periode pada anak perempuan (amenorea)Penurunan libido, impotensi pada priaKelaparan gejala, seperti metabolisme berkurang, denyut jantung lambat (bradikardia), hipotensi, hipotermia dan anemiaKelainan tingkat mineral dan elektrolit dalam tubuhPenipisan rambutTerus-menerus merasa dinginseng kekurangansembelitkulit keringDalam kasus penurunan berat badan ekstrim, bisa ada kerusakan saraf, menyebabkan kesulitan dalam menggerakkan kakiPenampilan Fragile; gambar tubuh lemahPerlambatan laju pertumbuhan payudaraDrastis perubahan tekanan darah pada saat berdiriDizzyness dan pingsanDan lain-lain

• Psychological features :• 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 • loss in memory • hallucinations

• Psikologis fitur:Terdistorsi citra tubuhmiskin wawasanEvaluasi diri sebagian besar, atau bahkan eksklusif, dalam hal bentuk dan beratPra-pekerjaan atau pikiran obsesif tentang makanan dan berat badanperfeksionismeObsesif kompulsif (OCD)Keyakinan bahwa kontrol atas makanan / tubuh sama dengan menjadi mengendalikan kehidupan seseorangPenolakan untuk menerima berat yang seseorang adalah sangat rendah bahkan ketika itu bisa mematikanPenolakan untuk menerima berat yang satu adalah normal, atau sehatkerugian dalam memorihalusinasi

• Emotional features :

• Low self-esteem and self-efficacy

• Phobia of becoming overweight

• Clinical depression

• Mood swings

• Feelings of loneliness

• Emosional fitur:Rendah harga diri dan self-efficacyFobia menjadi kelebihan berat badanklinis depresiperubahan suasana hatiPerasaan kesendirian

• Behavioral features :

• Excessive exercise, food restrictions • Secretive about eating or exercise behavior • Self-harm, substance abuse • Very sensitive to references about body weight • Aggressive when forced to eat • Social withdraw or being anti-social • Checking body in the mirror constantly • Checking body weight on scale constantly• Thoughts of suicide

• Perilaku fitur:Berlebihan olahraga, pembatasan makananRahasia tentang makan atau latihan perilakuMenyakiti diri, penyalahgunaan zatSangat sensitif terhadap referensi tentang berat badanAgresif ketika dipaksa makanSosial menarik diri atau menjadi anti-sosialMemeriksa tubuh di cermin terusMemeriksa berat badan pada skala terusPikiran bunuh diri

Table 1. DSM-IV-TR Diagnostic Criteria for Anorexia Nervosa

A.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).B.Intense fear of gaining weight or becoming fat, even though underweight.C.Disturbance in the way in which 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.D.In postmenarcheal women, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)Specify type:Restricting type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)Binge-eating or purging type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Table 2. ICD-10 Diagnostic Criteria for Anorexia Nervosa

Anorexia nervosa :A.There is weight loss or, in children, a lack of weight gain, leading to a body weight at least 15% below the normal or expected weight for age and height.B.The weight loss is self-induced by avoidance of “fattening foods.”C.There is self-perception of being too fat, with an intrusive dread of fatness, which leads to a self-imposed low weight threshold.D.A widespread endocrine disorder involving the hypothalamic-pituitary-gonadal axis is manifest in women as amenorrhea and in men as a loss of sexual interest and potency. (An apparent exception is the persistence of vaginal bleeds in anorexic women who are on replacement hormonal therapy, most commonly taken as a contraceptive pill.)E.The disorder does not meet Criteria A and B for bulimia nervosa.Comments :The following features support the diagnosis but are not essential elements: self-induced vomiting, self-induced purging, excessive exercise, and use of appetite suppressants or diuretics.If onset is prepubertal, the sequence of pubertal events is delayed or even arrested (growth ceases—in girls, the breasts do not develop and there is a primary amenorrhea; in boys, the genitals remain juvenile). With recovery, puberty is often completed normally, but the menarche is late.Atypical anorexia nervosa :Researchers studying atypical forms of anorexia nervosa are recommended to make their own decisions about the number and type of criteria to be fulfilled.

COMPLICATIONS

• Cardiovascular

• Muscular Skeletal

• GIT

• Endocrine System

• Death

TREATMENT

• Medical care

• Psychotherapy

• Nutritional therapy

• Medications

• Hospitalization

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