|
|
Anorexia Nervosa (AN) is one type of eating disorder that has a lifetime prevalence of 4% among females and 0.3% among males (van Eeden, 2021). AN, like all other eating disorders, is classified as a mental disorder. The three criteria for diagnosing AN are: prolonged self-restriction of nutrient intake, fear of gaining weight, and a distorted self body image or self-perceived weight. Due to their obsession with self-body image, patients with AN will often find extreme measures of losing weight, such as calorie counting, starvation, excessive exercise, purging, and taking laxatives (Morris, 2007). There are other factors that lead to extreme weight loss, such as depressive episodes and medical conditions; however, AN is different in that there is an underlying psychological fear of gaining weight that fuels this unhealthy behavior.
What causes AN? There seems to be both biological and environmental bases for the development of AN. Many patients with AN seem to differ in the structure and function of their brains. For example, AN patients show decreased dopamine (reward system) and serotonin (impulse control) levels (Moore, 2022). The median age of onset is around 15, and the disorder is most common among female teens. AN is also significantly more prevalent in Western cultures, which suggest an environmental basis for the condition. This may potentially be due to how the media portrays body expectations and weight loss. For instance in Western cultures, models and actors exhibit unrealistic standards for thinness, often accentuated by photoshop and make up, and athletes in sports like ballet, running, martial arts have to lose weight to optimize performance. There also exist other risk factors for AN, like childhood obesity, mood disorders, sexual abuse, and familial problems (Moore, 2022). Out of all psychiatric disorders, AN has the highest mortality, with most of the deaths resulting from suicide or complications from nutrient deficit (Morris, 2007). Patients with AN often have comorbid disorders like major depressive disorder, generalized anxiety disorder, or obsessive compulsive disorder. This means treatment of AN often necessarily involves treating the mental health of the patients. There are also numerous physical complications from malnutrition, such as delayed onset of puberty, amenorrhea (absence of menstruation), bone weakness, and respiratory, cardiac, or gastrointestinal problems (Peterson, 2019). Therefore, AN is a serious disorder that requires a careful, multidisciplinary approach to treatment. Because there is no known cure or cause of AN, it is incredibly important to recognize the disorder early and help patients manage it. The two most common intervention methods are nutrition rehabilitation, where patients are slowly given nutrients to restore their body homeostasis, and psychotherapy, which aims to target the underlying mental health issues. In severe cases, partial hospitalization may be necessary. Another method of treatment is family intervention and education (Moore, 2022). In this way, family members are educated on how to reduce risk factors for AN and help manage the symptoms of the disorder. Medications, like antipsychotics or antidepressants, may also be helpful in the treatment of AN. References Moore, C. A., & Bokor, B. R. (2022, August 29). Anorexia nervosa - statpearls . NIH National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK459148/ Morris, J., & Twaddle, S. (2007). Anorexia nervosa. BMJ, 334(7599), 894–898. https://doi.org/10.1136/bmj.39171.616840.be Peterson, K., & Fuller, R. (2019). Anorexia nervosa in adolescents. Nursing, 49(10), 24–30. https://doi.org/10.1097/01.nurse.0000580640.43071.15 van Eeden, A. E., van Hoeken, D., & Hoek, H. W. (2021). Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry, 34(6), 515–524. https://doi.org/10.1097/yco.0000000000000739
0 Comments
In the United States, over 2.7 percent of adults have eating disorders and over 13 percent of adolescents will develop an eating disorder by the age of 20. The prevalence rate for females is more than double that of males, although males are more likely to underreport eating disorders due to factors such as stigma, substance use, and masking of their disorder by restrictive diets in sports or fitness training (Strother, 2012). Eating disorders are much more common in Western cultures, potentially due to the prevalent use of social media and the unrealistic body expectations instilled on these platforms. Feeding disorders are more common than eating disorders and have a prevalence rate of around 26% in infants and children in the general population (Galai, 2022).
So, what are eating and feeding disorders? Although they seem like similar concepts, it is important to differentiate between the two. Feeding disorders are more commonly associated with infants and children and refer to restrictive or abnormal eating habits due to food preferences or intolerances. The three types of feeding disorders are avoidant/restrictive food intake disorder (ARFID), pica disorder, and rumination disorder. ARFID involves restricting food intake by avoiding certain types of foods with specific color or texture. This may be due to the children’s food preference or simply an overall lack of interest in food. PICA refers to when children eat non-food substances, like chalk, earth, plastic, etc. This disorder cannot be explained by another mental disorder and is not problematic unless it causes health problems. Rumination disorder refers to when a child constantly spits up partially digested food and either rechews it or spits it out (Anxiety and Depression Association of America, n.d). Eating disorders, on the other hand, are more common in adolescents and adults, and usually involve a psychological basis for their unhealthy eating behaviors. The three types of eating disorders are anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Anorexia nervosa is most common amongst young women and adolescent girls. It is similar to ARFID in that restrictive eating leads to abnormal weight loss but the motive is different. Individuals with AN have a distorted body image and a pathological fear of gaining weight. This leads to excessive dieting and extreme measures of food restriction like purging, resulting in unhealthy weight loss. Bulimia nervosa refers to the recurrent pattern of binge-eating and compensatory behavior (usually vomiting). Individuals with BN also have a distorted body image and may have other related symptoms like chronic sore throat or heartburn from excessive vomiting. Binge-eating disorder refers to binge-eating without compensatory behavior. Individuals with BED have lack of control with their eating and are very likely to have comorbid obesity. They often feel disgusted or embarrassed by their eating habits and are more likely to be depressed (Anxiety and Depression Association of America, n.d). Unlike feeding disorders, eating disorders are major mental health conditions that require the proper diagnosis and treatment from a healthcare professional. Eating disorders are highly associated with major psychological problems, like distorted self-image, anxiety, or depression and are one of the most life-threatening types of mental disorders. Every year, an estimated 3.3 million people die from eating disorders due to numerous factors such as adverse health effects, decreased quality of life, and suicide (van Hoeken, 2020). Therefore, it is important that we be able to recognize eating disorders and differentiate them from simply overeating or dieting so that individuals with such disorders can get the help that they need. References Eating disorders in teens. Eating Disorder Hope. (2022, February 26). https://www.eatingdisorderhope.com/risk-groups/eating-disorders-teens#:~:text=Teenage%20Eating%20Disorder%20Statistics&text=Studies%20have%20determined%20that%3A,an%20eating%20disorder%20%5B1%5D Galai, T., Friedman, G., Moses, M., Shemer, K., Gal, D. L., Yerushalmy-Feler, A., Lubetzky, R., Cohen, S., & Moran-Lev, H. (2022). Demographic and clinical parameters are comparable across different types of pediatric feeding disorder. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-12562-1 Lindvall Dahlgren, C., Wisting, L., & Rø, Ø. (2017). Feeding and eating disorders in the DSM-5 ERA: A systematic review of prevalence rates in non-clinical male and female samples. Journal of Eating Disorders, 5(1). https://doi.org/10.1186/s40337-017-0186-7 Strother, E., Lemberg, R., Stanford, S. C., & Turberville, D. (2012a). Eating disorders in men: Underdiagnosed, undertreated, and misunderstood. Eating Disorders, 20(5), 346–355. https://doi.org/10.1080/10640266.2012.715512 Types of eating disorders. Types of Eating Disorders | Anxiety and Depression Association of America, ADAA. (n.d.). https://adaa.org/eating-disorders/types-of-eating-disorders U.S. Department of Health and Human Services. (n.d.). Eating disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/eating-disorders van Hoeken, D., & Hoek, H. W. (2020). Review of the burden of eating disorders: Mortality, disability, costs, quality of life, and family burden. Current Opinion in Psychiatry, 33(6), 521–527. https://doi.org/10.1097/yco.0000000000000641 Gaslighting refers to the act of manipulating someone into doubting their own judgment or sanity. Often, the term is used in abusive relationships but has been increasingly more prominent in medical settings. Gaslighting in medicine can happen between doctors and patients, which often compromises the trust in a doctor-patient relationship. Gaslighting is dangerous because it is often subtle and difficult to detect. The victim and those around the victim often don’t realize it is happening, yet it can have lasting effects on the victim’s self-esteem (Fraser, 2021).
Most often, medical gaslighting occurs when a doctor knowingly or unknowingly dismisses a patient’s symptoms or concerns, causing the patient to question his/her own judgment or self-reporting abilities. For instance, a patient comes into the hospital complaining of a headache. The doctor, at the end of his long shift, runs a couple simple diagnostic tests and does not find anything serious. The doctor tells the patient that it is nothing serious and that it will pass with time. The patient, who is still in pain, has failed to receive the treatment they need and now begins to question their own judgment. They may think, “maybe I was too sensitive and I didn’t need to go to the hospital” or “maybe I failed to give a proper report of my symptoms.” Then, the patient may feel a lowered sense of self-esteem. This is medical gaslighting (Au, 2022). Medical gaslighting was particularly prominent among long COVID patients. Long COVID patients are patients that have lingering effects from contracting COVID-19, such as brain fog, difficulty focusing, memory loss and problems with mobility. Because COVID-19 is a relatively recent and under-researched disease, many doctors were unsure of the causes and treatment of long COVID symptoms. Therefore, many long COVID patients reported that their symptoms were dismissed by doctors because doctors didn’t have enough knowledge about the condition. Not taking seriously the concerns of long COVID patients, who clearly had symptoms, is a form of medical gaslighting (Au, 2022). Gaslighting is also common in obstetric medicine. Gaslighting in obstetric medicine consists of making decisions on behalf of the mother, acting without the mother’s consent or blaming the mother for unfavorable outcomes. Gaslighting in this field is especially prevalent due to the general discrimination against women in medicine. Historically, clinical trials and treatment recommendations have been tailored toward men. Also, there is a history of women’s health problems being dismissed because of the false assumption that they are being hysterical or irrational. For such reasons, women are at higher risk of medical gaslighting. One example is traumatic childbirth, which refers to the trauma due to feelings of helplessness and horror during childbirth. In many cases, the traumatic experiences during childbirth can lead to higher risk of postpartum depression and anxiety and detachment from the child. However, to obstetric doctors, these experiences are seen as normal and routine. This can lead mothers to question their own sanity or mental fortitude (Fielding-Singh, 2022). One of the key tenets of medicine is trust between doctors and patients and the mutual understanding that the doctor is acting in the best interest of the patient. However, medical gaslighting can completely compromise this trust and lead to mistrust and animosity between doctors and patients. This is why it is crucial that we are able to understand and recognize gaslighting when it happens and intervene. As a patient, it is important to have a friend or family present during check-ups and get second opinions from different doctors to make sure that they are not being manipulated. As a doctor, it is important to treat all patients with the same level of respect and allow them to have autonomy in their decision-making. Doctors and patients must be able to work together to produce the best possible results for the patients. References
|
Categories
All
Archives
June 2024
|