Introduction Women’s health refers to a branch of medicine that focuses on the treatment and diagnosis of diseases and conditions that affect a woman’s physical and emotional well-being. According to the U.S National Library of Medicine, women have unique health issues. It may appear unfair to men as both genders have many of the same health problems. However, these effect of these health issues can vary from men to women.
At any given time, the number of people in Australia with an eating disorder is estimated to be 4% of the population, or 913,986 people. Eating disorders are serious mental illnesses and are not a lifestyle choice or a diet gone "too far" as described by the National Eating Disorders Collaboration. They stated that approximately one in 20 Australians suffer from an eating disorder and it continues to increase overtime. In the United States, 20 million women will suffer from a clinically significant eating disorder at some time in their life as opposed to men, which is only 10 million. Anorexia Nervosa is the most well-known eating disorder and is characterised by persistent energy intake restriction, extreme fear of weight gain and concern over body image that would interfere with daily activities. There are two main sub-types of Anorexia Nervosa: Restricting subtype
: Severe restrictions on the amount and type of food they consume. This may include methods such as restricting certain food groups, counting calories, intentionally skipping meals, obsessive rules and rigid thinking or even excessive exercising.
Binge-Eating or Purging subtype
: Binge eating behaviour is eating a large amount of food in a short period of time. Purging behaviour involved self-induced vomiting, or intentionally abusing laxatives, diuretics or enemas to make up for eating food
Obtained from http://www.nedc.com.au/eating-disorders-in-australia
Causes A definite cause of Anorexia Nervosa is yet to be discovered as certain factors may show correlation and not causation. However it is most likely caused by a limited number of factors. Environmental factors Biological factors Psychological factors
– media, peer pressure, cultural expectations – Irregular hormones (the role of genetics is not confirmed) – Obsessive compulsive disorder (OCD), perfectionism
Symptoms Physical symptoms Extreme weight loss without a reason such as an illness Abnormal body weight Fatigue and fainting without a reason such as an illness Increase in dental decay Development of bloating, constipation and food intolerance Psychological symptoms Intense fear of weight gain Depression and anxiety Reduced ability to concentrate Low self esteem Above all, the individual may include excessive exercise in their daily routine and self-induce vomiting as a method of getting rid of the food they have ingested.
Treatments. NEDC states that psychological treatment has been clinically proven to reduce the severity, impact and duration of Anorexia. This can be a range of different physical and psychological health care including: Family-based treatment (FBT) Family-based treatment can be offered to those under the age of 19 who have had the eating disorder for a maximum of three years. This three-phase treatment spans over a 12-month period has been shown to be the most effective treatment for children and adolescents. 1 Commonly, the Maudsley Model is used to treat adolescents with Anorexia Nervosa and the three phases are: Phase 1 (Weight Restoration)
: The parents of the individual will be responsible in helping to regain their child’s weight. This is due to severe malnutrition the individual suffers, causing hypothermia, growth hormone changes, cardiac dysfunction and cognitive and emotional changes. During this phase, the therapist will educate the parents in their effort to restore their child’s weight.
Phase 2 (Returning Control)
: After the patient’s acceptance of a constant and stable weight regain, the individual is then encouraged to take control of their food intake. Gradually, parents are able to return control of eating to their child.
Phase 3 (Treatment Completion) : The treatment is focused on strengthening the individual’s sense of identity after they are free of the eating disorder, emphasising on the impact of Anorexia Nervosa on his/her life.
A trial conducted at the Royal Children’s Hospital in Melbourne, Australia by J Pediatrician Health Care has shown that after FBT was implemented, admissions for Anorexia Nervosa has decreased by 50%, readmissions decreased by 75% and the overall number of day patients spent in the hospital fell by 51%. 1
Cognitive and behavioural therapy Adults can access CBT to educate themselves on skills to help themselves gain a thorough understanding of their body. This includes their negative or distorted view of their bodies resulting from shame, anxiety or disgust. CBT is another three-phase treatment aiming to emphasise on how the patient’s thoughts and actions can maintain an eating disorder. Phase 1 (Behavioural)
: The patient and the therapist identifies negative emotions and behaviours, providing education and awareness on balanced eating and nutrition. By formulating a plan, the aim is to stabilise the patient’s eating habits and thus eliminating symptoms. As mentioned earlier, their negative and distorted views and feelings about themselves interfere with their daily life. Consequently, this phase aids in managing these feelings by creating coping strategies.
Phase 2 (Cognitive)
: Cognitive restructuring techniques are introduced here. These techniques aim to recognize and change problem thinking patterns that exacerbate the problems. By developing fresh perspectives and ideas, the individual abandons their unhealthy thoughts that restrict eating behaviours.
Phase 3 (Maintenance)
: The final stage of this treatment concentrates on reducing triggers, preventing relapse and maintaining the progress that has been made. Assuming that they have eliminated all symptoms, the patient is then able to depart into a healthier and fulfilling life. This treatment may continue to proceed in order to aid in the individual’s emotional wellbeing.
Other forms of therapy includes: - Ego-oriented therapy - Focal psychodynamic therapy - Interpersonal psychotherapy - Specialist supportive clinical management Supplements to aid malnutrition may be used during the process of treatment. Furthermore, whilst medication such as antidepressants or antipsychotics can be used to treat Anorexia Nervosa, it is not highly recommended. It should not be the only option for affected individuals. Most of the patients suffering from Anorexia Nervosa are treated by a psychologist or therapist. However, certain scenarios such as severe malnutrition caused by the unhealthy weight will lead to treatment in hospital settings. Individuals are commonly outpatients, participating in day programs and thus can accommodate their needs as they make changes to their physical and mental lifestyle.
Comparison Graph 1: Countries Where Each of the Genders Suffer the Most From Anorexia Nervosa
Obtained from http://global-diseases.healthgrove.com/l/184/Anorexia-Nervosa
The above diagram shows the top 25 countries and their annual years of healthy life lost according to gender. On the left (blue) is male whilst the right (pink) is female. Observably, the diagram suggests that more females of all ages suffer from Anorexia Nervosa, with Finland having the highest numbers for both genders.
Graph 2: Correlation between GDP per Capita and Loss of Health due to Anorexia Nervosa Spain
Finland
Luxemburg United States
Greece
Obtained from http://global-diseases.healthgrove.com/l/184/Anorexia-Nervosa
With further research on the correlation between the country’s GDP and the annual mortality rate, it is also shown that higher GDP is associated with Anorexia Nervosa. 5 countries from Graph 1 is labelled on Graph 2 and it displays the connection between GDP per Capita and the mortality rate of the country due to Anorexia.
Bibliography
"Anorexia Nervosa." Health Information for Western Australians. N.p., n.d. Retrieved from http://healthywa.wa.gov.au/ Australian Psychological Society. "Understanding and Managing Eating Disorders." Australian Psychological Society : Understanding and Managing Eating Disorders. N.p., n.d. Retrieved from https://www.psychology.org.au/publications/tip_sheets/eating/ Department of Health & Human Services. "Anorexia Nervosa." Better Health Channel. Department of Health & Human Services, 30 Aug. 2013. Retrieved from https://www.betterhealth.vic.gov.au/health/healthyliving/anorexia-nervosa Department of Health. "What Is an Eating Disorder? Eating Disorders Explained." Eating Disorders Explained. N.p., n.d. Retrieved from https://www.eatingdisorders.org.au/eating-disorders/what-is-an-eating-disorder "Eating Disorders and Adolescents." Eating Disorders Victoria. N.p., 7 Feb. 2017. Retrieved from https://www.eatingdisorders.org.au/eating-disorders/eating-disorders-children-teens-and-older-adults/eating-disorders-aadolescents Grabhorn, R., W. Köpp, I. Gitzinger, J. Von, and J. Kaufhold. "[Differences between Female and Male Patients with Eating Disorders--results of a Multicenter Study on Eating Disorders (MZ-Ess)]." Psychotherapie, Psychosomatik, Medizinische Psychologie. U.S. National Library of Medicine, Jan. 2003. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12514763 Hughes, E. K., D. Le, A. Court, M. Yeo, S. Campbell, M. Whitelaw, L. Atkins, and S. M. Sawyer. "Implementation of Family-based Treatment for Adolescents with Anorexia Nervosa." Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. U.S. National Library of Medicine, July-Aug. 2014. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24055072 LeGrange, D., and L. James. "Maudsley Parents." Maudsley Parents - Family-based Treatment for Eating Disorders, Anorexia Nervosa, and Bulimia Nervosa. N.p., n.d. Retrieved from http://www.maudsleyparents.org/whatismaudsley.html Unknown. "Anorexia Nervosa." Anorexia Nervosa - Child and Adolescent Eating Disorder Program - Adolescent Medicine - Golisano Children's Hospital - University of Rochester Medical Center. Unknown, 2017. Retrieved from https://www.urmc.rochester.edu/childrens-hospital/adolescent/eating-disorders/teens/anorexia-nervosa.aspx Unknown. "What Is Anorexia Nervosa? Eating Disorders Explained." Eating Disorders Explained. Unknown, 22 Feb. 2017. Retrieved from http://www.nedc.com.au/anorexia-nervosa Walden Psychiatric. "Cognitive Behavioral Therapy & Binge Eating Disorder: 8 Key Treatment Benchmarks." Walden Eating Disorders Treatment. N.p., n.d. Retrieved from https://www.waldeneatingdisorders.com/cognitive-behavioral-therapy-bingeeating-disorder-8-key-treatment-benchmarks/ "What Is an Eating Disorder?" Eating Disorders Explained. N.p., 24 Mar. 2017. Retrieved from https://www.eatingdisorders.org.au/eating-disorders/what-is-an-eating-disorder http://www.ceed.org.au/sites/default/files/resources/documents/Family%20Based%20Therapy%20August%202016.pdf http://global-diseases.healthgrove.com/l/184/Anorexia-Nervosa