Anorexia is an eating disorder characterized by an obsessive fear of gaining weight and refusal to maintain a healthy body weight. It is caused by a combination of psychological, environmental, and biological factors. Symptoms include extreme weight loss, distorted body image, and excessive exercise or fasting. Treatment involves restoring healthy eating habits and weight through medical care and psychotherapy to address the underlying psychological issues and behaviors. Hospitalization may be necessary in severe cases due to medical complications.

1. Anorexia
Introduction:
● Anorexia or anorexia nervosa فقدان الشهية العصبى is an eating disorder causes people
to obsess about their weight and the food they eat characterized by markedly
reduced appetite or total aversion to food.
● It's a serious psychological disorder,a condition that goes well beyond out-of-control
dieting
● It's much more common in females than males.
● People with anorexia nervosa:
1. attempt to maintain a weight that's far below normal for their age and height (at
least 15 per cent below what is expected for a person's age, sex and height)
2. It is self-induced weight loss caused by avoiding fattening foods and may
involve taking excessive exercise, using laxatives ملين or diuretics مدررات البول or
enemas الحقنة الشرجية or self-induced vomiting or overuse of diet pills to induce
loss o f appetite often to a point close to starvation .
CAUSES:
There is no single cause for anorexia. Most experts have argued that the condition is
caused by a combination of psychological, environmental and biological factors, which
lead to a destructive cycle of behaviour.
Psychological factors:
Psychological characteristics that can make a person more likely to develop anorexia
nervosa include:
● Low self-esteem قلة التقدير بالنفس
● Feelings of ineffectiveness . الشعور بعدم الفعالية
● a tendency towards depression اكتئاب and anxiety . قلق وتوتر
● excessive worrying and feeling scared or doubtful about the future

2. ● inhibition – where a person restrains يكبح او يقيد or controls their behaviour and
expression
● feelings of obsession and compulsion , an obsession الستتحواذ او الهاجس is an
unwanted thought, image or urge that repeatedly enters a person’s mind. A
compulsion الكراه او اللزام is a repetitive behaviour or mental act that a person
feels compelled to perform.
● They may have an extreme drive for perfectionism الكمالية , which means they
may never think they're thin enough.
● Avoidance of conflict with others. تجنب التعامل مع الخررين
Environmental factors:
● Most cases of anorexia develop during puberty ستن البلوغ ,It
may be that the combination of the hormonal changes during
puberty and feelings of stress, anxiety and low self-esteem
could trigger anorexia.
● Another important environmental factor is Western culture
and society where wide range of different media which
constantly reinforce the message that being thin is the only
way to be beautiful, and that thinness should be pursued at
all costs.
● a stressful life event, such as losing a job or a relationship
● pressures and stress at school, such as exams or bullying
● difficult family relationships
● physical or sexual abuse
● participation in an activity that demands slenderness النحافة , such as ballet رقص
الباليه , gymnastics, or modeling.
● It also includes having parents who are overly controlling, put a lot of emphasis ال
تشديد on looks, diet themselves, or criticize ينتقد their children’s bodies and
appearance
Biological factors:

3. ● A genetic predisposition العامل الوراثى may be
partially responsible for the development of
anorexia.
● The genetic variant in serotonin receptors
found in anorexics may predispose them to
high levels of serotonin. At high levels,
serotonin leads to anxiety. Serotonin levels
decrease without access to food, so the self-starvation
associated with anorexia will leave
the person feeling calmer and depression may
set in.
● Once the person eats again, serotonin levels rise again, The increase in
serotonin may re-trigger anxiety symptoms.Over time, the anorexic
subconsciously learns to avoid anxiety by avoiding food thereby maintaining low
serotonin levels.
Signs and Symptoms:
Physical symptoms of anorexia:
Physical signs and symptoms of anorexia include:
● Extreme weight loss قلة وزن مفرطة
● Thin appearance مظهر نحيف
● Fatigue تعب
● Abnormal blood counts
● Insomnia أرق
● Dizziness or fainting الشعور بالدوار والغمماء
● A bluish discoloration of the fingers تزرق الصاابع
● Brittle nails اظافر هشة وستريعة النكسار
● Hair that thins, breaks or falls out شعر متساقط
● Absence of menstruation غمياب الدورة الشهرية for
women and girls.
● Constipation امساك

4. ● Dry skin and dry or chapped lips جفاف الجلد و تشقش الشفتين
● Irregular heart rhythms عدم انتظام ضربات القلب
● Low blood pressure انخفاض ضغط الدم
● Dehydration الجفاف
● Osteoporosis هشاشة العظام
● Swelling of arms or legs تورجم الذرجاعين والرججل
● Feeling cold, with a lower-than-normal body temperature.
Emotional and behavioral anorexia symptoms:
Emotional and behavioral characteristics associated with
anorexia include:
● Refusal to eat رجفض الكلل
● Denial of hunger أنكارج الجوع
● Excessive/ unhealthy exercise تمارجين مفرطة و غير صحية
● lack of emotion تبلد المشاعر
● Social withdrawal النطواء الجتماعى
● Irritability حاد الطباع
● Reduced interest in sex
● Self-harm ("cutting" or even suicide attempts).
● Using herbal products,diet pills, laxatives, or diuretics
● Throwing up after eating
● Obsession with calories, fat grams, and nutrition ا
النشغال الدائم بالكلل والسعر الحرارجى له
● Body image distortion تشويه and excessive reliance on
weight or shape for self-esteem
● Denial that you’re too thin. انكارج النحافة
● Low self opinion/low self-esteem قلة التقدير للنفس
● Exhibiting symptoms of depression اكلتئاب
● Strange or secretive food rituals – Refusing to eat around
others or in public places. Eating in rigid, ritualistic ways

5. (e.g. cutting food “just so”, chewing food and spitting it out, using a specific
plate).
● Irrational (morbid) fear of fatness coupled with an intense drive for thinness.
Diagnosis:
● Physical exams: This may include
1. Measuring your height and weight;
2. Calculate your body mass index (BMI). A normal
BMI for adults is 20-25. People with anorexia
generally have a BMI below 17.5.
3. Checking the vital signs, such as heart rate,
blood pressure and temperature.
4. Checking the skin and nails for dryness or other problems.
● Laboratory tests:.
1. Complete blood count (CBC),
2. More specialized blood tests to check electrolytes
and protein as well as functioning of your liver,
kidney and thyroid.
3. Urinalysis.
● Psychological evaluation: A doctor or mental
health provider can assess thoughts, feelings and
eating habits. Psychological self-assessments and
questionnaires also are used.
● Other studies:.
1. X-rays may be taken to check for broken bones, pneumonia or heart
problems.
2. Electrocardiograms جهاز رجسم القلب may be done to look for heart
irregularities.
3. Bone density testing may be done to check your bone health.
4. Testing may also be done to determine how much energy your body uses,
which can help in planning nutritional requirements.

6. Treatment:
Treatment for anorexia nervosa tries to address three main areas.
1) Restoring the person to a healthy weight;
2) Treating the psychological disorders related to the illness;
3) Reducing or eliminating behaviours or thoughts that originally led to the disordered
eating
Dietary:
● Zinc :is beneficial in the treatment of anorexia even in patients not suffering from
zinc deficiency, by helping to increase weight gain.
● Essential fatty acids:The omega-3 fatty acids docosahexaenoic acid and
eicosapentaenoic acid have been shown to benefit various neuropsychiatric
disorders of anorexia.
● Nutrition counseling
● Medical Nutrition Therapy;
● The first goal of treatment is getting back to a healthy weight and learning
proper nutrition.
● A dietitian can offer guidance on a healthy diet, including providing specific
meal plans and calorie requirements that will help you meet your weight
goals.
● also referred to as Nutrition Therapy is the development and provision of a
nutritional treatment or therapy based on a detailed assessment of a person's
medical history, psychosocial history, physical examination, and dietary
history.
Medications:
There are no medications specifically designed to treat anorexia because they've
shown limited benefit in treating this eating disorder. However, antidepressants,
antipsychotics, and mood stabilizers may help some anorexic patients when given as
part of a complete treatment program.
ل يوجد دواء لعلج فقدان الشهية العصبي مباشرة ولكن يمكن عرلج العرراض المصاحبة له من الكتتئاب والتوتر ويعتمد
هذا المرض فى عرلجه عرلى نظام التغذية السليم وعرلى العلج النفسي اكتثر

7. Antipsychotic Drugs:
● Research supports their efficacy in inducing weight gain and helping lessen the
frequency and intensity of intrusive anorexic thoughts.
● Weight restoration is undoubtedly a critical aspect of recovery, yet it is also, for
many patients, the most difficult. During this weight restoration process, severe
psychological distress and anxiety are not uncommon, as the often individual
feels that she is ‘losing control’.
● Current research literature suggests that atypical antipsychotics, particularly
olanzapine, can be effective in reducing agitation and distress obsessionality,
including obsessional thoughts about food during this time.
Olanzapine
Olapex 10 mg tabs Zyprexia 5&10 mg tabs
Antidepressants drugs:
● Selective serotonin reuptake inhibitors -- These antidepressants are sometimes
prescribed for people with anorexia.
● Fluoxetine has been studied in people with anorexia and depression, with
mixed results. In some early studies, it appeared to increase weight and improve
mood over several months. But in another, it helped relieve symptoms of
depression, but did not affect the anorexia itself.
Fluoxetine
Depreban 20 mg caps Flutin 20 mg caps Prozac 20 mg caps

8. ● Recent studies indicate that the use of Prozac and other antidepressants may
cause children and teenagers to have suicidal thoughts. Children who are taking
these drugs must be monitored very carefully for signs of potential suicidal
behavior.
Psychotherapy;
Individual, family-based and group therapy may all be beneficial.
● Individual therapy:.
● This type of therapy can help you deal with the behavior and thoughts that
contribute to anorexia.
● to identify the feelings and fears that caused you to stop eating, and develop a
healthier attitude towards food and your body.
● You can gain a healthier self-esteem تقدير النفس and learn positive ways to
cope with distress تتعلم طرق ايجابية للتعامل مع المحن and other strong feelings.
● A type of talk therapy called cognitive behavioral therapy (CBT) is
commonly used improve neurocognitive abilities such as attention, working
memory, cognitive flexibility and planning , and executive functioning
● A mental health provider can help assess the need for psychiatric
hospitalization or day treatment programs.
● Family-based therapy.:
● Family therapy helps a person with anorexia see and
understand the often-times dysfunctional role they
play within the family
● Family therapy is usually conducted with the person
who has anorexia and their family. However, in some instances, a few family

9. therapy sessions may involve therapy without the person who has anorexia
present.
● This may help the family understand the roles they are playing in supporting
the disordered eating, and suggest ways the family can help the person with
anorexia acknowledge the problem and seek out treatment.
● Group therapy.:
● This type of therapy gives you a way to connect to others facing eating
disorders.
● careful with informal groups that aren't led by a mental health professional.
For some people with anorexia, support groups might result in competitions
مسابقات to be the thinnest person there.
Hospitalization:
● In cases of medical complications, psychiatric emergencies, severe malnutrition
سوء تغذية (this person may need to be fed through a vein or stomach tube) or
continued refusal to eat,distressed that you no longer want to live,
hospitalization may be needed.
● Hospitalization may be on a medical or psychiatric ward.
● Some clinics specialize in treating people with eating disorders. Some may offer day
programs or residential programs, rather than full hospitalization.
● Specialized eating disorder programs may offer more intensive treatment over longer
periods of time. Also, even after hospitalization ends, ongoing therapy and nutrition
education are highly important to continued recovery.
Complications of anorexia:
● Heart disease—The heart may develop
dangerous rhythms, blood flow is reduced,
blood pressure may drop and cholesterol levels
tend to rise.
● Electrolyte imbalance—The dehydration and
starvation of anorexia can reduce fluid and

10. mineral levels, which can be life-threatening unless fluids and minerals are
replaced.
● Reproductive and hormonal abnormalities—Anorexia causes low levels of
reproductive hormones, changes in thyroid hormones, increased levels of the
stress hormones and long-term irregular or absent menstruation, which may
cause sterility and bone loss.
● Blood problems—Anemia, pernicious anemia caused by severely low levels of
vitamin B12.
● Neurological problems—Anorexics may suffer nerve damage and experience
seizures, disordered thinking, loss of feeling and other nerve problems in the
hands or feet.
● Gastrointestinal problems: constipation
● Risk of death from starvation or suicide
References:
1. http://www.umm.edu/altmed/articles/anorexia-nervosa.
2. http :/ / www . nam i . org / template
3. http :/ / www . nhs . uk / Conditions / Anorexia - nervosa
4. http :/ / www . mayoclinic . com / health / anorexia /
5. http://www.medicinenet.com/anorexia_nervosa/article.
6. http :/ / www . webmd . com / menta l - health / anorexia - nervosa
7. http :/ / www . eatingdisordertreatment . com / abou t - eating - disorders / anorexia -
nervosa - information - symptoms - and - treament - o f - anorexia
8. http :/ / www . netdoctor . co . uk /
9. http :/ / www . womenshealth . gov /
10. http :/ / www . helpguide . org /
11. http :/ / en . wikipedia . org /
12.http://www.bupa.co.uk/individuals/health-information/directory/a/anorexia
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