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Anorexia Nervosa is not a disease. Critically discuss this statement and it's implication for treatment?

 

Following is an essay plan a study group came up with. An essay written on this plan would clearly score enough marks to pass.

 

Introduction

Anorexia Nervosa, epidemiology

Prevalence among different social classes, and age groups, sex distribution.

Definition of the term 'disease' (presence of objective pathology)

 

Body

Diagnostic criteria in ICD 10

Clinical features  of AN that can be considered as objective pathology

                                                                  Amenorrhoea (which may precede loss of weight)

                                                                  Lanugo Hair

                                                                  Endocrine abnormalities

                                                                  Leptin levels

Is it an abnormality of hypothalamic disturbance? (with amenorrhoea, Endocrine abnormalities, hypothermia etc)

 

The spectrum of eating habits in the society.

Is AN an illness of developed countries? The differing prevalence in developed and developing countries and in immigrants to developed countries?

The pressure to be slim, and struggle for control versus specific psychopathology in AN. Is it induced by social factors?

Most clinical features are the result of starvation. The Minnesota Studies, Starvation leading to anorexic psychopathology.

 

Implications for treatment

Need to correct physical complications before psychotherapeutic interventions.

CBT- Educating about the spectrum of eating habits, how they can become pathological.

Family therapy-using family system formulations as an explanation of the patient's illness.

Leptin levels as a guide to treatment.

Ultra sound of the abdomen (ovaries) as a guide to recovery.

Amenorrhoea may outlast other symptoms.

 

Conclusions

No simple answer to the question, whether AN is a disease?

Probably a psychiatric disorder with bio, psycho, socio aetiology, but there is also evidence of objective pathology.

New knowledge has resulted in better methods of monitoring, of outcome.

Further research needed to refine treatment.

 

 

 

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