Gabriella Angelia 11.2013.

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Anorexia Nervosa
Signs, Symptoms, Causes, and Treatment
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It's only human to wish you looked different or could fix something about yourself. But when a preoccupation with being thin takes over your eating habits, thoughts, and life, it's a sign of an eating disorder. hen you have anorexia, the desire to lose weight becomes more important than anything else. !ou may even lose the ability to see yourself as you truly are. "norexia is a serious eating disorder that affects women and men of all ages. It can damage your health and even threaten your life. But you're not alone. #here's help available when you're ready to make a change. !ou deserve to be happy. #reatment will help you feel better and learn to value yourself.

What is anorexia nervosa?

"norexia nervosa is a complex eating disorder with three key features:

refusal to maintain a healthy body weight an intense fear of gaining weight a distorted body image

Because of your dread of becoming fat or disgusted with how your body looks, eating and mealtimes may be very stressful. "nd yet, what you can and can$t eat is practically all you can think about. #houghts about dieting, food, and your body may take up most of your day%leaving little time for friends, family, and other activities you used to en&oy. 'ife becomes a relentless pursuit of thinness and going to extremes to lose weight. But no matter how skinny you become, it$s never enough. hile people with anorexia often deny having a problem, the truth is that anorexia is a serious and potentially deadly eating disorder. (ortunately, recovery is possible. ith proper treatment and support, you or someone you care about can break anorexia$s self)destructive pattern and regain health and self)confidence.

Types of anorexia nervosa

#here are two types of anorexia. In the restricting type of anorexia, weight loss is achieved by restricting calories *following drastic diets, fasting, and exercising to excess+. In the purging type of anorexia, weight loss is achieved by vomiting or using laxatives and diuretics.

Are you anorexic?

,o you feel fat even though people tell you you$re not"re you terrified of gaining weight,o you lie about how much you eat or hide your eating habits from others"re your friends or family concerned about your weight loss, eating habits, or appearance,o you diet, compulsively exercise, or purge when you$re feeling overwhelmed or bad about yourself-

,o you feel powerful or in control when you go without food, over)exercise, or purge,o you base your self)worth on your weight or body si.e-

Anorexia is not about eight or foo!

Believe it or not, anorexia isn$t really about food and weight%at least not at its core. /ating disorders are much more complicated than that. #he food and weight)related issues are symptoms of something deeper: things like depression, loneliness, insecurity, pressure to be perfect, or feeling out of control. #hings that no amount of dieting or weight loss can cure.

What need does anorexia meet in your life?

It$s important to understand that anorexia meets a need in your life. (or example, you may feel powerless in many parts of your life, but you can control what you eat. Saying 0no1 to food, getting the best of hunger, and controlling the number on the scale may make you feel strong and successful %at least for a short while. !ou may even come to en&oy your hunger pangs as reminders of a 0special talent1 that most people can$t achieve. "norexia may also be a way of distracting yourself from difficult emotions. hen you spend most of your time thinking about food, dieting, and weight loss, you don$t have to face other problems in your life or deal with complicated emotions. 2nfortunately, any boost you get from starving yourself or shedding pounds is extremely short)lived. ,ieting and weight loss can$t repair the negative self)image at the heart of anorexia. #he only way to do that is to identify the emotional need that self)starvation fulfills and find other ways to meet it.

The difference between dieting and anorexia

Healthy Dieting
3ealthy dieting is an attempt to control weight. !!our self)esteem is based on more than &ust weight and body image. o u

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c o n t r o l y o u r l i f e a n d e m o t i o n s . Y !our goal is to lose weight in a healthy way. o u r 7

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t h i n y o u a r e . #ecomin" thin is all that matters$ health is not a concern. "igns an! sy#pto#s of

anorexia
'iving with anorexia means you$re constantly hiding your habits. #his makes it hard at first for friends and family to spot the warning signs. hen confronted, you might try to explain away your disordered eating and wave away concerns. But as anorexia progresses, people close to you wont be able to deny their instincts that something is wrong%and neither should you.

"s anorexia develops, you become increasingly preoccupied with the number on the scale, how you look in the mirror, and what you can and can$t eat.

Anorexic food behavior signs and symptoms

Dieting despite being thin 4 (ollowing a severely restricted diet. /ating only certain low) calorie foods. Banning 0bad1 foods such as carbohydrates and fats.

Obsession with calories, fat grams, and nutrition 4 5eading food labels, measuring and weighing portions, keeping a food diary, reading diet books.

Pretending to eat or lying about eating 4 3iding, playing with, or throwing away food to avoid eating. 6aking excuses to get out of meals *0I had a huge lunch1 or 06y stomach isn$t feeling good.1+.

Preoccupation with food 4 7onstantly thinking about food. 7ooking for others, collecting recipes, reading food maga.ines, or making meal plans while eating very little.

trange or secretive food rituals 4 5efusing to eat around others or in public places. /ating in rigid, ritualistic ways *e.g. cutting food 0&ust so1, chewing food and spitting it out, using a specific plate+.

Anorexic appearance and body image signs and symptoms

Dramatic weight loss 4 5apid, drastic weight loss with no medical cause. !eeling fat, despite being underweight 4 !ou may feel overweight in general or &ust 0too fat1 in certain places such as the stomach, hips, or thighs.

!ixation on body image 4 8bsessed with weight, body shape, or clothing si.e. (re9uent weigh)ins and concern over tiny fluctuations in weight.

Harshly critical of appearance 4 Spending a lot of time in front of the mirror checking for flaws. #here$s always something to critici.e. !ou$re never thin enough.

Denial that you"re too thin 4 !ou may deny that your low body weight is a problem, while trying to conceal it *drinking a lot of water before being weighed, wearing baggy or oversi.ed clothes+.

Purging signs and symptoms

#sing diet pills, laxatives, or diuretics 4 "busing water pills, herbal appetite suppressants, prescription stimulants, ipecac syrup, and other drugs for weight loss.

$hrowing up after eating 4 (re9uently disappearing after meals or going to the bathroom. 6ay run the water to disguise sounds of vomiting or reappear smelling like mouthwash or mints.

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%ompulsive exercising 4 (ollowing a punishing exercise regimen aimed at burning calories. /xercising through in&uries, illness, and bad weather. bingeing or eating something 0bad.1 orking out extra hard after

&aria"s

tory

Seventeen)year)old 6aria has been on one diet or another since she was in &unior high. She recently lost :; pounds from an already slender frame after becoming a strict vegetarian. 3er parents are concerned about the weight loss, but 6aria insists that she$s &ust under stress at school. 6eanwhile, her vegetarian diet is becoming stricter by the day. 6aria obsessively counts calories, measures food portions, and weighs herself at least twice a day. She refuses to eat at restaurants, in the school cafeteria, or anywhere else in public, and she lives on salad dressed with vinegar, rice cakes, and sugar)free <ello. 6aria also has a large stash of fat)free candy in her room. She allows herself to indulge as long as she goes for a run right afterwards.

Anorexia nervosa $auses an! ris% fa$tors

#here are no simple answers to the causes of anorexia and other eating disorders. "norexia is a complex condition that arises from a combination of many social, emotional, and biological factors. "lthough our culture$s ideali.ation of thinness plays a powerful role, there are many other contributing factors, including your family environment, emotional difficulties, low self)esteem, and traumatic experiences you may have gone through in the past.

Psychological causes and ris' factors for anorexia

=eople with anorexia are often perfectionists and overachievers. #hey$re the 0good1 daughters and sons who do what they$re told, excel in everything they do, and focus on pleasing others. But while they may appear to have it all together, inside they feel helpless, inade9uate, and worthless. #hrough their harshly critical lens, if they$re not perfect, they$re a total failure.

!amily and social pressures

In addition to the cultural pressure to be thin, there are other family and social pressures that can contribute to anorexia. #his includes participation in an activity that demands slenderness, such as ballet, gymnastics, or modeling. It also includes having parents who are overly controlling, put a lot of emphasis on looks, diet themselves, or critici.e their children$s bodies and appearance. Stressful life events%such as the onset of puberty, a breakup, or going away to school%can also trigger anorexia.

(iological causes of anorexia

5esearch suggests that a genetic predisposition to anorexia may run in families. If a girl has a sibling with anorexia, she is :; to >; times more likely than the general population to develop anorexia herself. Brain chemistry also plays a significant role. =eople with anorexia tend to have high levels of cortisol, the brain hormone most related to stress, and decreased levels of serotonin and norepinephrine, which are associated with feelings of well)being.

Major risk factors for anorexia nervosa

Body dissatisfaction

=erfectionism

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Strict dieting 'ow self)esteem ,ifficulty expressing feelings

#roubled family relationships 3istory of physical or sexual abuse (amily history of eating disorders

&ffe$ts of anorexia
8ne thing is certain about anorexia. Severe calorie restriction has dire physical effects. hen your body doesn$t get the fuel it needs to function normally, it goes into starvation mode and slows down to conserve energy. /ssentially, your body begins to consume itself. If self)starvation continues and more body fat is lost, medical complications pile up and your body and mind pay the price.

ome of the physical effects of anorexia include)

Ganggua n bingeeating AN*__'

e(ere mood s in"s$ depressi on

7on stipatio n and bloating #oot h decay and gum damage Source: National Women's Health Information Center

Jenis yang membatasi AN*

Jenis binge/purge AN*

Getting help for anorexia

If you or a loved one has anorexia...
7all the Aational /ating ,isorders "ssociation$s toll )free hotline at :)B;;)CD:)>>DE for free referrals, information, and advice. ,eciding to get help for anorexia is not an easy choice to make. It$s not uncommon to feel like anorexia is part of your identity%or even your 0friend.1

'ack of energy and weakness

,i..i ness, fainting , and headac hes

Slowed thinking? poor memory

,ry, yellowish skin and brittle nails

@ro wth of fine hair all over the body

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and face

!ou may think that anorexia has such a powerful hold over you that you$ll never be able to overcome it. But while change is hard, it is possible.

teps to anorexia recovery

Admi t you have a problem* 2p until now, you$ve been invested in the idea that life will be better %that you$ll finally feel good %if you lose more weight. #he first step in

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anorexia recovery is admitting that your relentless pursuit of thinness is out of your control and acknowle dging the physical and emotional damage that you$ve suffered because of it.

to

$al'

someon e* It can be hard to talk about what you$re

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going through, especially if you$ve kept your anorexia a secret for a long time. !ou may be ashamed, ambivale nt, or afraid. But it$s important to understa nd that you$re not alone. (ind a good listener% someone who will support you as you try to get better.

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tay away from people, places, and activitie s that trigger your obsessio n with being thin* !ou may need to avoid looking at fashion or fitness maga.ine s, spend less time with friends who constantl y diet and talk about losing weight, and stay

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away from weight loss web sites and 0pro)ana1 sites that promote anorexia.

ee' professi onal help* #he advice and support of trained eating disorder professio nals can help you regain your health, learn to eat normally again, and develop healthier

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attitudes about food and your body.

Anorexia treat#ent an! therapy

Since anorexia involves both mind and body, a team approach to treatment is often best. #hose who may be involved in anorexia treatment include medical doctors, psychologists, counselors, and dieticians. #he participation and support of family members also makes a big difference in treatment success. 3aving a team around you that you can trust and rely on will make recovery easier. #reating anorexia involves three steps:

@ettin g back to

1!

a healthy weight

Starti ng to eat more food

7hang ing how you think about yourself and food

&edical treatment for anorexia

#he first priority in anorexia treatment is addressing and stabili.ing any serious health issues. 3ospitali.ation may be necessary if you are dangerously malnourished or so distressed that you no longer want to live. !ou may also need to be hospitali.ed until you reach a less critical weight. 8utpatient treatment is an option when you$re not in immediate

1%

medical danger.

+utritional treatment for anorexia

" second component of anorexia treatment is nutritional counseling. " nutritionist or dietician will teach you about healthy eating and proper nutrition. #he nutritionist will also help you develop and follow meal plans that include enough calories to reach or maintain a normal, healthy weight.

%ounseling and therapy for anorexia

7ounseling is crucial to anorexia treatment. Its goal is to identify the negative thoughts and feelings that fuel your eating disorder and replace them with healthier, less distorted beliefs. "nother

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important goal of counseling is to teach you how to deal with difficult emotions, relationship problems, and stress in a productive, rather than a self)destructive, way.

Getting past your fear of gaining weight

@etting back to a normal weight is no easy task. #he thought of gaining weight is probably extremely frightening% especially if you$re being forced%and you may be tempted to resist. But research shows that the closer your body weight is to normal at the end of treatment, the greater your chance of recovery, so getting to a healthy weight should be a top treatment goal. #ry to understand that your fear of gaining weight is a symptom of

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your anorexia. 5eading about anorexia or talking to other people who have lived with it can help. It also helps to be honest about your feelings and fears% including your family and your treatment team. #he better they understand what you$re going through, the better support you$ll receive.

'elping an anorexi$ person

/ncouraging an anorexic friend or family member to get treatment is the most caring and supportive thing you can do. But because of the defensiveness and denial involved in anorexia, you$ll need to tread lightly. aving around articles about the dire effects of anorexia or declaring 0!ou$ll die if you don$t eatF1 probably won$t work. "

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better approach is to gently express your concerns and let the person know that you$re available to listen. If your loved one is willing to talk, listen without &udgment, no matter how out of touch the person sounds. It$s deeply distressing to know that your child or someone you love may be struggling with anorexia. #here$s no way to solve the problem yourself, but here are a few ideas for what you can do now to help make a difference for someone you love.

$ips for helping a person with anorexia

of yourself as an ,outside $hin'

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r*- In other words, someone not suffering from anorexia. In this position, there isn$t a lot you can do to 0solve1 your loved one$s anorexia. It is ultimately the individual $s choice to decide when they are ready.

(e a role model fo r healthy

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eating, exercisin g, and body image. ,on$t make negative comment s about your own body or anyone else$s.

$a'e care of yourself* Seek advice from a health professio nal, even if your friend or family member won$t. "nd you can bring others% from

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peers to parents% into the circle of support.

Don"t act li'e the food police* " person with anorexia needs compassi on and support, not an authority figure standing over the table with a calorie counter.

Avoid threats, scare tactics, angry outburst s, and put.

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downs* Bear in mind that anorexia is often a symptom of extreme emotional distress and develops out of an attempt to manage emotional pain, stress, andGor self)hate. Aegative communi cation will only make it worse.

http)** .h elp"uide.or"* mental*anore xia+si"ns+sy mptoms+caus es+treatment. 27

htm

A,-./01A ,/.2-'A -ran" den"an anore3sia ner(osa berusaha melapar3an diri4 hidup den"an sedi3it atau tanpa ma3anan untu3 a3tu yan" san"at lama4 namun mere3a tetap ya3in bah a mere3a masih perlu untu3 menurun3an berat badan lebih banya3 la"i. Anore3sianer (osalebih dari se3edarmasal ahden"an ma3anan. 1ni adalahcara men""una3a nma3anan untu3merasa men"endali3 2!

anperasaanperasaan lainyan" mun"3intamp a3 luar biasa. 5elaparanada lah carauntu3 oran" den"ananore 3siamerasale bih men"endali3 an3ehidupan mere3adan untu3mereda 3an 3ete"an"an4 3emarahan4 dan 3ecemasan. 6es3ipuntida 3 ada penyebabtun ""altahuanor e3sianer(osa4 beberapa hal yan" mun"3inber3 ontribusi padaper3emb an"an "an""uan ini) 1. 5eluar"a. -ran" den"anibu atausaudara perempuan den"ananore 3sialebihmun "3in untu3 men"emban" 3anpenya3it 2%

ini. -ran"tua yan"terlalu banya3mene mpat3an nilaipada penampilan4 diet sendiri4 dan men"3riti3tub uhana3-ana3 mere3alebih mun"3inuntu 3 memili3i ana3den"ana nore3sia. 2. #udaya. A'memili3icit a-citasosial danbudaya3e tipisane3stri m.7anitaseb a"ianmendefi nisi3an diri mere3a sendiritentan " ba"aimanam enari3 secara fisi3mere3a. 3. 3ara3teristi3 pribadi. 'eseoran" den"ananore 3siamun"3in merasaburu3 tentan"diriny a sendiri4 merasa tida3 berdaya4 dan membencicar 3&

a diaterlihat. 8ia memili3ihara pan yan" tida3 realististerha dap dirinya sendiri danberusaha untu3 3esempurnaa n. 8ia merasatida3 berhar"a4 mes3ipun prestasi danmerasa3a nte3anansosi al untu3men9adi 3urus. 4. :an""uan lain emosional. ;ainmasalah3 esehatan mental4 seperti depresiatau 3ecemasan4 ter9adi bersama den"ananore 3sia. 5. 'tres peristi a atau perubahan hidup.<al-hal sepertimemul aise3olahbaru 31

ataupe3er9aa n ataudi"odape risti a traumati3sep erti pemer3osaan dapat menyebab3a nanore3siaon set. 6. #iolo"i. #eberapafa3t or biolo"isterma su3 "eneti3a4 re"ulasineuro transmitter=> at 3imia saraf di ota3?4 dan hormonhormonter3ai t lainnyamun" 3in pentin" untu3timbuln ya"an""uan ini @anda dan :e9ala Anorexia ,er(osa 'eseoran" den"an anore3sia a3an memili3i banya3 tanda-tanda ini) 3ehilan"an 32

banya3 berat badan berbicara tentan" berat badan dan ma3anan sepan9an" a3tu ber"era3 ma3anan di se3itar pirin"$ tida3 mema3annya berat dan 9umlah 3alori ma3anan men"i3uti diet 3etat 3e3ha atiran 3enai3an berat badan tida3 a3an ma3an di depan oran" lain men"abai3an * menyan"3al 3elaparan men""una3a n lan"3ahlan"3ah e3strem untu3 menurun3an berat badan =self-induced muntah4 33

penyalah"un aan la3satif4 penyalah"un aan diureti34 pil diet4 puasa4 olahra"a yan" berlebihan? berpi3ir dia "emu3 3eti3a dia terlalu 3urus banya3 mendapat sa3it yan" beratnya beberapa 3ali sehari diri tinda3an moody merasa terte3an merasa tersin""un" tida3 bersosialisasi mema3ai pa3aian lon""ar untu3 menyembuny i3an tampilan

6emperla3u3 an Anorexia 34

,er(osa 1. -ran" den"an penya3it ini bisa men9adi lebih bai3. Aen"obatan ter"antun" pada apa yan" oran" 3ebutuhan. -ran" tersebut harus 3embali 3e berat badan yan" sehat. 5adan"3adan"4 ini berarti a3an 3e rumah sa3it dan tin""al di sana untu3 pen"obatan. #erba"ai 9enis penyedia layanan 3esehatan4 seperti do3ter4 ahli "i>i4 dan terapis4 a3an membantu pasien men9adi lebih bai3. <BAs ini a3an membantu pasien mendapat3an 35

3embali berat badan4 menin"3at3a n 3esehatan fisi3 dan "i>i4 bela9ar pola ma3an sehat4 dan men"atasi pi3iran dan perasaan yan" ter3ait den"an "an""uan tersebut. 'etelah menin""al3a n rumah sa3it4 pasien terus mendapat3an bantuan dari <BAs nya. 2. @api tin""al di rumah sa3it mun"3in tida3 diperlu3an. @ipe lain dari pro"ram pen"obatan adalah satu di mana seseoran" per"i 3e rumah sa3it sian" hari4 tetapi 3ehidupan di rumah. -ran" lain den"an 36

anore3sia dapat sembuh den"an mendapat3an 3onselin" indi(idu dari suatu <BA4 seperti terapis yan" men"3husus3 an diri dalam "an""uan ma3an. 3. #anya3 3ali4 "an""uan ma3an ter9adi den"an masalah lain4 seperti depresi dan masalah 3ecemasan. 6asalah ini 9u"a diobati bersama den"an anore3sia4 dan mun"3in melibat3an obat-obatan yan" membantu men"uran"i perasaan depresi dan 3ecemasan. 4. 5eluar"a 3onselin" dan 3elompo337

3elompo3 pendu3un" 9u"a dapat men9adi ba"ian dari pen"obatan. Ci3a pasien masih muda4 terapi 3eluar"a san"at pentin". 5elompo3 pendu3un" membantu pasien dan 3eluar"a berbicara tentan" pen"alaman mere3a dan salin" membantu men9adi lebih bai3.

8ia"nosis4 Are(alensi dan Aro"nosis Anorexia ,er(osa 8ia"nosis anorexia ner(osa men"harus3a n seseoran" mela3u3an penola3an a"ar bisa mempertaha n3an berat 3!

badan yan" sehat dan normal untu3 usia dan tin""i badannya =lihat 5riteria 8'6-12-@. pada @abel 15.1?. 5riteria 8'6-12-@. untu3 anore3sia ner(osa men"harus3a n a"ar berat badan seseoran" setida3nya 15 persen lebih rendah dari berat badan yan" sehat minimum untu3 usia dan tin""i badannya =AAA4 2&&&?. 'erin"3ali4 berat badan oran" tersebut 9auh di ba ah itu. 'eba"ai contoh4 seoran" anita muda den"an tin""i 5 3a3i 6 inci yan" men"alami anore3sia mun"3in 3%

memili3i berat %5 pound4 9i3a berat badan sehat anita yan" tin""i ini adalah antara 12& dan 15% pound. Aada anita dan ana3 perempuan yan" mulai menstruasi4 3ehilan"an berat badan menyebab3a n mere3a berhenti men"alami si3lus menstruasi4 3ondisi yan" di3enal seba"ai amenore. 8'6-12-1. 5riteria 8ia"nosti3 dari Anorexia ,er(osa 8'6-12-@. menetap3an bah a disen"a9a atau tida3 penurunan berat badan yan" e3strim dan 4&

pemi3iran yan" menyimpan" tentan" tubuh seseoran" adalah fitur 3unci dari anore3sia ner(osa. a. Aenola3an untu3 mempertaha n3an berat badan pada atau di atas berat badan minimal yan" normal untu3 usia dan tin""i badan =misalnya4 penurunan berat badan men9adi 15 persen di ba ah berat badan minimal yan" sehat4 atau 3etida3mamp uan untu3 mempertaha n3an berat badan yan" diharap3an selama periode pertumbuhan 4 men"a3ibat3 an berat 41

badan 15 persen di ba ah berat badan minimal yan" sehat? b. 5e3ha atiran berlebihan terhadap berat badan atau men9adi "emu34 mes3ipun sebenarnya 3urus. c. 8istorsi dalam persepsi berat badan atau bentu3 tubuh seseoran"4 pen"aruh berat badan atau bentu3 yan" tida3 semestinya pada e(aluasi diri4 atau penola3an pada 3eadaan berat badan yan" rendah. d. Aada anita yan" telah mencapai menarche4 amenore 42

=tida3 adanya setida3nya ti"a si3lus menstruasi berturutturut? 6es3ipun 3urus4 namun oran"-oran" den"an anore3sia ner(osa memili3i 3e3ha atiran yan" berlebihan terhadap 3e"emu3an. 6ere3a memili3i ima"e yan" menyimpan" tentan" "ambaran tubuhnya4 merasa ya3in bah a mere3a "emu3 dan perlu menurun3an berat badan lebih banya3. /(aluasi diri dari penderita anore3sia ber"antun" sepenuhnya pada berat badan dan 3ontrol 43

mere3a atas ma3annya. 6ere3a percaya bah a 3ondisi mere3a adalah bai3 dan berhar"a 9i3a mere3a memili3i 3ontrol penuh atas ma3an mere3a dan 3eti3a mere3a 3ehilan"an berat badan. Aenurunan berat badan menyebab3a n oran" den"an anore3sia men9adi mudah lelah4 dan mere3a berusaha untu3 berolahra"a secara berlebihan dan men"atur 9ad al yan" melelah3an di tempat 3er9a atau se3olah. -ran" den"an anore3sia serin" 44

menun9u33an ritual yan" rumit dalam hal ma3anan4 seperti yan" telah di9elas3an penulis 6arya <ornbacher dalam otobio"rafiny a4 7asted =<ornbacher4 1%%!4 hlm 254 255?) 'aya menyebar 3ertas depan saya4 menyimpan yo"hurt sampin"4 dan melihat 9am tan"an. 'aya membaca 3alimat yan" sama berulan"ulan"4 untu3 membu3ti3an bah a saya bisa dudu3 di depan ma3anan tanpa menyentuhny a4 untu3 membu3ti3an bah a hal itu bu3an masalah besar. 45

'etelah lima menit berlalu4 saya mulai meminum yo"hurt itu...Anda men"ambil seu9un" sendo3 yo"hurt4 dan den"an hatihati hanya men"ambil ba"ian yan" meleleh. 5emudian membiar3an yo"urt itu menetes sampai hanya ada sedi3it yo"hurt tersisa di sendo3. 8en"an berhatihatilah saya menun""u untu3 men9ilatinya4 Anda hanya men9ilat sedi3it pada suatu a3tu4 dan ini berlan"sun" setida3nya empat atau lima 9ilatan4 dan Anda harus men9ilat ba"ian 46

bela3an" sendo3 pertama4 3emudian membali33an ba"ian atas sendo3 dan men9ilat ba"ian depannya4 den"an u9un" lidah. 5emudian menyimpan la"i yo"hurt itu sampin". 6embaca satu halaman penuh4 dan tida3 melihat yo"hurt untu3 memasti3an ia mencair. #erulan"ulan". Can"an men"ambil satu sendo3 penuh4 9an"an ma3an apapun 3ecuali yo"hurt itu meleleh. Can"an ber3hayal tentan" toppin"4 -reo yan" hancur4 atau saus co3elat. Can"an 47

berfantasi tentan" sand ich. sand ich a3an membuat situasi men9adi san"at rumit. -ran" den"an anore3sia ner(osa beratnya secara si"nifi3an 3uran" dari tin""i dan berat badan mere3a yan" semestinya. 'e3itar 1 persen oran" a3an men"alami anorexia ner(osa dalam hidupnya4 dan antara %& dan %5 persen oran" yan" didia"nosis den"an anore3sia ner(osa adalah perempuan =<oe3 D (an <oe3en4 4!

2&&3$ 'trie"el6oore4 8ohm4 d334 2&&3?. Aerempuan 3ulit putih lebih mun"3in untu3 men"alami dibandin"3an perempuan <itam dalam hal "an""uan ini. Anorexia ner(osa biasanya dimulai pada masa rema9a4 antara usia 15 dan 1% ='trie"el6oore4 1%%5?. Calannya "an""uan san"at ber(ariasi dari oran" 3e oran". 'tudi 9an"3a pan9an" yan" dila3u3an di /ropa menun9u33an bah a seten"ah dari anita yan" men"alami anore3sia ner(osa sepenuhnya pulih dalam a3tu 1& 4%

tahun setelah pen"obatan4 tetapi sisanya terus menderita masalah yan" ter3ait den"an ma3anan atau psi3opatolo"i lain4 terutama depresi =<erpert>8ahlmann4 6uller4 d334 2&&1$.. ;o e d334 2&&1$ 7ent> d334 2&&1?.. Anorexia ner(osa adalah "an""uan fisiolo"is yan" san"at berbahaya. @in"3at 3ematian di antara oran"oran" den"an anore3sia adalah 5 sampai ! persen =Aoli(y D <erman4 2&&2?. #eberapa 3onse3uensi palin" serius 5&

dari anore3sia adalah 3ompli3asi 3ardio(as3ula r4 termasu3 bradi3ardia =perlambatan denyut 9antun" e3strim?4 aritmia =denyut 9antun" tida3 teratur?4 dan "a"al 9antun". 5ompli3asi lain yan" berpotensi serius dari anore3sia adalah pembesaran perut yan" a3ut4 sampai pecah. 5e3uatan tulan" merupa3an masalah ba"i anita den"an anore3sia yan" memili3i amenore4 mun"3in 3arena 3adar estro"en rendah mempen"aru hi 3e3uatan tulan". 51

5erusa3an "in9al telah ditemu3an pada beberapa pasien den"an anore3sia4 dan "an""uan fun"si sistem 3e3ebalan tubuh dapat membuat oran" den"an anore3sia lebih rentan terhadap penya3it parah. Cenis Anorexia ner(osa 8alam 3utipan 'uara sebelumnya4 <ornbacher men""ambar 3an salah satu dari dua 9enis anore3sia4 9enis tertentu. -ran" den"an tipe anorexia ner(osa tertentu hanya menola3 ma3an 52

seba"ai cara untu3 mence"ah 3enai3an berat badan. #eberapa oran" den"an anorexia tertentu mencoba 3eluar rumah sehari penuh tanpa ma3an apapun. 5ebanya3an mere3a ma3an dalam 9umlah yan" san"at 3ecil setiap hari4 seba"ian hanya untu3 tetap hidup dan seba"ian 3arena pa3saan dari oran" lain untu3 ma3an. <ornbacher bertahan selama berbulanbulan hanya den"an secan"3ir yo"urt dan muffin bebas lema3 per hari. 8aphne4 dalam studi 3asus beri3ut ini4 9u"a memili3i tipe 53

anorexia ner(osa tertentu. /fe3 Anorexia ner(osa @ubuh tida3 mendapat3an ener"i dari ma3anan yan" dibutuh3an4 sehin""a melambat. ;ihatlah "ambar untu3 men"etahui ba"aimana anore3sia mempen"aru hi 3esehatan Anda. 1. -ta3 dan 'araf @ida3 bisa berpi3ir benar ta3ut berat badan menyedih3an 6oody mudah marah memori buru3 pin"san perubahan 3imia ota3 54

rambut rambut menipis dan a3an rapuh 2. 9antun" @e3anan darah rendah @in"3at memperlamb at 9antun" 3epa3an 9antun" =palpitasi? "a"al 9antun" 3. darah anemia dan masalah darah lainnya 4. -tot dan 'endi lemah otot ben"3a3 sendi patah tulan" osteoporosis

5. "in9al batu "in9al "a"al "in9al 6. Bairan 55

tubuh 3alium rendah ma"nesium rendah rendah natrium 7. usus sembelit 3embun" !. hormon periode berhenti 3eropos tulan" %. 6asalah tumbuh 3esulitan hamil Ci3a hamil4 risi3o lebih tin""i untu3) a? 5e"u"uran b? memili3i Bsection c? bayi den"an berat lahir rendah d? depresi pascamelahir 3an 56

1&.3ulit mudah memar 3ulit 3erin" pertumbuhan rambut halus di seluruh tubuh men9adi din"in den"an mudah 3ulit 3unin" 3u3u mendapat3an rapuh

Tabel 15.2 Tinjauan Konsep Perbandingan Gangguan Makan Gangguan makan bervariasi menurut karakteristiknya . Gejala Berat badanJenis Harus kurang Harus kurang $eringkali $eringkali $eringkali purging lebi dari lebi dari !"# normal atau normal atau sangat berat AN*Jenis non !"# kadang berlebi kadang berlebi purging AN* %mage tubu &etat &etat 'erlalu k a(atir
57

'erlalu k a(atir

$eringkali ben)i dengan

berat berlebi Binge 'idak *a *a *a *a *a 'idak *a 'idak

+erilaku purge 'idak atau kompensasi lain &urang )ontrol 'idak saat makan Amenorr ea pada (anita *a

$elama binge *a

*a

*a

*a

'idak la,im

*a

*a

E A, men"acu pada anore3sia ner(osa4 #, untu3 bulimia ner(osa. Cenis lainnya adalah 9enis bin"e*pur"e anore3sia ner(osa4 di mana oran" secara ber3ala terlibat dalam perila3u ma3an berlebihan atau membersih3an =misalnya4 muntah atau penyalah"unaan obat pencahar atau diureti3?. :an""uan ini berbeda den"an bulimia ner(osa dalam dua hal. Aertama4 oran" den"an tipe 1n"e*pur"e anore3sia setida3nya tetap berada 15 persen di ba ah berat badan yan" sehat4 sedan"3an oran"-oran" den"an bulimia ner(osa biasanya pada berat badan normal atau a"a3 3elebihan berat badan. 5edua4 anita den"an bin"e*pur"e anore3sia serin" men"alami amenore4 sedan"3an anita den"an bulimia ner(osa biasanya tida3. 'erin"3ali4 seseoran" den"an 9enis bin"e*pur"e anore3sia ner(osa tida3 terlibat dalam bin"es di mana dia ma3an banya3 ma3anan4 namun4 9i3a dia ma3an bah3an dalam 9umlah 3ecil4 dia merasa seolah-olah dia telah ma3an berlebih dan a3an membersih3an ma3anan itu. -ran" den"an tipe membatasi anore3sia lebih mun"3in dibandin"3an den"an 9enis bin"e*pur"e den"an memili3i perasaan yan" mendalam tentan" rasa tida3 percaya terhadap oran" lain dan 3ecenderun"an untu3 menyan"3al bah a mere3a memili3i masalah. -ran" den"an bin"e*pur"e anore3sia lebih cenderun" memili3i masalah den"an suasana hati yan" tida3 stabil dan pen"endalian impuls4 den"an al3ohol dan penyalah"unaan obat lain4 dan melu3ai diri sendiri =:arner4 :arfin3el4 D -F'hau"hnessy4 1%!5?. 6ere3a 9u"a cenderun" memili3i banya3 "an""uan 3ronis.

@./A@6/, Aen"obatan untu3 anorexia ner(osa mencoba untu3 men"atasi ti"a bidan" utama. 5!

1. 6en"embali3an seseoran" untu3 berat badan yan" sehat4 2. 6en"obati "an""uan psi3olo"is yan" ber3aitan den"an penya3it 3. 6en"uran"i atau men"hilan"3an perila3u atau pi3iran yan" a alnya men"arah pada ma3an teratur. Ci3a anore3sia ner(osa tida3 diobati4 3ompli3asi serius seperti seba"ai 3ondisi 9antun" dan "a"al "in9al dapat innitiate dan a3hirnya menyebab3an 3ematian. A. 8ietary 'uplemen >inc telah ditun9u33an dalam berba"ai penelitian bermanfaat dalam pen"obatan A, bah3an pada pasien tida3 menderita defisiensi sen"4 den"an membantu menin"3at3an berat badan. Asam lema3 esensial) Asam Asam lema3 ome"a-3 docosahexaenoic acid =8<A? dan eicosapentaenoic acid =/AA? telah terbu3ti bermanfaat ba"i berba"ai "an""uan neuropsi3iatri. Ada melapor3an penin"3atan pesat dalam sebuah 3asus yan" parah A, diobati den"an etil-asam eicosapentaenoic =/-/AA? dan mi3ronutrien8<A dan /AA suplemen telah terbu3ti men9adi manfaat di banya3 "an""uan 3omorbid A, termasu3) perhatian. defisit * hyperacti(ity disorder =A8<8?4 autisme4 "an""uan depresi utama =A85?4 "an""uan bipolar4 dan "an""uan 3epribadian borderline. Aercepatan penurunan 3o"nitif dan "an""uan 3o"nitif rin"an =6B1? ber3orelasi den"an tin"3at 9arin"an menurun3an 8<A * /AA4 dan suplemen telah menin"3at3an fun"si 3o"nitif.

,utrisi 3onselin" ,utrisi @erapi 6edis$ =6,@? 9u"a disebut seba"ai @erapi :i>i adalah pen"emban"an dan penyediaan pera atan "i>i atau terapi berdasar3an penilaian rinci se9arah medis seseoran"4 se9arah psi3ososial4 pemeri3saan fisi34 dan se9arah diet #. -bat -lan>apine) telah terbu3ti efe3tif dalam men"obati aspe3-aspe3 tertentu A, termasu3 untu3 membantu menai33an inde3s massa tubuh dan men"uran"i obsessionality4 termasu3 pi3iran obsesif tentan" ma3anan B. @erapi @erapi perila3u 3o"nitif =B#@? B#@ adalah sebuah pende3atan berbasis bu3ti yan" dalam studi sampai saat ini telah terbu3ti ber"una pada rema9a dan oran" de asa den"an anore3sia ner(osa 5%

Aenerimaan dan terapi 3omitmen) Cenis B#@4 telah men9an9i3an dalam pen"obatan A, Gpeserta men"alami perbai3an 3linis yan" si"nifi3an pada setida3nya beberapa tinda3an4 tida3 ada peserta memburu3 atau hilan" berat badan bah3an di 1-tahun tinda3-lan9ut.G @erapi 5o"nitif .emediasi =B.@?) adalah terapi rehabilitasi 3o"nitif di3emban"3an di 5in" Bolle"e di ;ondon yan" dirancan" untu3 menin"3at3an 3emampuan neuro3o"nitif seperti perhatian4 memori 3er9a4 fle3sibilitas 3o"nitif dan perencanaan4 dan fun"si e3se3utif yan" men"arah 3e fun"si sosial ditin"3at3an. Aenelitian neuropsi3olo"i telah menun9u33an bah a pasien den"an A, memili3i 3esulitan dalam fle3sibilitas 3o"nitif. 8alam studi yan" dila3u3an di 5in"s Bolle"e dan di Aolandia den"an rema9a B.@ terbu3ti bermanfaat dalam men"obati anore3sia ner(osa4 di Ameri3a 'eri3at u9i 3linis masih sedan" dila3u3an oleh 1nstitut ,asional 5esehatan 6ental pada rema9a usia 1&-17 dan 'tanford Hni(ersity di lebih dari 16 mata pela9aran seba"ai terapi pen"hubun" den"an terapi perila3u 3o"nitif. 5eluar"a @erapi) #entu3 yan" palin" efe3tif terapi untu3 rema9a den"an anore3sia adalah terapi 3eluar"a I1%&J Ada berba"ai bentu3 terapi 3eluar"a yan" telah terbu3ti untu3 be3er9a dalam pen"obatan rema9a A, termasu3 Gcon9oint terapi 3eluar"aG =BK@?4. di mana oran" tua dan ana3 terlihat bersama-sama oleh para terapis yan" sama4 Gdipisah3an terapi 3eluar"aG ='K@? di mana oran" tua dan ana3 men"hadiri terapi secara terpisah den"an terapis yan" berbeda. G6enun9u33an 3ohort /isler bah a4 terlepas dari 9enis K#@4 75L pasien memili3i hasil yan" bai34 15L hasil antara ...G 6audsley 5eluar"a @erapi) tahun 4 sampai 5 meninda3lan9uti studi pende3atan 6audsley4 model manuali>ed4 yan" menun9u33an pemulihan penuh pada tin"3at hin""a %&L I1%3J.

Aen"obatan alternati(e Yo"a) 8alam penelitian pendahuluan pen"obatan yo"a indi(uali>ed telah menun9u33an hasil positif untu3 di"una3an seba"ai terapi tambahan untu3 pera atan standar. Aen"obatan itu terbu3ti men"uran"i "e9ala "an""uan ma3an4 termasu3 3easyi3an ma3anan4 yan" men"alami penurunan se"era setelah setiap sesi. '3or pada Aemeri3saan :an""uan 6a3an menurun secara 3onsisten selama pen"obatan. 8. Aro"nosis Aro"nosis 9an"3a pan9an" dari anore3sia adalah lebih pada sisi yan" men"untun"3an. 5omorbiditas 'ur(ei ,asional .epli3asi dila3u3an di antara lebih 6&

dari %.2!2 peserta di seluruh Ameri3a 'eri3at4 hasil menemu3an bah a rata-rata durasi anore3sia ner(osa adalah 147 tahun. G#ertentan"an den"an apa yan" oran" mun"3in percaya4 anore3sia tida3 selalu merupa3an penya3it 3ronis4 dalam banya3 3asus4 itu ber9alan sa9a dan oran"-oran" mendapat3an yan" lebih bai3 ...G 8alam 3asus-3asus anore3sia ner(osa rema9a yan" memanfaat3an pen"obatan 5eluar"a 75L dari pasien memili3i hasil yan" bai3 dan 15L menun9u33an hasil yan" belum menen"ah yan" lebih positif. I1%1J 8alam lima tahun pasca pera atan tinda3 lan9ut dari @erapi 5eluar"a 6audsley pemulihan penuh rate antara 75L dan %&L. #ah3an dalam 3asus yan" parah A,4 mes3ipun tin"3at 3ambuhan mencatat 3&L setelah ra at inap4 dan a3tu pan9an" untu3 pemulihan mulai 57-7% bulan4 tin"3at pemulihan penuh masih 76L . Ada 3asus-3asus relaps minimal bah3an pada 9an"3a pan9an" follo -up dila3u3an antara 1&-15 tahun .Aro"nosis 9an"3a pan9an" dari anore3sia ner(osa berubah). 'eperlima dari pasien tetap sa3it parah4 lain 3elima pasien sembuh sepenuhnya dan 3 * 5 dari pasien memili3i pro"ram berflu3tuasi dan 3ronis =:elder4 6ayou dan :eddes 2&&5?. /. /pidemiolo"i Anore3sia memili3i pre(alensi rata-rata &43-1L pada anita dan &41L pada pria untu3 dia"nosis di ne"ara ma9u. 5ondisi ini san"at mempen"aruhi anita rema9a muda4 den"an antara 15 dan 1% tahun membuat sampai 4&L dari semua 3asus. 'e3itar 75L oran" den"an anore3sia adalah perempuan I1%%J. Anore3sia ner(osa lebih umum di 3elas sosial atas dan dinyata3an men9adi lan"3a di ne"ara-ne"ara 3uran" ber3emban" =:elder4 6ayou dan :eddes 2&&5?. 5esimpulan Anorexia ner(osa ditandai den"an usaha untu3 melapar3an-diri4 ima"e tubuh yan" terdistorsi4 3eta3utan intens men9adi 3e"emu3an4 dan amenore. Are(alensi seumur hidup anore3sia adalah 1 persen4 den"an %& sampai %5 persen 3asus dialami perempuan. Anore3sia biasanya dimulai pada masa rema9a4 dan tentu sa9a memili3i perbedaan (ariabel dari satu oran" 3e oran" yan" lain. -ran" den"an tipe membatasi untu3 ma3an dalam ran"3a mence"ah 3enai3an berat badan. -ran" den"an tipe bin"e*pur"e secara ber3ala terlibat dalam ma3an berlebihan dan 3emudian men"eluar3annya untu3 mence"ah 3enai3an berat badan

61

8iceta3 ulan" sesuai i>in dari 8ia"nostic dan 'tatistical 6anual of 6ental 8isorders4 /disi 5eempat4 .e(isi. <a3 Bipta M 2&&& Asosiasi Asi3iater Ameri3a. ='H'A, ,-;/,<-/5'/6A? ;auren #.Alloy and Chon <..is3ind4 Abnormal Asycholo"y http)** .netdoctor.co.u3*diseases*facts*anorexianer(osa.htm

A.D.A.M. Medical Encyclopedia.

Anorexia nervosa
ating disorder ! anorexia
Last reviewed: Fe ruary !", !#$%.

Anore&ia nervosa is an eating disorder t'at ma(es people lose more weig't t'an is considered 'ealt'y )or t'eir age and 'eig't. *ersons wit' t'is disorder may 'ave an intense )ear o) weig't gain, even w'en t'ey are underweig't. T'ey may diet or e&ercise too muc' or use ot'er ways to lose weig't.

"auses# incidence# and risk factors

T'e e&act causes o) anore&ia nervosa are not (nown. Many )actors may e involved. +enes and 'ormones may play a role. Social attitudes t'at promote very t'in ody types may also e involved. Family con)licts are no longer t'oug't to contri ute to t'is or ot'er eating disorders. ,is( )actors )or anore&ia include: -eing more worried a out, or paying more attention to, weig't and s'ape .aving an an&iety disorder as a c'ild .aving a negative sel)/image .aving eating pro lems during in)ancy or early c'ild'ood .aving certain social or cultural ideas a out 'ealt' and eauty Trying to e per)ect or overly )ocused on rules

Anore&ia o)ten egins during t'e pre/teen or teen years or young adult'ood. 0t is more common in )emales, ut may also e seen in males. T'e disorder is seen mainly in w'ite women w'o are 'ig' ac'ievers in sc'ool and w'o 'ave a goal/oriented )amily or personality.

$y%pto%s
To e diagnosed wit' anore&ia, a person must:

62

.ave an intense )ear o) gaining weig't or ecoming )at, even w'en s'e is underweig't ,e)use to (eep weig't at w'at is considered normal )or 'er age and 'eig't 1$23 or more elow t'e normal weig't4 .ave a ody image t'at is very distorted, e very )ocused on ody weig't or s'ape, and re)use to admit t'e danger o) weig't loss .ave not 'ad a period )or t'ree or more cycles 1in women4

*eople wit' anore&ia may severely limit t'e amount o) )ood t'ey eat. 5r t'ey eat and t'en ma(e t'emselves t'row up. 5t'er e'aviors include: Cutting )ood into small pieces or moving t'em around t'e plate instead o) eating E&ercising all t'e time, even w'en t'e weat'er is ad, t'ey are 'urt, or t'eir sc'edule is usy +oing to t'e at'room rig't a)ter meals ,e)using to eat around ot'er people 6sing pills to ma(e t'emselves urinate 1water pills or diuretics4, 'ave a owel movement 1enemas and la&atives4, or decrease t'eir appetite 1diet pills4

5t'er symptoms o) anore&ia may include: -lotc'y or yellow s(in t'at is dry and covered wit' )ine 'air Con)used or slow t'in(ing, along wit' poor memory or 7udgment Depression Dry mout' E&treme sensitivity to cold 1wearing several layers o) clot'ing to stay warm4 Loss o) one strengt' 8asting away o) muscle and loss o) ody )at

$igns and tests

Tests s'ould e done to 'elp )ind t'e cause o) weig't loss, or see w'at damage t'e weig't loss 'as caused. Many o) t'ese tests will e repeated over time to monitor t'e patient. T'ese tests may include: Al umin -one density test to c'ec( )or t'in ones 1osteoporosis4 C-C Electrocardiogram 1EC+ or E9+4 Electrolytes

63

9idney )unction tests Liver )unction tests Total protein T'yroid )unction tests 6rinalysis

Treat%ent
T'e iggest c'allenge in treating anore&ia nervosa is 'elping t'e person recogni:e t'at 'e or s'e 'as an illness. Most people wit' anore&ia deny t'at t'ey 'ave an eating disorder. *eople o)ten enter treatment only w'en t'eir condition is serious. +oals o) treatment are to restore normal ody weig't and eating 'a its. A weig't gain o) $ to % pounds per wee( is considered a sa)e goal. Di))erent programs 'ave een designed to treat anore&ia. Sometimes t'e person can gain weig't y: 0ncreasing social activity ,educing t'e amount o) p'ysical activity 6sing sc'edules )or eating

Many patients start wit' a s'ort 'ospital stay and )ollow/up wit' a day treatment program. A longer 'ospital stay may e needed i): T'e person 'as lost a lot o) weig't 1 eing elow ;#3 o) t'eir ideal ody weig't )or t'eir age and 'eig't4. For severe and li)e/t'reatening malnutrition, t'e person may need to e )ed t'roug' a vein or stomac' tu e. 8eig't loss continues even wit' treatment Medical complications, suc' as 'eart pro lems, con)usion, or low potassium levels develop T'e person 'as severe depression or t'in(s a out committing suicide

Care providers w'o are usually involved in t'ese programs include: <urse practitioners *'ysicians *'ysician assistants Dietitians Mental 'ealt' care providers

Treatment is o)ten very di))icult. *atients and t'eir )amilies must wor( 'ard. Many t'erapies may e tried until t'e patient overcomes t'is disorder. *atients may drop out o) programs i) t'ey 'ave unrealistic 'opes o) eing =cured= wit' t'erapy alone.

64

Di))erent (inds o) tal( t'erapy are used to treat people wit' anore&ia: Cognitive e'avioral t'erapy 1a type o) tal( t'erapy4, group t'erapy, and )amily t'erapy 'ave all een success)ul. +oal o) t'erapy is to c'ange patients> t'oug'ts or e'avior to encourage t'em to eat in a 'ealt'ier way. T'is (ind o) t'erapy is more use)ul )or treating younger patients w'o 'ave not 'ad anore&ia )or a long time. 0) t'e patient is young, t'erapy may involve t'e w'ole )amily. T'e )amily is seen as a part o) t'e solution, instead o) t'e cause o) t'e eating disorder. Support groups may also e a part o) treatment. 0n support groups, patients and )amilies meet and s'are w'at t'ey 'ave een t'roug'.

Medicines suc' as antidepressants, antipsyc'otics, and mood sta ili:ers may 'elp some anore&ic patients w'en given as part o) a complete treatment program. T'ese medicines can 'elp treat depression or an&iety. Alt'oug' medicines may 'elp, none 'as een proven to decrease t'e desire to lose weig't.

$upport Groups
T'e stress o) illness can e eased y 7oining a support group. S'aring wit' ot'ers w'o 'ave common e&periences and pro lems can 'elp you not )eel alone.

xpectations &prognosis'
Anore&ia nervosa is a serious condition t'at can li)e/t'reatening. -y some estimates, it leads to deat' in $#3 o) cases. E&perienced treatment programs can 'elp people wit' t'e condition return to a normal weig't, ut it is common )or t'e disease to return. 8omen w'o develop t'is eating disorder at an early age 'ave a etter c'ance o) recovering completely. Most people wit' anore&ia will continue to pre)er a lower ody weig't and e very )ocused on )ood and calories. 8eig't management may e 'ard. Long/term treatment may e needed to stay at a 'ealt'y weig't.

"o%plications
Complications may include: -one wea(ening Decrease in w'ite lood cells, w'ic' leads to increased ris( o) in)ection Low potassium levels in t'e lood, w'ic' may cause dangerous 'eart r'yt'ms Severe lac( o) water and )luids in t'e ody 1de'ydration4 Lac( o) protein, vitamins, minerals, and ot'er important nutrients in t'e ody 1malnutrition4 Sei:ures due to )luid or sodium loss )rom repeated diarr'ea or vomiting T'yroid gland pro lems Toot' decay

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"alling your health care provider

Tal( to your 'ealt' care provider i) a loved one is: Too )ocused on weig't 5ver/e&ercising Limiting t'e )ood 'e or s'e eats ?ery underweig't

+etting medical 'elp rig't away can ma(e an eating disorder less severe.

http)**

.ncbi.nlm.nih."o(*pubmedhealth*A6<&&&14&1*

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