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Anorexia Nervosa By: Brianna, Christina, Jacqueline, and Nikki

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Anorexia Nervosa Defined Anorexia nervosa (AN) is a deeply perplexing illnessthat ravages both mind and body. (Mccallum, 1985) AN is a mental disorder that consists of very little eating combined with over exercising. Individuals with this disorder refuse to maintain a body weight at or above the standard healthy weight for their height and age. Body weight is maintained at least 15% below that expected. (Mccallum, 1985)

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Who Gets Anorexia Nervosa? More common in women than in men, as men make up only 10-15% of the anorexic population. (ANAD, 2015) Gay males make up for 20% of anorexic population MOST CASES involve young women between the ages of 12 and 25. (ANRED, 2011)

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Beliefs and Consequences Beliefs Phobia Intense fear of gaining weight therefore restricts food intake Body Perception Warped perception of body image (appear overweight in mirror) Denies the seriousness of their low body weight Consequences Girls Amenorrhea: absence of 3 or more consecutive periods Absence of breast development in puberty Boys Loss of sexual interest Loss in potency Genitals remain juvenile Both Increased levels of: growth hormone & cortisol Changes in metabolism of thyroid hormone Abnormal insulin secretion Hair loss (Mccallum, 1985)

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Persisting Consequences Psychological Depression, anxiety, social withdrawl, heightened self consciousness, and fatigue (Mccallum, 1985) Mortality Rate 4% (The American Journal of Psychiatry, 2009) Eating disorders have the highest mortality rate of any mental illness. (ANAD, 2015)

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Biological Factors of Anorexia Anorexia Nervosa is most often inherited biologically through your family and passed down. New research studies suggests that inherited biological and genetic factors contribute approximately 56% of the risk for developing an eating disorder such as anorexia (Engel, Staats Reiss and Dombeck, 2015), Individuals who have a mother or a sister with anorexia nervosa are approximately twelve times more likely to develop anorexia compared to a family who hasnt experienced genetic factors of this disorder. It has always been thought that socio-cultural factors such as (e.g., media, parents, peers) and problems with self-esteem were the main causes of developing a disorder but it is now understood that anorexia is more of a brain disorder and current research is being done to find the exact biological factors of anorexia nervosa. (Blair, 2015), (Douglas.qc.ca, 2015), (Engel, Staats Reiss and Dombeck, 2015), (Nationaleatingdisorders.org, 2015)

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Continued In some individuals with anorexia, certain chemicals in the brain that control digestion, appetite, and hunger have been found to be unbalanced Deformity involving the neurotransmitters that regulate mood and appetite are also thought to have an impact on anorexia. Studies have shown that twins have a higher rate of getting anorexia when they are identical compared to fraternal twins. Some research finds that some individuals are addicted to the chemicals that are released in the brain at the time of starvation and physical activity and has been determined that individuals with anorexia tend to get some sort of high from not eating. (Blair, 2015), (Douglas.qc.ca, 2015), (Engel, Staats Reiss and Dombeck, 2015), (Nationaleatingdisorders.org, 2015) (Blair, 2015), (Douglas.qc.ca, 2015), (Engel, Staats Reiss and Dombeck, 2015), (Nationaleatingdisorders.org, 2015)

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Therapeutic Recreation Program Planning Model Beneficial for patience with anorexia nervosa Summary of model: Provides the basis for sound and logical program development. Helping specialists to examine factors that most affect program development, and develop programs based on client needs. Section of model using Agency: In this section it looks at Mental Health Agencies and their mission statements. Example Mission statement: Our mission is to assist county residents with symptoms of mental illness in achieving and maintaining their high level of functioning. To accomplish this mission we will: Respect the dignity and worth of all individuals Provide quality services in a caring, nonjudgmental manner Encourage the development of full potential and individual responsibility in the areas of living, learning, working, parenting, and socializing Work cooperatively with other community resources Promote a positive working environment for all staff Maintain compliance with state mental hygiene laws and office of mental health regulations (Stumbo, 2009)

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Benefits of this Model for Anorexia To regain self esteem and confidence To reintegrate themselves back into societies norms To have the motivation from their community to support them back to health Helping them, and their families to better understand the disorder Teaching them ways to overcome the disorder, and accept themselves for the way they are Assist them into developing ways to overpowering thoughts of body dis-morphia (Stumbo, 2009)

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TR Interventions to support the recovery of Anorexia Anorexia often leads to serious medical complications. Since you are dealing with patients who are underweight and are not in a safe condition to do much activity, as a TR specialist you need to more careful with the intervention plan you chose. Anorexia patients are known for obsessing over exercise. Anorexia patients often have OCD traits with exercising. The idea of exercise to them is to burn a specific amount of calories/fat. Exercise to a patient with anorexia is seen more as a punishment , They feel like the NEED to exercise and burn whatever food they ate. (tremendous amount of guilt if they do not exercise) TR Intervention= Exercise Prescription & Self-Esteem Boosting -Provide empowerment through appropriate and self-controlled leisure and recreation. Enhance patient s self-concept and confidence. Develop leisure knowledge to live a healthier lifestyle and healthy copping mechanisms. (painting, reading, meditation etc.) Therapy should be client-centred approach as each individual patient will be in different stages of their Anorexia and/or recovery

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Exercise Prescription This intervention will help patients understand the role of healthy levels of exercise, balance of life choices, and improve the clients physical and psychological health. Help the patient gain greater control over their leisure lifestyle and obsessive exercise. Teach patients that exercise is not a solution to turn to when feeling guilty about what they ate or feeling low about themselves. When client says they feel guilty about what they eat, ask them to draw words/pictures to express what their eating disorder voice is saying and making them feel. Teach them exercise should not be a punishment (or how many calories you can burn) but can actually be used as play (soccer, dancing, hiking). Ensure that activities are properly motivated (Wanting to exercise vs. NEEDING to.) Help them find balance in life.

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Self-Esteem Strengthening Self-Esteem Exercise: Tell patient that they need to write down 3 things they like about themselves. The patient will most likely struggle with thinking of these things but when they come up with them you then help the patients to embrace their traits. Gain Confidence: Eating disorder voice will tell them all the negative things they hear, teach them to fight the ED thoughts. It is important to teach patient that they ARE NOT their Anorexia and to separate those thoughts. Media Exercise: Photoshop Before & After: Show patients the effects of photoshop. Teach them that the models in the magazines don t even look like what the picture is. Media has a lot of effects on how young females and males should look..

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References Mccallum, Richard W., et al. "Definition of a gastric emptying abnormality in patients with anorexia nervosa." Digestive diseases and sciences 30.8 (1985): 713-722. The American Journal of Psychiatry., et al. Increased Mortality in Bulimia Nervosa and Other Eating Disorders. (2009, January 1), from http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2009.09020247 http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2009.09020247 The National Association of Anorexia Nervosa and Associated Disorders (ANAD) (2009, January 1). Eating Disorders Statistics. Retrieved from http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/ http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/ ANRED: Who Gets Eating Disorders. (2011, January 1). Retrieved March 21, 2015, from http://www.anred.com/who.htmlhttp://www.anred.com/who.html Blair, H. (2015). NAMI: National Alliance on Mental Illness | NAMI: The National Alliance on Mental Illness. [online] Www2.nami.org. Available at: http://www2.nami.org/Content/NavigationMenu/Top_Story/Discovering_the_Biological_Basis_of_Anorexia.htm [Accessed 22 Mar. 2015]. Douglas.qc.ca, (2015). Eating Disorders: causes and symptoms - Mental Health A-Z - Douglas Mental Health University Institute. [online] Available at: http://www.douglas.qc.ca/info/eating-disorders-causes-symptoms [Accessed 22 Mar. 2015] Engel, B., Staats Reiss, N. and Dombeck, M. (2015). Causes of Eating Disorders - Biological Factors Continued - Eating Disorders (Anorexia, Bulimia, Binge Eating) Professional Treatment, & Help. [online] Mentalhelp.net. Available at: http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=11749&cn=46 [Accessed 22 Mar. 2015]. Nationaleatingdisorders.org, (2015). Factors That May Contribute to Eating Disorders | National Eating Disorders Association. [online] Available at: https://www.nationaleatingdisorders.org/factors-may-contribute-eating-disorders [Accessed 22 Mar. 2015]. Stumbo, N., & Peterson, C. (n.d.). Comprehensive Program Design. In Therapeutic Recreation Design Principles & Procedures (5th ed., pp. 109-113). Glenview, Illinois: Pearson. Robertson, Terry, and Terry Long. "Chapter 10: Therapeutic Recreation and Mental Health." Foundations of Therapeutic Recreation. Champaign, IL.: Human Kinetics, 2008. 151-53. Print. Mitchell, Jon, and Robyn Eisenbach. "The Recreational Therapist Role in Prescribing Exercise to the Eating Disorder Patient." The Recreational Therapist Role in Prescribing Exercise to the Eating Disorder Patient. University of Iowa Hospitals and Clinics, 23 July 2001. Web. 20 Mar. 2015. http://www.recreationtherapy.com/articles/mitchell.htm