Description of impact
Anorexia nervosa, often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. Anorexia is a term of Greek origin: an- (ἀν-, prefix denoting negation) and orexis (ὄρεξις, "appetite"), translating literally to "a loss of appetite"; instead, the adjective nervosa indicates the functional and non-organic nature of the disorder. Anorexia nervosa was coined by Gull in 1873 but, despite literal translation, the symptom of hunger is frequently present and the pathological control of this instinct is a source of satisfaction for the patients. Patients with anorexia nervosa commonly see themselves as overweight, although they are in fact underweight. The DSM-5 describes this perceptual symptom as "disturbance in the way in which one's body weight or shape is experienced". In research and clinical settings, this symptom is called "body image disturbance". Patients with anorexia nervosa also often deny that they have a problem with low weight. They may weigh themselves frequently, eat small amounts, and only eat certain foods. Some exercise excessively, force themselves to vomit (in the "anorexia purging" subtype), or use laxatives to lose weight and control body shapes. Medical complications may include osteoporosis, infertility, and heart damage, among others. Women will often stop having menstrual periods. In extreme cases, patients with anorexia nervosa who continually refuse significant dietary intake and weight restoration interventions, and are declared incompetent to make decisions by a psychiatrist, may be fed by force under restraint via nasogastric tube after asking their parents or proxies to make the decision for them.The cause of anorexia is currently unknown. There appear to be some genetic components with identical twins more often affected than fraternal twins. Cultural factors also appear to play a role, with societies that value thinness having higher rates of the disease. Additionally, it occurs more commonly among those involved in activities that value thinness, such as high-level athletics, modeling, and dancing. Anorexia often begins following a major life-change or stress-inducing event. The diagnosis requires a significantly low weight and the severity of disease is based on body mass index (BMI) in adults with mild disease having a BMI of greater than 17, moderate a BMI of 16 to 17, severe a BMI of 15 to 16, and extreme a BMI less than 15. In children, a BMI for age percentile of less than the 5th percentile is often used.Treatment of anorexia involves restoring the patient back to a healthy weight, treating their underlying psychological problems, and addressing behaviors that promote the problem. While medications do not help with weight gain, they may be used to help with associated anxiety or depression. Different therapy methods may be useful, such as cognitive behavioral therapy or an approach where parents assume responsibility for feeding their child, known as Maudsley family therapy. Sometimes people require admission to a hospital to restore weight. Evidence for benefit from nasogastric tube feeding is unclear; such an intervention may be highly distressing for both anorexia patients and healthcare staff when administered against the patient's will under restraint. Some people with anorexia will have a single episode and recover while others may have recurring episodes over years. Many complications improve or resolve with the regaining of weight.Globally, anorexia is estimated to affect 2.9 million people as of 2015. It is estimated to occur in 0.9% to 4.3% of women and 0.2% to 0.3% of men in Western countries at some point in their life. About 0.4% of young women are affected in a given year and it is estimated to occur ten times more commonly among women than men. Rates in most of the developing world are unclear. Often it begins during the teen years or young adulthood. While anorexia became more commonly diagnosed during the 20th century it is unclear if this was due to an increase in its frequency or simply better diagnosis. In 2013, it directly resulted in about 600 deaths globally, up from 400 deaths in 1990. Eating disorders also increase a person's risk of death from a wide range of other causes, including suicide. About 5% of people with anorexia die from complications over a ten-year period, a nearly six times increased risk. The term "anorexia nervosa" was first used in 1873 by William Gull to describe this condition. In recent years, evolutionary psychiatry as an emerging scientific discipline has been studying mental disorders from an evolutionary perspective. It is still debated whether eating disorders such as anorexia have evolutionary functions or if they are problems resulting from a modern lifestyle.History (from Greek ἱστορία, historia, meaning "inquiry; knowledge acquired by investigation") is the study of the past. Events before the invention of writing systems are considered prehistory. "History" is an umbrella term comprising past events as well as the memory, discovery, collection, organization, presentation, and interpretation of these events. Historians seek knowledge of the past using historical sources such as written documents, oral accounts, art and material artifacts, and ecological markers.History also includes the academic discipline which uses narrative to describe, examine, question, and analyze past events, and investigate their patterns of cause and effect. Historians often debate which narrative best explains an event, as well as the significance of different causes and effects. Historians also debate the nature of history as an end in itself, as well as its usefulness to give perspective on the problems of the present.Stories common to a particular culture, but not supported by external sources (such as the tales surrounding King Arthur), are usually classified as cultural heritage or legends. History differs from myth in that it is supported by evidence. However, ancient cultural influences have helped spawn variant interpretations of the nature of history which have evolved over the centuries and continue to change today. The modern study of history is wide-ranging, and includes the study of specific regions and the study of certain topical or thematic elements of historical investigation. History is often taught as part of primary and secondary education, and the academic study of history is a major discipline in university studies. Herodotus, a 5th-century BC Greek historian, is often considered the "father of history" in the Western tradition, although he has also been criticized as the "father of lies". Along with his contemporary Thucydides, he helped form the foundations for the modern study of past events and societies. Their works continue to be read today, and the gap between the culture-focused Herodotus and the military-focused Thucydides remains a point of contention or approach in modern historical writing. In East Asia, a state chronicle, the Spring and Autumn Annals, was reputed to date from as early as 722 BC, although only 2nd-century BC texts have survived.A number is a mathematical object used to count, measure, and label. The original examples are the natural numbers 1, 2, 3, 4, and so forth. Numbers can be represented in language with number words. More universally, individual numbers can be represented by symbols, called numerals; for example, "5" is a numeral that represents the number five. As only a relatively small number of symbols can be memorized, basic numerals are commonly organized in a numeral system, which is an organized way to represent any number. The most common numeral system is the Hindu–Arabic numeral system, which allows for the representation of any number using a combination of ten fundamental numeric symbols, called digits. In addition to their use in counting and measuring, numerals are often used for labels (as with telephone numbers), for ordering (as with serial numbers), and for codes (as with ISBNs). In common usage, a numeral is not clearly distinguished from the number that it represents. In mathematics, the notion of a number has been extended over the centuries to include 0, negative numbers, rational numbers such as one half ( 1 2 ) {\displaystyle \left({\tfrac {1}{2}}\right)} , real numbers such as the square root of 2 ( 2 ) {\displaystyle \left({\sqrt {2}}\right)} and π, and complex numbers which extend the real numbers with a square root of −1 (and its combinations with real numbers by adding or subtracting its multiples). Calculations with numbers are done with arithmetical operations, the most familiar being addition, subtraction, multiplication, division, and exponentiation. Their study or usage is called arithmetic, a term which may also refer to number theory, the study of the properties of numbers. Besides their practical uses, numbers have cultural significance throughout the world. For example, in Western society, the number 13 is often regarded as unlucky, and "a million" may signify "a lot" rather than an exact quantity. Though it is now regarded as pseudoscience, belief in a mystical significance of numbers, known as numerology, permeated ancient and medieval thought. Numerology heavily influenced the development of Greek mathematics, stimulating the investigation of many problems in number theory which are still of interest today.During the 19th century, mathematicians began to develop many different abstractions which share certain properties of numbers, and may be seen as extending the concept. Among the first were the hypercomplex numbers, which consist of various extensions or modifications of the complex number system. In modern mathematics, number systems (sets) are considered important special examples of more general categories such as rings and fields, and the application of the term "number" is a matter of convention, without fundamental significance.Impact date | 13 Sept 2020 |
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