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Query: UMLS:C0038187 (starvation)
 24,951 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Extreme forms of self-starvation can be traced across time and place, and may be construed using a variety of explanatory models. Curiously, the prevailing biomedical definition of anorexia nervosa has assigned primacy to the exclusive use of 'fat phobia' by the affected subjects to justify their diminished food intake. This paper assembles evidence to show that this culturally constructed version of fat phobic anorexia nervosa has neglected the full metaphorical significance of self-starvation and, when applied in a cross-cultural context, may constitute a category fallacy. By delegitimizing other rationales for non-eating and thereby barring subjective expressions, this regnant interpretive strategy may obscure clinicians' understanding of patients' lived experience, and even jeopardize their treatment. Nonetheless, it is a relatively simple task to attune the extant diagnostic criteria to a polythetic approach which will avert cultural parochialism in psychiatric theory and practice. As a corollary of the archival and ethnocultural study of extreme self-starvation, there is, contrary to epistemological assumptions embedded in the biomedical culture of contemporary psychiatry, no 'core psychopathology' of anorexia nervosa.
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PMID:Self-starvation in context: towards a culturally sensitive understanding of anorexia nervosa. 766 70

A mixed retrospective-prospective study of 70 Chinese anorexic patients in Hong Kong shows that although they were similar to Western anorexics in most other ways, 41 (58.6%) of them did not exhibit any fear of fatness throughout their course of illness. Instead, these non-fat phobic patients used epigastric bloating (31.4%), no appetite/hunger (15.7%) or simply eating less (12.9%) as legitimating rationales for food refusal and emaciation. Compared to fat phobic anorexics, they were significantly slimmer pre-morbidly (P < 0.0001) and were less likely to exhibit bulimia (P = 0.001). The possible explanations for the absence of fat phobia and the interpretive dilemma this provokes are discussed from historical, pathoplastic and cultural anthropological perspectives. It is argued that anorexia nervosa may display phenomenological plurality in a Westernizing society, and its identity may be conceptualized without invoking the explanatory construct of fat phobia exclusively. As non-fat phobic anorexia nervosa displays no culturally peculiar features, it is not strictly speaking a Western culture-bound syndrome, but may evolve into its contemporary fat phobic vogue under the permeative impact of Westernization. Its careful evaluation may help clarify the aetiology and historical transformation of eating disorder, foster the development of a cross-culturally valid taxonomy of morbid states of self-starvation, and exemplify some of the crucial issues that need to be tackled in the cross-cultural study of mental disorders.
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PMID:Fat phobic and non-fat phobic anorexia nervosa: a comparative study of 70 Chinese patients in Hong Kong. 813 23

Several reviews of the history of anorexia nervosa have concluded that weight phobia, a basic diagnostic criterion for the disorder, did not emerge as a predominant motive for food refusal until around 1930. In addition, investigators have reported cases of self-starvation without apparent weight phobia in non-Western cultures. Three explanations have been proposed for these findings: 1) patients who do not demonstrate a definite weight phobia are in fact suffering from an eating disorder not otherwise specified, 2) weight phobia has been overlooked or concealed, and 3) there has been a transformation in the content of anorexia nervosa in the West and an analogous situation may be occurring in the developing countries. The authors conclude that a change in the core features of anorexia nervosa in Western cultures since 1930 can be demonstrated. They explore the question of whether anorexia nervosa would be the same illness if the criterion of weight phobia were not required and conclude that anorexia nervosa may be conceptualized in several different ways without including the phenomenon of weight phobia or body image disturbance. Finally, they recommend that because the desire for thinness appears to be culture-bound, anorexia nervosa is the best disorder to use in examining the influence of culture on psychopathology. Therefore, cases of self-starvation in non-Western cultures should be studied carefully because they may clarify the core features of anorexia nervosa.
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PMID:Is weight phobia always necessary for a diagnosis of anorexia nervosa? 837 48

Based on Ritenbaugh's 1982 definition, this essay reconsiders the status of anorexia nervosa as a Western culture-bound syndrome (CBS). It argues that anorexia nervosa, in its culturally reconstructed fat phobic form, is no longer bound to specific Western localities. Instead, it may be conceived as being grounded in the transnational culture of 'modernity', characterized by an internationalised socio-economic stratum now found in many rapidly urbanising parts of the world, and composed of increased affluence, as well as the globalization of fat phobia and diffusion of biomedical technology. Although the treatment implication of Ritenbaugh's CBS concept may appear to be misplaced from the clinician's pragmatic perspective, its salience for clarifying the interaction of individual and cultural concerns in self-starvation, as well as for fostering a needed self-scrutiny in psychiatry, is affirmed. A critique of the dialectical relationship between culture and psychopathology is then put forward. This addresses the apparently conflicting role of anorexia nervosa in enacting as well as combating the cultural pursuit of thinness, and ends by highlighting the inadvertent influence of the biomedical establishment in propagating the condition with measures intended, ironically, for preventing it.
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PMID:Reconsidering the status of anorexia nervosa as a western culture-bound syndrome. 874 5

This paper reviews research on the psychological characteristics of patients suffering from anorexia nervosa and that examining the therapeutic relationship. The former research suggests that anorexic patients possess a psychological profile characterized by: a phobia of weight gain and fear of loss of control; alexithymia and lack of introceptive awareness; mistrust of self and others; cognitive dysfunction; low self-esteem; and often the presence of starvation-induced depression. The latter strongly suggests that in order for a relationship to be therapeutic it needs to be characterized by: empathy; positive regard and acceptance; warmth; commitment; trust; genuineness; and be non-judgemental. The implications of these research findings regarding the nurse's role in forming a therapeutic relationship with anorexic patients is then discussed. It is seen that it is vital that nurses receive adequate education before working with such patients, and that their knowledge is regularly updated. Nurses should receive regular clinical supervision and support, in order to ensure that they are able to provide therapeutic care for such patients.
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PMID:The psychological characteristics of patients suffering from anorexia nervosa and the nurse's role in creating a therapeutic relationship. 937 93

Anorexia nervosa is currently considered a disorder confined to Western culture. Its recent identification in non-Western societies and different subcultures within the Western world has provoked a theory that Western cultural ideals of slimness and beauty have infiltrated these societies. The biomedical definition of anorexia nervosa emphasizes fat-phobia in the presentation of anorexia nervosa. However, evidence exists that suggests anorexia nevosa can exist without the Western fear of fatness and that this culturally biased view of anorexia nervosa may obscure health care professionals' understanding of a patient's own cultural reasons for self-starvation, and even hinder their recovery.
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PMID:Anorexia nervosa and culture. 1189 58

The basic criterion for the diagnosis of anorexia (AN - anorexia nervosa) by ICD-10 (International Classification of Diseases, version 10) is the body weight less than 15% of the expected normal body weight. According to DSM-IV (Diagnostic and Statistical Manual for Mental Disorders, version IV) the basic feature of AN is a refusal to maintain body weight equal or greater than the minimal normal weight. The prevalence of anorexia nervosa is 0.3-0.5% or even 1.3-3.7% if include pre-anorexic states (eg. the phenomenon of pro-ana). The main feature of anorexia is a reduction of caloric intake. According to the recommendations of the American Psychiatric Association (APA) for nutritional treatment of patients with AN the main goals in therapy of AN are: restoration of body weight, normalization of eating patterns, achievement a normal feeling of hunger and satiety and correction of the consequences of improper nutrition. APA suggests that achievable weight gain is about 0.9-1.4 kg per week in the case of hospitalized patients and approximately 0.23-0.45 kg per week in the case of outpatients. During the nutritional treatment of AN numerous side effects including anxiety, phobia, occurrence of obsessive thoughts and compulsive behavior, suicidal thoughts and intentions may occur. According to National Institute for Clinical Excellence (NICE) the most important goal of AN therapy is weight gain in the range of 0.5-1 kg per week in hospitalized patients and 0.5 kg per week for outpatients. A person suffering from anorexia in the initial period of nutritional treatment spends twice more energy to maintain elevated body temperature, which significantly increases during the night rest. This phenomenon is called nocturnal hyperthermia and has a negative effect on the healing process. "Refeeding syndrome" is an adverse effect of nutritional treatment in anorexia. It is caused by too rapid nutrition in a patient suffering from chronic starvation. It can endanger the patient's life.
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PMID:[Contemporary criteria of the diagnosis and current recommendations for nutritional therapy in anorexia nervosa]. 2496 16