title: Knights of the Round Table

text: Osenain (one of many spelling variants), often appearing with the moniker translating either (depending of the French spelling) as 'Braveheart', 'the Hardhearted', 'the Bold' or 'Hard Body', is a character often appearing as one of the Round Table's knights errant in the works of Arthurian romance. In English, he is best known from Thomas Malory's "Le Morte d'Arthur" as Ozanna le Cure Hardy ("Ozanna le Coeur Hardi" in the Winchester Manuscript; rendered as Ozana of the hardy heart in William Morris' "The Chapel in Lyonesse"). Different Middle English versions of the "Merlin Continuation" call him Gosenain Hardy Body, Gosnayn de Strangot, Osenayn Cors Hardy and Osoman Hardi of Hert. In many works he is associated with the often similarly named nephew of King Arthur, Gawain of Orkney, while being cast as Gawain's companion or opponent.


title: Knights of the Round Table

text: Like Gawain's, his character is considered to be derived from the prototype of the warrior by the name Gwrvan and its variants, found in the early Welsh Arthurian tales "Culhwch ac Olwen", "Peredur fab Efrawg", "Preiddeu Annwn", and "Trioedd Ynys Prydein". Within the chivalric romance tradition, he is first found as Garravain[s] d'Estrangot among Arthur's knights in some manuscripts of Chretien de Troyes' Old French "Erec et Enide" (Gasosin von Strangot in its German version "Erec"). He is also listed by the name Gasouains in the First Continuation of Chrétien's "Perceval ou le Conte du Graal". In "Les Merveilles de Rigomer", Garradains is named as the knight of Arthur traveling with Gawain on a quest to conquer the enchanted castle of the Irish queen Dionise.


title: Knights of the Round Table

text: In "Diu Crône", Gasozein de Dragoz arrives at King Arthur's court and claims to be the first lover and rightful husband of Queen Guinevere, unsuccessfully demanding her to be returned to him. Gasozein later rescues the queen from her brother Gotegrin, who wants to kill Guinevere for her infidelity, but then he kidnaps her in turn and nearly rapes her, however Gawain arrives in time, defeats Gasozein in a duel, sends him back to Arthur to revoke his claim, and even arranges Gasozein's marriage with his own sister-in-law, Sgoidamur. The plot of "Meraugis de Portlesguez" revolves around the protagonist Meraugis competing for the love of Queen Lidoine with his friend Gorvain Cadrut ("Gornain[s]", "Gornenis"; -"Cadrus", "Cadruz", "Kadrus"), in addition to dealing with Gawain. Gorvain loses Lidoine to his rival, but ends up happily married to one of her maidens, Avice. In another text, "Hunbaut", Gorvain Cadrus of Castle Pantelion takes Gawain's unnamed sister hostage, seeking vengeance against him for the death of one of his relatives. He is taken captive by Gawain, then sent as a prisoner to Arthur's court at Caerleon where he eventually becomes a Knight of the Round Table.


title: Knights of the Round Table

text: He recurringly features as Osenain[s] Cuer Hardi ("Gosenain", "Osanain", "Osevain", "Osoain", "Osuain", "Oswain", etc.; -"Cors Hardi[z]", "Corsa Hardy", "Corps Hardi", "au Cœur-Hardi", "Chore Ardito") in the Prose "Lancelot", and as Ossenain Cuer Hardi ("Oselain", "Osenaín", "Ossenain", "Ossenam", "Ossenet d'Estrangot") in the Prose "Tristan". In the Vulgate "Estoire de Merlin" (and the English "Of Arthour and of Merlin"), the young Gasoain d'Estrango[r]t ("Gaswain", "Gosenain"; -"of / d'Estrangor[r]e") fights alongside Gawain in the battles against the invading Saxons, his great feats earning him an early seat at the Round Table. When Gawain wrongly accuses him of treason, he gives Gawain a severe face wound in a trial by combat in front of King Arthur. In the Vulgate "Lancelot", he is noted as "very valorous and a good speaker", and is involved in the adventures of Kay and others. He is with Gawain when they are both captured and imprisoned in the Dolorous Prison until their rescue by Lancelot, who also later frees him from Turquine's captivity on another occasion. He assists Maleagant of Gore in the abduction of Queen Guinevere and is imprisoned by King Arthur after Lancelot's rescue of her (in Malory's version, he is instead one the loyal Queen's Knights captured by Maleagant along with her). He is later forgiven and fights for Arthur against King Rience, eventually participating in the Grail Quest. The Guiron le Courtois section of "Palamedes" describes him as son of King Quinados.


title: Knights of the Round Table

text: In the Italian "Tavola Ritonda", Suziano of the Valiant Heart ("Cuoe Ardito") is a young son of Lady Largina and uncertainly either King Esclabor the Unknown or King Amorotto (that is, Lamorak) of Listenois, as his promiscuous and power-hungry mother was a lover of both of them at the same time. He comes into service of the evil Lady Losanna of the Ancient Tower ("Losanna dela Torre Antica") after falling in love with her, and is slain by Tristan protecting Losanna's enemy Tessina from his attempt on her life. He also appears under the name Guengasoain[s] ("Gasouains", "Guengasouain", "Guingasoain") as the antagonist of "La Vengeance Raguidel", in which Gawain and Yder attempt to avenge his murder of the knight Raguidel. Here he is a nephew of King Aguissant (meaning Angusel, a brother of King Lot in the "Historia Regum Britanniae") and a knight of the fay enchantress Lingrenote, the lady of the Nameless Castle ("Castiel sans Non"), who has armed him with powerful enchanted weapons that made him near invincible. He is nevertheless defeated by Gawain with the help of Yder, the latter of whom then marries Guengasoain's orphaned daughter, Trevilonete.


title: Knights of the Round Table

text: Priamus ("Pryamus") is a Roman ally of Emperor Lucius in Malory's "Le Morte d'Arthur", following the Alliterative "Morte Arthure". He claims to be descended from Alexander of Africa and Judas Maccabeus. Upon meeting Gawain in "The Tale of King Arthur and Emperor Lucius", he defects from Lucius to join forces with King Arthur. In return, Arthur appoints him as the Duke of Lorraine. He later dies at the fight for Guinevere. In Malory's version, two of Priamus' brothers also become Knights of the Round Table: Edward of Carnarvon and Hectymere.


title: Knights of the Round Table

text: Safir ("Safire", "Safere", "Saphar") is the youngest son of the Saracen king Esclabor in the Arthurian legend. He appeared in several works of Arthurian literature, including the Prose "Tristan" and "Le Morte d'Arthur"; his name was also included on the Winchester Round Table. Two of his brothers, Segwarides and Palamedes, also belong to the Round Table.


title: Knights of the Round Table

text: Safir usually appears alongside his brother Palamedes. In one story, Safir disguises himself as Ector de Maris, fights with Helior le Preuse, defeats him, and wins Espinogres' lady. Vowing to defend the lady's honor, Palamedes arrives and locks swords with Safir, not realizing it is his brother. After fighting for an hour to a standstill, both are impressed with each other's prowess and skill, and decide to ask the other's identity. Safir is devastated to find that he was fighting with his own brother and asks Palamedes for forgiveness; together, they return the lady to Espinogres. Later, after the affair between Lancelot and Guinevere is exposed, Safir and Palamedes join Lancelot's side in the ensuing civil war between Lancelot and King Arthur. When they are banished to Lancelot's homeland in Gaul, Safir is made Duke of Landok while Palamedes becomes Duke of Provence.


title: Knights of the Round Table

text: Segwarides ("Seguarades", "Seguradés", "Seguradez", etc.) is a son of the Saracen king Esclabor who becomes a liegeman of King Mark. His other brothers include the fellow Round Table knights Palamedes and Safir. It is possible there have been originally two characters of this name, but the stories in which they appear fail to differentiate between them.


title: Knights of the Round Table

text: He is cuckolded by Tristan in the Prose "Tristan" and Thomas Malory's "Le Morte d'Arthur". Tristan has a brief affair with Segwarides' wife, and wounds the knight after being found out. Tristan encounters Segwarides again on the Isle of Servage; Segwarides forgives him, saying he "will never hate a noble knight for a light lady," and the two team up to avoid the dangers of the isle. Soon afterwards, Tristan makes Segwarides the Lord of Servage. In Malory, Segwarides is eventually killed trying to repel Lancelot's rescue of Guinevere from the stake.


title: Knights of the Round Table

text: Tor appears frequently in Arthurian literature, albeit always in minor roles. In earlier mentions Tor's father is King Ars ("Aries"), but in Post-Vulgate Cycle and Thomas Malory's "Le Morte d'Arthur", Aries is his adoptive father while his natural father is King Pellinore. His namesake, Le Tor of Scotland, is also featured in the story of Sebile in the Arthurian prequel romance "Perceforest".


title: Knights of the Round Table

text: In the Post-Vulgate and Malory, Tor's many siblings include Aglovale, Drian, Lamorak, Percival, and Dindrane. He is born when Pellinore sleeps with his mother "half by force", and she marries Aries shortly afterward; here Aries is not a king, but a shepherd. The young Tor is also raised as a shepherd but dreams of becoming a knight. His parents take him to the teenage King Arthur, who makes the boy one of his first knights in recognition of his qualities. Later Merlin reveals Tor's true parentage, and Pellinore embraces his son; neither Aries nor his wife seem offended. Tor distinguishes himself at the wedding feast of Arthur and Guinevere when he takes up a quest to retrieve a mysterious white brachet hound that had come into the court. According to Malory, Tor and his brother Aglovale are present among the knights charged by Arthur with guarding the execution of Guinevere and they both die when Lancelot and his followers rescue the queen.


title: Knights of the Round Table

text: Yvain the Bastard ("Yvain[s] / Yvonet / Uwains li/le[s] Avou[l]tres", -"l'Avo[u]ltre", -"li Batarz") is a son of King Urien of Gore, often confused with his half-brother Yvain, after whom he was named. While the older Yvain is Urien's legitimate child from his wife Morgan le Fay, Yvain the Bastard was sired by Urien on the wife of his seneschal. He is encountered frequently in Arthurian romance as a hearty and usually sensible knight, fighting in Arthur's wars and questing for the Holy Grail with Galahad and Gareth. He was killed by his cousin Gawain late during the Grail Quest when the two, disguised by their armour, randomly meet and decide to joust. It is not until Gawain takes him to a hermitage for his last rites that he realizes he has fought, and killed, his own cousin.


title: Knights of the Round Table

text: Thomas Malory in "Le Morte d'Arthur" split him into two characters: Uwaine les Avoutres, the son of Urien, and Uwaine les Adventurous, an unrelated knight. Malory further splits Morganor, the name of Urien's "good knight" bastard son in "Of Arthour and of Merlin", into a separate character he calls Sir Morganor[e] (first appearing as a senschal of the King of the Hundred Knights, then as a king himself). Yvain the Bastard and Yvain les Avoutres are also separate characters in the Scottish "Lancelot of the Laik". In "Perlesvaus", Yvain the Bastard's own son named Cahus dies while serving as Arthur's own squire on a strange adventure, killed by a giant in a deadly dream.


title: Knights of the Round Table

text: Yvain of the White Hands ("Yvain/Yvonet aux Blanches Mains") is another different Knight of the Round Table named Yvain in the Old French romances. There, and in the English "Arthour and Merlin", he is unrelated to Iseult of the White Hands and to the "main" Yvain (son of Urien), although Thomas Malory later merged him with the latter. He serves Arthur in the Saxon wars, later participating in the quests to learn the fate of Merlin and to find the missing Lancelot. In "Palamedes", he is son of a knight named Darie. In the Prose "Tristan", he is injured by King Mark and healed in a Cornish abbey. In the Post-Vulgate "Queste", he is mistakenly slain by Erec, for which in turn Erec is killed by Gawain, and his seat at the Round Table is then taken by the Unknown Knight (Arthur the Less).


title: Knights of the Round Table

text: The Queen's Knights ("Chevaliers de la Roine") are the knights who serve King Arthur's wife Queen Guinevere in the Old French prose cycles. They are also known in French texts as the "Knights of Queen Guinevere" ("Chevaliers de la Roine Guenievre," the form used in the "Livre d'Artus") and the more elaborate "Valiant Knights of Queen Guinevere" ("Chevalier vaillant de la Roine Gueneure"). Members of this group carry only plain white shields, often accompanying the queen and engaging in rivalry against the more experienced Knights of the Round Table. Heroes Gawain and Lancelot are among those who first serve as the Queen's Knights in their youth after being knighted by Arthur, before winning enough honour to be promoted to fill the Round Table when a vacancy occurs. Others include the young Sagramore when he mortally wounds the Knight of the Round Table named Agravadain (unrelated to Agravain), grandfather of Hector de Maris, in defense of his comrades.


title: Knights of the Round Table

text: In the Middle English compilation "Le Morte d'Arthur", the simple "Queen's Knights" form is used by the author Thomas Malory who also describes them as ""a grete felyshyp of men of arms"". In Malory's version, Lancelot later rescues a new generation of them when they are captured together with Guinevere by the villain Maleagant (himself sometimes depicted as a rogue member of the Round Table), after the Queen ordered her knightly companions to surrender as to not forfeit their lives.


title: Knights of the Round Table

text: The Post-Vulgate Cycle has two other table-based orders within Arthur's court. The first of these is the Table of Errant Companions ("Tables des Compaignons Errans"), reserved for the knights errant who are actively seeking adventures while awaiting promotion to the Round Table.


title: Knights of the Round Table

text: The second one is rather ingloriously called the Table of Less-Valued Knights ("Tables des Chevaliers Moins Prisiés"), the members of which (who originally included Perceval) are, as its name indicates, lower in their rank and status. This group seems to be derived from the knights of the Watch (also translated as the Guard), featured in the Vulgate Cycle's Prose "Lancelot" and first mentioned by Chrétien in "Perceval".


title: Knights of the Round Table

text: Robert de Boron's "Joseph d'Arimathie" introduced the Grail Table as a direct precursor to the Round Table, once used by the followers of Joseph of Arimathea, one of the earliest Christians and the original Grail guardian, who had traveled from the Holy Land to Britain generations earlier. In the prose continuations of Robert's poem, their descendants include Lancelot and the Fisher King. The Grail Table is again briefly used by the holy knight Galahad (offspring of the union between Lancelot and the Fisher King's daughter) when he and his companions (Percival and Bors) are served mass after successfully completing the Grail Quest.


title: Knights of the Round Table

text: Some French and Italian prose romances and poetry feature the original fifty knights of the Round Table from the times of Uther Pendragon, the late father of King Arthur. It is known in Italian retellings of the Prose "Tristan" as the Old Table ("Tavola Vecchia"), contrasting with those of Arthur's Round Table known as the New Table ("Tavola Nuova"). Their stories include that of Branor the Dragon Knight, "the flower of the Old Table", still unsurpassed in his skills at the age of over 100, known in French as Segu[a]rant ("Sigurant") le Brun (Malory's Severause le Breuse). Following the death of Uther, the Round Table is kept in possession of King Leondegrance until he gives it to the young Arthur as the dowry of his daughter Guinevere.


title: Knights of the Round Table

text: An even earlier forerunner of the Round Table appears in "Perceforest", where Arthur's distant ancestor, the eponymous King Perceforest, establishes the elite Order of the Franc Palais ("Ordre du Franc Palais") to fight against the forces of darkness; the Order ends up destroyed by the evil Julius Caesar during his invasion of Britain. This happens even before the birth of Christ, but nevertheless is presented in the author's contemporary High Middle Ages style setting just like the other Arthurian romances; as willed by the Sovereign God ("Dieu Souverain", here apparently the coming Christian god to whom the Roman and other pagan deities willingly submit and work for), the Franc Palais numbers the selected 300 British knights chosen for their valor and seated in the specially constructed building by the same name.


title: Anorexia nervosa

text: 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"; the adjective "nervosa" indicating the functional and non-organic nature of the disorder. "Anorexia nervosa" was coined by Gull in 1873 but, despite literal translation, the feeling of hunger is frequently present and the pathological control of this instinct is a source of satisfaction for the patients.


title: Anorexia nervosa

text: Individuals with anorexia nervosa have a fear of being overweight or being seen as such, 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". Individuals 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, and/or binge eat. 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.


title: Anorexia nervosa

text: 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.


title: Anorexia nervosa

text: 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.


title: Anorexia nervosa

text: Globally, anorexia is estimated to affect 2.9 million people . It is estimated to occur in 0.3% to 4.3% of women and 0.2% to 1% 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. According to a study conducted in 2020, it was observed that the unadjusted odds ratio of mortality among male (6.1%) patients was more than twice the ratio for female patients (2.6%) in Japan (Edakubo & Fushimi). The term "anorexia nervosa" was first used in 1873 by William Gull to describe this condition.


title: Anorexia nervosa

text: 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.


title: Anorexia nervosa

text: Anorexia nervosa is an eating disorder characterized by attempts to lose weight to the point of starvation. A person with anorexia nervosa may exhibit a number of signs and symptoms, the type and severity of which may vary and be present but not readily apparent.


title: Anorexia nervosa

text: Anorexia nervosa, and the associated malnutrition that results from self-imposed starvation, can cause complications in every major organ system in the body. Hypokalaemia, a drop in the level of potassium in the blood, is a sign of anorexia nervosa. A significant drop in potassium can cause abnormal heart rhythms, constipation, fatigue, muscle damage, and paralysis.


title: Anorexia nervosa

text: Interoception involves the conscious and unconscious sense of the internal state of the body, and it has an important role in homeostasis and regulation of emotions. Aside from noticeable physiological dysfunction, interoceptive deficits also prompt individuals with anorexia to concentrate on distorted perceptions of multiple elements of their body image. This exists in both people with anorexia and in healthy individuals due to impairment in interoceptive sensitivity and interoceptive awareness.


title: Anorexia nervosa

text: Aside from weight gain and outer appearance, people with anorexia also report abnormal bodily functions such as indistinct feelings of fullness. This provides an example of miscommunication between internal signals of the body and the brain. Due to impaired interoceptive sensitivity, powerful cues of fullness may be detected prematurely in highly sensitive individuals, which can result in decreased calorie consumption and generate anxiety surrounding food intake in anorexia patients. People with anorexia also report difficulty identifying and describing their emotional feelings and the inability to distinguish emotions from bodily sensations in general, called alexithymia.


title: Anorexia nervosa

text: Interoceptive awareness and emotion are deeply intertwined, and could mutually impact each other in abnormalities. Anorexia patients also exhibit emotional regulation difficulties that ignite emotionally-cued eating behaviors, such as restricting food or excessive exercising. Impaired interoceptive sensitivity and interoceptive awareness can lead anorexia patients to adapt distorted interpretations of weight gain that are cued by physical sensations related to digestion (e.g., fullness). Combined, these interoceptive and emotional elements could together trigger maladaptive and negatively reinforced behavioral responses that assist in the maintenance of anorexia. In addition to metacognition, people with anorexia also have difficulty with social cognition including interpreting others' emotions, and demonstrating empathy. Abnormal interoceptive awareness and interoceptive sensitivity shown through all of these examples have been observed so frequently in anorexia that they have become key characteristics of the illness.


title: Anorexia nervosa

text: Other psychological issues may factor into anorexia nervosa. Some people have a previous disorder which may increase their vulnerability to developing an eating disorder and some develop them afterwards. The presence of psychiatric comorbidity has been shown to affect the severity and type of anorexia nervosa symptoms in both adolescents and adults.


title: Anorexia nervosa

text: Obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) are highly comorbid with AN. OCD is linked with more severe symptomatology and worse prognosis. The causality between personality disorders and eating disorders has yet to be fully established. Other comorbid conditions include depression, alcoholism, borderline and other personality disorders, anxiety disorders, attention deficit hyperactivity disorder, and body dysmorphic disorder (BDD). Depression and anxiety are the most common comorbidities, and depression is associated with a worse outcome. Autism spectrum disorders occur more commonly among people with eating disorders than in the general population. Zucker "et al." (2007) proposed that conditions on the autism spectrum make up the cognitive endophenotype underlying anorexia nervosa and appealed for increased interdisciplinary collaboration.


title: Anorexia nervosa

text: There is evidence for biological, psychological, developmental, and sociocultural risk factors, but the exact cause of eating disorders is unknown.


title: Anorexia nervosa

text: Anorexia nervosa is highly heritable. Twin studies have shown a heritability rate of 28–58%. First-degree relatives of those with anorexia have roughly 12 times the risk of developing anorexia. Association studies have been performed, studying 128 different polymorphisms related to 43 genes including genes involved in regulation of eating behavior, motivation and reward mechanics, personality traits and emotion. Consistent associations have been identified for polymorphisms associated with agouti-related peptide, brain derived neurotrophic factor, catechol-o-methyl transferase, SK3 and opioid receptor delta-1. Epigenetic modifications, such as DNA methylation, may contribute to the development or maintenance of anorexia nervosa, though clinical research in this area is in its infancy.


title: Anorexia nervosa

text: A 2019 study found a genetic relationship with mental disorders, such as schizophrenia, obsessive–compulsive disorder, anxiety disorder and depression; and metabolic functioning with a negative correlation with fat mass, type 2 diabetes and leptin.


title: Anorexia nervosa

text: One gene that has been linked to anorexia might be of particular interest. This gene codes for a protein called the estrogen related receptor alpha (ERRalpha). In some tissues, this gene alters the ability of estrogen and estrogen receptors to interact with DNA and change the function of cells. Since estrogen has potent effects upon appetite and feeding, any genetic abnormality in the estrogen signaling pathway could contribute to the symptoms of anorexia and explain why anorexia typically appears in young women just after the onset of puberty.


title: Anorexia nervosa

text: Obstetric complications: prenatal and perinatal complications may factor into the development of anorexia nervosa, such as preterm birth, maternal anemia, diabetes mellitus, preeclampsia, placental infarction, and neonatal heart abnormalities. Neonatal complications may also have an influence on harm avoidance, one of the personality traits associated with the development of AN.


title: Anorexia nervosa

text: Neuroendocrine dysregulation: altered signalling of peptides that facilitate communication between the gut, brain and adipose tissue, such as ghrelin, leptin, neuropeptide Y and orexin, may contribute to the pathogenesis of anorexia nervosa by disrupting regulation of hunger and satiety.


title: Anorexia nervosa

text: Gastrointestinal diseases: people with gastrointestinal disorders may be more at risk of developing disorders of eating practices than the general population, principally restrictive eating disturbances. An association of anorexia nervosa with celiac disease has been found. The role that gastrointestinal symptoms play in the development of eating disorders seems rather complex. Some authors report that unresolved symptoms prior to gastrointestinal disease diagnosis may create a food aversion in these persons, causing alterations to their eating patterns. Other authors report that greater symptoms throughout their diagnosis led to greater risk. It has been documented that some people with celiac disease, irritable bowel syndrome or inflammatory bowel disease who are not conscious about the importance of strictly following their diet, choose to consume their trigger foods to promote weight loss. On the other hand, individuals with good dietary management may develop anxiety, food aversion and eating disorders because of concerns around cross contamination of their foods. Some authors suggest that medical professionals should evaluate the presence of an unrecognized celiac disease in all people with eating disorder, especially if they present any gastrointestinal symptom (such as decreased appetite, abdominal pain, bloating, distension, vomiting, diarrhea or constipation), weight loss, or growth failure; and also routinely ask celiac patients about weight or body shape concerns, dieting or vomiting for weight control, to evaluate the possible presence of eating disorders, especially in women.


title: Anorexia nervosa

text: Studies have hypothesized the continuance of disordered eating patterns may be epiphenomena of starvation. The results of the Minnesota Starvation Experiment showed normal controls exhibit many of the behavioral patterns of AN when subjected to starvation. This may be due to the numerous changes in the neuroendocrine system, which results in a self-perpetuating cycle.


title: Anorexia nervosa

text: Anorexia nervosa is more likely to occur in a person's pubertal years. Some explanatory hypotheses for the rising prevalence of eating disorders in adolescence are "increase of adipose tissue in girls, hormonal changes of puberty, societal expectations of increased independence and autonomy that are particularly difficult for anorexic adolescents to meet; [and] increased influence of the peer group and its values."


title: Anorexia nervosa

text: Early theories of the cause of anorexia linked it to childhood sexual abuse or dysfunctional families; evidence is conflicting, and well-designed research is needed. The fear of food is known as "sitiophobia" or "cibophobia", and is part of the differential diagnosis. Other psychological causes of anorexia include low self-esteem, feeling like there is lack of control, depression, anxiety, and loneliness. People with anorexia are, in general, highly perfectionistic and most have obsessive compulsive personality traits which may facilitate sticking to a restricted diet. It has been suggested that patients with anorexia are rigid in their thought patterns, and place a high level of importance upon being thin.


title: Anorexia nervosa

text: A risk factor for anorexia is trauma. Although the prevalence rates vary greatly, between 37% and 100%, there appears to be a link between traumatic events and eating disorder diagnosis. Approximately 72% of individuals with anorexia report experiencing a traumatic event prior to the onset of eating disorder symptoms, with binge-purge subtype reporting the highest rates. There are many traumatic events that may be risk factors for development of anorexia, the first identified traumatic event predicting anorexia was childhood sexual abuse. However, other traumatic events, such as physical and emotional abuse have also been found to be risk factors. Interpersonal, as opposed to non-interpersonal trauma, has been seen as the most common type of traumatic event, which can encompass sexual, physical, and emotional abuse. Individuals who experience repeated trauma, like those who experience trauma perpetrated by a caregiver or loved one, have increased symptom severity of anorexia and a greater prevalence of comorbid psychiatric diagnoses.


title: Anorexia nervosa

text: In individuals with anorexia, the prevalence rates for those who also qualify for a PTSD diagnosis ranges from 4% to 52% in non-clinical samples to 10% to 47% in clinical samples. A complicated symptom profile develops when trauma and anorexia meld; the bodily experience of the individual is changed and intrusive thoughts and sensations may be experienced. Traumatic events can lead to intrusive and obsessive thoughts, and the symptom of anorexia that has been most closely linked to a PTSD diagnosis is increased obsessive thoughts pertaining to food. Similarly, impulsivity is linked to the purge and binge-purge subtypes of anorexia, trauma, and PTSD. Emotional trauma (e.g., invalidation, chaotic family environment in childhood) may lead to difficulty with emotions, particularly the identification of and how physical sensations contribute to the emotional response. Trauma and traumatic events can disturb an individual's sense of self and affect their ability to thrive, especially within their bodies.


title: Anorexia nervosa

text: When trauma is perpetrated on an individual, it can lead to feelings of not being safe within their own body; that their body is for others to use and not theirs alone. Individuals may experience a feeling of disconnection from their body after a traumatic experience, leading to a desire to distance themselves from the body. Trauma overwhelms individuals emotionally, physically, and psychologically. Both physical and sexual abuse can lead to an individual seeing their body as belonging to an "other" and not to the "self". Individuals who feel as though they have no control over their bodies due to trauma may use food as a means of control because the choice to eat is an unmatched expression of control. By exerting control over food, individuals can choose when to eat and how much to eat. Individuals, particularly children experiencing abuse, may feel a loss of control over their life, circumstances, and their own bodies. Particularly sexual abuse, but also physical abuse, can make individuals feel that the body is not a safe place and an object over which another has control. Starvation, in the case of anorexia, may also lead to reduction in the body as a sexual object, making starvation a solution. Restriction may also be a means by which the pain an individual is experiencing can be communicated.


title: Anorexia nervosa

text: Anorexia nervosa has been increasingly diagnosed since 1950; the increase has been linked to vulnerability and internalization of body ideals. People in professions where there is a particular social pressure to be thin (such as models and dancers) were more likely to develop anorexia, and those with anorexia have much higher contact with cultural sources that promote weight loss. This trend can also be observed for people who partake in certain sports, such as jockeys and wrestlers. There is a higher incidence and prevalence of anorexia nervosa in sports with an emphasis on aesthetics, where low body fat is advantageous, and sports in which one has to make weight for competition. Family group dynamics can play a role in the cause of anorexia including negative expressed emotion in overprotective families where blame is frequently experienced among its members. When there is a constant pressure from people to be thin, teasing and bullying can cause low self-esteem and other psychological symptoms.


title: Anorexia nervosa

text: Persistent exposure to media that present body ideals may constitute a risk factor for body dissatisfaction and anorexia nervosa. The cultural ideal for body shape for men versus women continues to favor slender women and athletic, V-shaped muscular men. A 2002 review found that, of the magazines most popular among people aged 18 to 24 years, those read by men, unlike those read by women, were more likely to feature ads and articles on shape than on diet. Body dissatisfaction and internalization of body ideals are risk factors for anorexia nervosa that threaten the health of both male and female populations.


title: Anorexia nervosa

text: Another online aspect contributing to higher rates of eating disorders such as anorexia nervosa are websites and communities on social media that stress the importance of attainment of body ideals extol and promote anorexia nervosa through the use of religious metaphors, lifestyle descriptions, "thinspiration" or "fitspiration" (inspirational photo galleries and quotes that aim to serve as motivators for attainment of body ideals). Pro-anorexia websites reinforce internalization of body ideals and the importance of their attainment.


title: Anorexia nervosa

text: The media portray a false view of what people truly look like. In magazines and movies and even on billboards most of the actors/models are digitally altered in multiple ways. People then strive to look like these "perfect" role models when in reality they are not near perfection themselves.


title: Anorexia nervosa

text: Evidence from physiological, pharmacological and neuroimaging studies suggest serotonin (also called 5-HT) may play a role in anorexia. While acutely ill, metabolic changes may produce a number of biological findings in people with anorexia that are not necessarily causative of the anorexic behavior. For example, abnormal hormonal responses to challenges with serotonergic agents have been observed during acute illness, but not recovery. Nevertheless, increased cerebrospinal fluid concentrations of 5-hydroxyindoleacetic acid (a metabolite of serotonin), and changes in anorectic behavior in response to acute tryptophan depletion (tryptophan is a metabolic precursor to serotonin) support a role in anorexia. The activity of the 5-HT receptors has been reported to be lower in patients with anorexia in a number of cortical regions, evidenced by lower binding potential of this receptor as measured by PET or SPECT, independent of the state of illness. While these findings may be confounded by comorbid psychiatric disorders, taken as a whole they indicate serotonin in anorexia. These alterations in serotonin have been linked to traits characteristic of anorexia such as obsessiveness, anxiety, and appetite dysregulation.


title: Anorexia nervosa

text: Neuroimaging studies investigating the functional connectivity between brain regions have observed a number of alterations in networks related to cognitive control, introspection, and sensory function. Alterations in networks related to the dorsal anterior cingulate cortex may be related to excessive cognitive control of eating related behaviors. Similarly, altered somatosensory integration and introspection may relate to abnormal body image. A review of functional neuroimaging studies reported reduced activations in "bottom up" limbic region and increased activations in "top down" cortical regions which may play a role in restrictive eating.


title: Anorexia nervosa

text: Compared to controls, people who have recovered from anorexia show reduced activation in the reward system in response to food, and reduced correlation between self reported liking of a sugary drink and activity in the striatum and anterior cingulate cortex. Increased binding potential of C radiolabelled raclopride in the striatum, interpreted as reflecting decreased endogenous dopamine due to competitive displacement, has also been observed.


title: Anorexia nervosa

text: Structural neuroimaging studies have found global reductions in both gray matter and white matter, as well as increased cerebrospinal fluid volumes. Regional decreases in the left hypothalamus, left inferior parietal lobe, right lentiform nucleus and right caudate have also been reported in acutely ill patients. However, these alterations seem to be associated with acute malnutrition and largely reversible with weight restoration, at least in nonchronic cases in younger people. In contrast, some studies have reported increased orbitofrontal cortex volume in currently ill and  in recovered patients, although findings are inconsistent. Reduced white matter integrity in the fornix has also been reported.


title: Anorexia nervosa

text: A diagnostic assessment includes the person's current circumstances, biographical history, current symptoms, and family history. The assessment also includes a mental state examination, which is an assessment of the person's current mood and thought content, focusing on views on weight and patterns of eating.


title: Anorexia nervosa

text: Anorexia nervosa is classified under the Feeding and Eating Disorders in the latest revision of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM 5). There is no specific BMI cut-off that defines low weight required for the diagnosis of anorexia nervosa.


title: Anorexia nervosa

text: Relative to the previous version of the DSM (DSM-IV-TR), the 2013 revision (DSM5) reflects changes in the criteria for anorexia nervosa. Most notably, the amenorrhea (absent period) criterion was removed. Amenorrhea was removed for several reasons: it does not apply to males, it is not applicable for females before or after the age of menstruation or taking birth control pills, and some women who meet the other criteria for AN still report some menstrual activity.


title: Anorexia nervosa

text: Body mass index (BMI) is used by the DSM-5 as an indicator of the level of severity of anorexia nervosa. The DSM-5 states these as follows:


title: Anorexia nervosa

text: Medical tests to check for signs of physical deterioration in anorexia nervosa may be performed by a general physician or psychiatrist, including:


title: Anorexia nervosa

text: A variety of medical and psychological conditions have been misdiagnosed as anorexia nervosa; in some cases the correct diagnosis was not made for more than ten years.


title: Anorexia nervosa

text: The distinction between binge purging anorexia, bulimia nervosa and Other Specified Feeding or Eating Disorders (OSFED) is often difficult for non-specialist clinicians. A main factor differentiating binge-purge anorexia from bulimia is the gap in physical weight. Patients with bulimia nervosa are ordinarily at a healthy weight, or slightly overweight. Patients with binge-purge anorexia are commonly underweight. Moreover, patients with the binge-purging subtype may be significantly underweight and typically do not binge-eat large amounts of food. In contrast, those with bulimia nervosa tend to binge large amounts of food. It is not unusual for patients with an eating disorder to "move through" various diagnoses as their behavior and beliefs change over time.


title: Anorexia nervosa

text: There is no conclusive evidence that any particular treatment for anorexia nervosa works better than others.


title: Anorexia nervosa

text: In some clinical settings a specific body image intervention is performed to reduce body dissatisfaction and body image disturbance. Although restoring the person's weight is the primary task at hand, optimal treatment also includes and monitors behavioral change in the individual as well. There is some evidence that hospitalization might adversely affect long term outcome, but sometimes is necessary. Psychotherapy for individuals with AN is challenging as they may value being thin and may seek to maintain control and resist change. Initially, developing a desire to change is fundamental. Despite no evidence for better treatment in adults patients, research stated that family based therapy is the primary choice for adolescents with AN.


title: Anorexia nervosa

text: Family-based treatment (FBT) has been shown to be more successful than individual therapy for adolescents with AN. Various forms of family-based treatment have been proven to work in the treatment of adolescent AN including conjoint family therapy (CFT), in which the parents and child are seen together by the same therapist, and separated family therapy (SFT) in which the parents and child attend therapy separately with different therapists. Proponents of family therapy for adolescents with AN assert that it is important to include parents in the adolescent's treatment.


title: Anorexia nervosa

text: A four- to five-year follow up study of the Maudsley family therapy, an evidence-based manualized model, showed full recovery at rates up to 90%. The Maudsley model of family therapy is problem focused, and the treatment targets re-establishing regular eating, weight restoration, and the reduction of illness behaviors like purging. The Maudsley model is split into three phases, with phase on focusing on the parents implementing weight restoration in the child; phase two transitioning control over food back to the individual at an age-appropriate level; and phase three focusing on other issues related to typical adolescent development (e.g., social and other psychological developments), and helps parents learn how to interact with their child. Although this model is recommended by the NIMH, critics claim that it has the potential to create power struggles in an intimate relationship and may disrupt equal partnerships. Cognitive behavioral therapy (CBT) is useful in adolescents and adults with anorexia nervosa. One of the most known psychotherapy in the field is CBT-E, an enhanced cognitive-behavior therapy specifically focus to eating disorder psychopathology. Acceptance and commitment therapy is a third-wave cognitive-behavioral therapy which has shown promise in the treatment of AN. Cognitive remediation therapy (CRT) is also used in treating anorexia nervosa. Schema-Focused Therapy (a form of CBT) was developed by Dr. Jeffrey Young and is effective in helping patients identify origins and triggers for disordered eating.


title: Anorexia nervosa

text: Diet is the most essential factor to work on in people with anorexia nervosa, and must be tailored to each person's needs. Food variety is important when establishing meal plans as well as foods that are higher in energy density. People must consume adequate calories, starting slowly, and increasing at a measured pace. Evidence of a role for zinc supplementation during refeeding is unclear.


title: Anorexia nervosa

text: Pharmaceuticals have limited benefit for anorexia itself. There is a lack of good information from which to make recommendations concerning the effectiveness of antidepressants in treating anorexia. Administration of olanzapine has been shown to result in a modest but statistically significant increase in body weight of anorexia nervosa patients.


title: Anorexia nervosa

text: Patients with AN may be deemed to have a lack of insight regarding the necessity of treatment, and thus may be involuntarily treated without their consent. AN has a high mortality and patients admitted in a severely ill state to medical units are at particularly high risk. Diagnosis can be challenging, risk assessment may not be performed accurately, consent and the need for compulsion may not be assessed appropriately, refeeding syndrome may be missed or poorly treated and the behavioural and family problems in AN may be missed or poorly managed. Guidelines published by the Royal College of Psychiatrists recommend that medical and psychiatric experts work together in managing severely ill people with AN.


title: Anorexia nervosa

text: The rate of refeeding can be difficult to establish, because the fear of refeeding syndrome (RFS) can lead to underfeeding. It is thought that RFS, with falling phosphate and potassium levels, is more likely to occur when BMI is very low, and when medical comorbidities such as infection or cardiac failure, are present. In those circumstances, it is recommended to start refeeding slowly but to build up rapidly as long as RFS does not occur. Recommendations on energy requirements vary, from 5–10 kcal/kg/day in the most medically compromised patients, who appear to have the highest risk of RFS, to 1900 kcal/day.


title: Anorexia nervosa

text: Patients involved in treatment sometimes felt that treatment focused on biological aspects of body weight and eating behaviour change rather than their perceptions or emotional state. Patients felt that a therapists trust in them shown by being treated as a complete person with their own capacities was significant. Some patients defined recovery from AN in terms of reclaiming a lost identity.


title: Anorexia nervosa

text: Healthcare workers involved in the treatment of anorexia reported frustration and anger to set backs in treatment and noncompliance and were afraid of patients dying. Some healthcare workers felt that they did not understand the treatment and that medical doctors were making decisions. They may feel powerless to improve a patient's situation and deskilled as a result. Healthcare workers involved in monitoring patients consumption of food felt watched themselves. Healthcare workers often feel a degree of moral dissonance of not being in control of outcomes which they may protect against by focusing on individual tasks, avoiding identifying with patients (for example by making their eating behavior very different and not sharing personal information with patients), and blaming patients for their distress. Healthcare workers would inflexibly follow process to avoid responsibility. Healthcare workers attempted to reach balance by gradually giving patients back control avoiding feeling sole responsibility for outcomes, being mindful of their emotional state, and trying to view eating disorders as external from patients.


title: Anorexia nervosa

text: AN has the highest mortality rate of any psychological disorder. The mortality rate is 11 to 12 times greater than in the general population, and the suicide risk is 56 times higher. Half of women with AN achieve a full recovery, while an additional 20–30% may partially recover. Not all people with anorexia recover completely: about 20% develop anorexia nervosa as a chronic disorder. If anorexia nervosa is not treated, serious complications such as heart conditions and kidney failure can arise and eventually lead to death. The average number of years from onset to remission of AN is seven for women and three for men. After ten to fifteen years, 70% of people no longer meet the diagnostic criteria, but many still continue to have eating-related problems.


title: Anorexia nervosa

text: Alexithymia (inability to identify and describe one's own emotions) influences treatment outcome. Recovery is also viewed on a spectrum rather than black and white. According to the Morgan-Russell criteria, individuals can have a good, intermediate, or poor outcome. Even when a person is classified as having a "good" outcome, weight only has to be within 15% of average, and normal menstruation must be present in females. The good outcome also excludes psychological health. Recovery for people with anorexia nervosa is undeniably positive, but recovery does not mean a return to normal.


title: Anorexia nervosa

text: Anorexia nervosa can have serious implications if its duration and severity are significant and if onset occurs before the completion of growth, pubertal maturation, or the attainment of peak bone mass. Complications specific to adolescents and children with anorexia nervosa can include the following:


title: Anorexia nervosa

text: Growth retardation may occur, as height gain may slow and can stop completely with severe weight loss or chronic malnutrition. In such cases, provided that growth potential is preserved, height increase can resume and reach full potential after normal intake is resumed. Height potential is normally preserved if the duration and severity of illness are not significant or if the illness is accompanied by delayed bone age (especially prior to a bone age of approximately 15 years), as hypogonadism may partially counteract the effects of undernutrition on height by allowing for a longer duration of growth compared to controls. Appropriate early treatment can preserve height potential, and may even help to increase it in some post-anorexic subjects, due to factors such as long-term reduced estrogen-producing adipose tissue levels compared to premorbid levels. In some cases, especially where onset is before puberty, complications such as stunted growth and pubertal delay are usually reversible.


title: Anorexia nervosa

text: Anorexia nervosa causes alterations in the female reproductive system; significant weight loss, as well as psychological stress and intense exercise, typically results in a cessation of menstruation in women who are past puberty. In patients with anorexia nervosa, there is a reduction of the secretion of gonadotropin releasing hormone in the central nervous system, preventing ovulation. Anorexia nervosa can also result in pubertal delay or arrest. Both height gain and pubertal development are dependent on the release of growth hormone and gonadotropins (LH and FSH) from the pituitary gland. Suppression of gonadotropins in people with anorexia nervosa has been documented. Typically, growth hormone (GH) levels are high, but levels of IGF-1, the downstream hormone that should be released in response to GH are low; this indicates a state of "resistance" to GH due to chronic starvation. IGF-1 is necessary for bone formation, and decreased levels in anorexia nervosa contribute to a loss of bone density and potentially contribute to osteopenia or osteoporosis. Anorexia nervosa can also result in reduction of peak bone mass. Buildup of bone is greatest during adolescence, and if onset of anorexia nervosa occurs during this time and stalls puberty, low bone mass may be permanent.


title: Anorexia nervosa

text: Hepatic steatosis, or fatty infiltration of the liver, can also occur, and is an indicator of malnutrition in children. Neurological disorders that may occur as complications include seizures and tremors. Wernicke encephalopathy, which results from vitamin B1 deficiency, has been reported in patients who are extremely malnourished; symptoms include confusion, problems with the muscles responsible for eye movements and abnormalities in walking gait.


title: Anorexia nervosa

text: The most common gastrointestinal complications of anorexia nervosa are delayed stomach emptying and constipation, but also include elevated liver function tests, diarrhea, acute pancreatitis, heartburn, difficulty swallowing, and, rarely, superior mesenteric artery syndrome. Delayed stomach emptying, or gastroparesis, often develops following food restriction and weight loss; the most common symptom is bloating with gas and abdominal distension, and often occurs after eating. Other symptoms of gastroparesis include early satiety, fullness, nausea, and vomiting. The symptoms may inhibit efforts at eating and recovery, but can be managed by limiting high-fiber foods, using liquid nutritional supplements, or using metoclopramide to increase emptying of food from the stomach. Gastroparesis generally resolves when weight is regained.


title: Anorexia nervosa

text: Anorexia nervosa increases the risk of sudden cardiac death, though the precise cause is unknown. Cardiac complications include structural and functional changes to the heart. Some of these cardiovascular changes are mild and are reversible with treatment, while others may be life-threatening. Cardiac complications can include arrhythmias, abnormally slow heart beat, low blood pressure, decreased size of the heart muscle, reduced heart volume, mitral valve prolapse, myocardial fibrosis, and pericardial effusion.


title: Anorexia nervosa

text: Abnormalities in conduction and repolarization of the heart that can result from anorexia nervosa include QT prolongation, increased QT dispersion, conduction delays, and junctional escape rhythms. Electrolyte abnormalities, particularly hypokalemia and hypomagnesemia, can cause anomalies in the electrical activity of the heart, and result in life-threatening arrhythmias. Hypokalemia most commonly results in patients with anorexia when restricting is accompanied by purging (induced vomiting or laxative use). Hypotension (low blood pressure) is common, and symptoms include fatigue and weakness. Orthostatic hypotension, a marked decrease in blood pressure when standing from a supine position, may also occur. Symptoms include lightheadedness upon standing, weakness, and cognitive impairment, and may result in fainting or near-fainting. Orthostasis in anorexia nervosa indicates worsening cardiac function and may indicate a need for hospitalization. Hypotension and orthostasis generally resolve upon recovery to a normal weight. The weight loss in anorexia nervosa also causes atrophy of cardiac muscle. This leads to decreased ability to pump blood, a reduction in the ability to sustain exercise, a diminished ability to increase blood pressure in response to exercise, and a subjective feeling of fatigue.


title: Anorexia nervosa

text: Some individuals may also have a decrease in cardiac contractility. Cardiac complications can be life-threatening, but the heart muscle generally improves with weight gain, and the heart normalizes in size over weeks to months, with recovery. Atrophy of the heart muscle is a marker of the severity of the disease, and while it is reversible with treatment and refeeding, it is possible that it may cause permanent, microscopic changes to the heart muscle that increase the risk of sudden cardiac death. Individuals with anorexia nervosa may experience chest pain or palpitations; these can be a result of mitral valve prolapse. Mitral valve prolapse occurs because the size of the heart muscle decreases while the tissue of the mitral valve remains the same size. Studies have shown rates of mitral valve prolapse of around 20 percent in those with anorexia nervosa, while the rate in the general population is estimated at 2–4 percent. It has been suggested that there is an association between mitral valve prolapse and sudden cardiac death, but it has not been proven to be causative, either in patients with anorexia nervosa or in the general population.


title: Anorexia nervosa

text: Rates of relapse after treatment range 30-72% over a period of 2-26 months, with a rate of approximately 50% in 12 months after weight restoration. Relapse occurs in approximately a third of people in hospital, and is greatest in the first six to eighteen months after release from an institution. BMI or measures of body fat and leptin levels at discharge were the strongest predictors of relapse, as well as signs of eating psychopathology at discharge. Duration of illness, age, severity, the proportion of AN binge-purge subtype, and presence of comorbidities are also contributing factors.


title: Anorexia nervosa

text: Anorexia 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 females are affected in a given year and it is estimated to occur three to ten times less commonly in males. Rates in most of the developing world are unclear. Often it begins during the teen years or young adulthood. Medical students are a high risk group, with an overall estimated prevalence of 10.4% globally.


title: Anorexia nervosa

text: The lifetime rate of atypical anorexia nervosa, a form of ED-NOS in which the person loses a significant amount of weight and is at risk for serious medical complications despite having a higher body-mass index, is much higher, at 5–12%.


title: Anorexia nervosa

text: 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. Most studies show that since at least 1970 the incidence of AN in adult women is fairly constant, while there is some indication that the incidence may have been increasing for girls aged between 14 and 20.


title: Anorexia nervosa

text: Eating disorders are less reported in preindustrial, non-westernized countries than in Western countries. In Africa, not including South Africa, the only data presenting information about eating disorders occurs in case reports and isolated studies, not studies investigating prevalence. Western countries experience slightly higher rates of eating disorders than non-western countries. Theories to explain these lower rates of eating disorders, lower reporting and lower research rates in include the effects of westernisation, and culture change.


title: Anorexia nervosa

text: Men (and women) who might otherwise be diagnosed with anorexia may not meet the DSM-IV criteria for BMI since they have muscle weight, but have very little fat. In many cases a subclinical "not otherwise specified" diagnosis is made instead; ED-NOS in the DSM-IV, and other specified feeding or eating disorder or unspecified feeding or eating disorder in the DSM-5. ED-NOS was the most diagnosed eating disorder in 2009, and it was also shown that AN did not differ significantly in eating pathology or general psychopathology from EDNOS involving restrictive eating.


title: Anorexia nervosa

text: The elderly population is increasingly experiencing anorexia nervosa, which has been termed the "Anorexia of Aging". The eating disorder is similar to that of typical anorexia nervosa but is more often accompanied by the overuse of laxatives in order to purge the individual of ingested food. Most geriatric anorexia patients limit their food intake to dairy or grains, whereas an adolescent anorexic has a more general limitation.


title: Anorexia nervosa

text: This eating disorder that affects older adults has two types - early onset and late onset. Early onset refers to a recurrence of anorexia in late life in an individual who experienced the disease during their youth. Late onset describes instances where the eating disorder begins for the first time late in life.


title: Anorexia nervosa

text: The stimulus for anorexia in elderly patients is typically a loss of control over their lives, which can be brought on by many events, including moving into an assisted living facility. This is also a time when most older individuals experience a rise in conflict with family members, such as limitations on driving or limitations on personal freedom, which increases the likelihood of an issue with anorexia. There can be physical issues in the elderly that leads to anorexia of aging, including a decline in chewing ability, a decline in taste and smell, and a decrease in appetite. Psychological reasons for the elderly to develop anorexia can include depression and bereavement, and even an indirect attempt at suicide. There are also common comorbid psychiatric conditions with aging anorexics, including major depression, anxiety disorder, obsessive compulsive disorder, bipolar disorder, schizophrenia, and dementia.


title: Anorexia nervosa

text: The signs and symptoms that go along with anorexia of aging are similar to what is observed in adolescent anorexia, including sudden weight loss, unexplained hair loss or dental problems, and a desire to eat alone.


title: Anorexia nervosa

text: There are also several medical conditions that can result from anorexia in the elderly. An increased risk of illness and death can be a result of anorexia. There is also a decline in muscle and bone mass as a result of a reduction in protein intake during anorexia. Another result of anorexia in the aging population is irreparable damage to kidneys, heart or colon and an imbalance of electrolytes.


title: Anorexia nervosa

text: Many assessments are available to diagnose anorexia in the aging community. These assessments include the Simplified Nutritional Assessment Questionnaire (SNAQ) and Functional Assessment of Anorexia/Cachexia Therapy (FAACT). Specific to the geriatric populace, the interRAI system identifies detrimental conditions in assisted living facilities and nursing homes. Even a simple screening for nutritional insufficiencies such as low levels of important vitamins, can help to identify someone who has anorexia of aging.


title: Anorexia nervosa

text: Anorexia in the elderly should be identified by the retirement communities but is often overlooked, especially in patients with dementia. Some studies report that malnutrition is prevalent in nursing homes, with up to 58% of residents suffering from it, which can lead to the difficulty of identifying anorexia. One of the challenges with assisted living facilities is that they often serve bland, monotonous food, which lessens residents desire to eat.


title: Anorexia nervosa

text: The treatment for anorexia of aging is undifferentiated as anorexia for any other age group. Some of the treatment options include outpatient and inpatient facilities, antidepressant medication and behavioral therapy such as meal observation and discussing eating habits.


title: Anorexia nervosa

text: Male and female athletes are often overlooked as anorexic. Research emphasizes the importance to take athletes' diet, weight and symptoms into account when diagnosing anorexia, instead of just looking at weight and BMI. For athletes, ritualized activities such as weigh-ins place emphasis on gaining and losing large amounts of weight, which may promote the development of eating disorders among them. While women use diet pills, which is an indicator of unhealthy behavior and an eating disorder, men use steroids, which contextualizes the beauty ideals for genders. In a Canadian study, 4% of boys in grade nine used anabolic steroids. Anorexic men are sometimes referred to as "manorexic".


title: Anorexia nervosa

text: The history of anorexia nervosa begins with descriptions of religious fasting dating from the Hellenistic era and continuing into the medieval period. The medieval practice of self-starvation by women, including some young women, in the name of religious piety and purity also concerns anorexia nervosa; it is sometimes referred to as "anorexia mirabilis." The earliest medical descriptions of anorexic illnesses are generally credited to English physician Richard Morton in 1689. Case descriptions fitting anorexic illnesses continued throughout the 17th, 18th, and 19th centuries.


title: Anorexia nervosa

text: The term "anorexia nervosa" was coined in 1873 by Sir William Gull, one of Queen Victoria's personal physicians. Gull published a seminal paper providing a number of detailed case descriptions of patients with anorexia nervosa. In the same year, French physician Ernest-Charles Lasègue similarly published details of a number of cases in a paper entitled "De l'Anorexie hystérique".


title: Anorexia nervosa

text: In the late 19th century anorexia nervosa became widely accepted by the medical profession as a recognized condition. Awareness of the condition was largely limited to the medical profession until the latter part of the 20th century, when German-American psychoanalyst Hilde Bruch published "The Golden Cage: the Enigma of Anorexia Nervosa" in 1978. Despite major advances in neuroscience, Bruch's theories tend to dominate popular thinking. A further important event was the death of the popular singer and drummer Karen Carpenter in 1983, which prompted widespread ongoing media coverage of eating disorders.


title: Vladivostok

text: Vladivostok () is the largest city and the administrative center of Primorsky Krai, Russia. The city is located around the Golden Horn Bay on the Sea of Japan, covering an area of , with a population of 600,871 residents as of 2021. Vladivostok is the second-largest city in the Far Eastern Federal District, as well as the Russian Far East, after Khabarovsk.


title: Vladivostok

text: Shortly after the signing of the Treaty of Aigun, the city was founded on July 2, 1860 as a Russian military outpost on formerly Chinese land. In 1872, the main Russian naval base on the Pacific Ocean was transferred to the city, stimulating the growth of modern Vladivostok. After the outbreak of the Russian Revolution in 1917, Vladivostok was occupied in 1918 by White Russian and Allied forces, the last of whom from Japan were not withdrawn until 1922; by that time the antirevolutionary White Army forces in Vladivostok promptly collapsed, and Soviet power was established in the city. After the dissolution of the Soviet Union, Vladivostok became the administrative center of Primorsky Krai.


title: Vladivostok

text: Vladivostok is the largest Russian port on the Pacific Ocean, and the chief cultural, economic, scientific, and tourism heart of the Russian Far East. As the terminus of the Trans-Siberian Railway, the city was visited by over three million tourists in 2017. The city is the administrative center of the Far Eastern Federal District, and is the home to the headquarters of the Pacific Fleet of the Russian Navy. Due to its geographical position, and its Russian culture, the city has been referred to as "Europe in the Far East". Many foreign consulates and businesses have offices in Vladivostok, and the city hosts the annual Eastern Economic Forum. With a yearly mean temperature of around Vladivostok has a cold climate for its mid-latitude coastal setting. This is due to winds from the vast Eurasian landmass in winter, also cooling the ocean temperatures.


title: Vladivostok

text: "Vladivostok" means 'Lord of the East' or 'Ruler of the East'. The name derives from Slavic (, 'to rule') and Russian (, 'east'); see the etymology of Vladimir (name). Colloquial Russian speech may use the short form "Vladik" () to refer to the city.


title: Vladivostok

text: The city, along with other features in the Peter the Great Gulf area, was first given its modern name in 1859 by Nikolay Muravyov-Amursky. The name initially applied to the bay, but following an expedition by in 1860, it was later applied to the new settlement. The form of the name appears analogous to that of the city of Vladikavkaz ("Ruler of the Caucasus" or "Rule the Caucasus"), now in North Ossetia–Alania, which was founded and named by the Russian Empire in 1784.


title: Vladivostok

text: Chinese maps from the Yuan dynasty (1271–1368) referred to Vladivostok as (). Since the Qing dynasty, the city has been known as () in Chinese, from the Manchu () or 'small seaside village'. In China, Vladivostok is now officially known by the transliteration ), although the historical Chinese name () is still often used in common parlance and outside Mainland China to refer to the city. According to the provisions of the Chinese government, all maps published in China must bracket the city's Chinese name.


title: Vladivostok

text: The modern-day Japanese name of the city is transliterated as . Historically, the city's name was transliterated with Kanji as and shortened to (, ).


title: Vladivostok

text: For a long time, the Russian government was looking for a stronghold in the Far East; this role was played in turn by the settlements of Okhotsk, Ayan, Petropavlovsk-Kamchatsky, and Nikolaevsk-on-Amur. By the middle of the 19th century, the search for the outpost had reached a dead end: none of the ports met the necessary requirement: to have a convenient and protected harbor next to important trade routes. After China was threatened with war on a second front by Governor-General of the Far East Nikolay Muraviev when China was suppressing the Taiping Rebellion.


title: Vladivostok

text: the Aigun Treaty was concluded by Muraviev's forces, after which Russian exploration of the Amur region began, and later, as a result of the signing of the Treaty of Tientsin and the Convention of Peking, the territory of modern Vladivostok was annexed to Russia. The name Vladivostok appeared in the middle of 1859, was used in newspaper articles and denoted a bay. On June 20 (or July 2nd of the Gregorian calendar), 1860 the transport of the Siberian Military Flotilla "Mandzhur" under the command of Lieutenant-Commander Alexei Karlovich Shefner delivered a military unit to the Golden Horn Bay to establish a military post, which has now officially received the name of Vladivostok.


title: Vladivostok

text: On October 31, 1861, the first civilian settler, a merchant, Yakov Lazarevich Semyonov, arrived in Vladivostok with his family. On March 15, 1862, the first act of his purchase of land was registered, and in 1870 Semyonov was elected the first head of the post, and a local self-government emerged. By this time, a special commission decided to designate Vladivostok as the main port of the Russian Empire in the Far East. In 1871, the main naval base of the Siberian Military Flotilla, the headquarters of the military governor and other naval departments were transferred from Nikolaevsk-on-Amur to Vladivostok.


title: Vladivostok

text: In the 1870s, the government encouraged resettlement to the South Ussuri region, which contributed to an increase in the population of the post: according to the first census of 1878, there were 4,163 inhabitants. The city status was adopted and the city Duma was established, the post of the city head, the coat of arms was adopted, although Vladivostok was not officially recognized as a city.


title: Vladivostok

text: Due to the constant threat of attack from the Royal Navy, Vladivostok also actively developed as a naval base.


title: Vladivostok

text: In 1880, the post officially received the status of a city. The 1890s saw a demographic and economic boom associated with the completion of the construction of the Ussuriyskaya branch of the Trans-Siberian Railway and the Chinese-Eastern Railway. According to the first census of the population of Russia on 9 February 1897, roughly 29,000 inhabitants lived in Vladivostok, and ten years later the city's population tripled.


title: Vladivostok

text: The first decade of the 20th century was characterized by a protracted crisis caused by the political situation: the government's attention was shifted to Lüshunkou and the Port of Dalian (Talien). As well as the Boxer uprising in North China in 1900–1901, the Russo-Japanese War of 1904–1905, and finally the first Russian revolution led to stagnation in the economic activity of Vladivostok.


title: Vladivostok

text: Since 1907, a new stage in the development of the city began: the losses of Lüshunkou and Dalian (Talien) again made Vladivostok the main port of Russia on the Pacific Ocean. A free port regime was introduced, and until 1914 the city experienced rapid growth, becoming an important economic hub in the Asia-Pacific, as well as an ethnically diverse city with a population exceeding over 100,000 inhabitants: during the time ethnic Russians made up less than half of the population, and large Asian communities developed in the city. The public life of the city flourished; many public associations were created, from charities to hobby groups.


title: Vladivostok

text: During World War I, no active hostilities took place in the city. However, Vladivostok was an important staging post for the import of military-technical equipment for troops from allied and neutral countries, as well as raw materials and equipment for industry.


title: Vladivostok

text: Immediately after the October Revolution in 1917, during which the Bolsheviks came to power, the Decree on Peace was announced, and as a result of the Treaty of Brest-Litovsk concluded between the Bolshevik government of Russia and the Central Powers, led to the end of Soviet Russia's participation in World War I. On October 30, the sailors of the Siberian Military Flotilla decided to "rally around the united power of the Soviets", and the power of Vladivostok, as well as all of the Trans-Siberian Railway passed to the Bolsheviks. During the Russian Civil War, from May 1918, they lost control of the city to the White Army-allied Czechoslovak Legion, who declared the city to be an Allied protectorate. Vladivostok became the staging point for the Allies' Siberian intervention, a multi-national force including Japan, the United States and China; China sent forces to protect the local Chinese community after appeals from Chinese merchants. The intervention ended in the wake of the collapse of the White Army and regime in 1919; all Allied forces except the Japanese withdrew by the end of 1920.


title: Vladivostok

text: Throughout 1919 the region was engulfed in a partisan war. To avoid a war with Japan, with the filing of the Soviet leadership, the Far Eastern Republic, a Soviet-backed buffer state between Soviet Russia and Japan, was proclaimed on 6 April 1920. The Soviet government officially recognized the new republic in May, but in Primorye a riot occurred, where significant forces of the White Movement were located, leading to the creation of the Provisional Priamurye Government, with Vladivostok as its capital.


title: Vladivostok

text: In October 1922, the troops of the Red Army of the Far Eastern Republic under the command of Ieronim Uborevich occupied Vladivostok, displacing the White Army formations from it. In November, the Far Eastern Republic liquidated and became a part of Soviet Russia.


title: Vladivostok

text: By the time of the establishment of Soviet power, Vladivostok was clearly in decline. The retreating forces of the Japanese army removed items of material value from the city. Life was paralyzed; there was no money in the banks, and the equipment of enterprise was plundered. Due to mass migration and repression, the city's population decreased to 106,000 inhabitants. Between 1923 and 1925, the government adopted a "three-year restoration" plan, during which operations at the commercial port were resumed, and it became the most profitable in the country (from 1924 to 1925). The "restoration" period was distinguished by a number of peculiarities: the Russian Far East did not adopt 'war communism', but was, immediately, inducted to the New Economic Policy.


title: Vladivostok

text: In 1925, the government decided to accelerate the industrialization of the country. A number of subsequent "five-year plans" changed the face of Primorye, making it an industrial region, partly as a result of the creation of numerous concentration camps in the region. In the 1930s and 1940s, Vladivostok served as a transit point on the route used to deliver prisoners and cargo for the Sevvostlag of the Soviet super-trust Dalstroy. The notorious Vladivostok transit camp was located in the city. In addition, in the late 1930s and early 1940s, the Vladivostok forced labour camp (Vladlag) was located in the area of the Vtoraya Rechka railway station.


title: Vladivostok

text: Vladivostok was not a place of hostilities during the Great Patriotic War, although there was a constant threat of attack from Japan. In the city, a "Defense Fund" was created (the first in the country), to which the residents of Vladivostok contributed personal wealth. During the war years Vladivostok handled imported cargo (lend-lease) of a volume almost four times more than Murmansk and almost five times more than Arkhangelsk.


title: Vladivostok

text: By the decree of the Council of Ministers of the Soviet Union "Issues of the Fifth Navy" dated August 11, 1951, a special regime was introduced in Vladivostok (it began to operate on January 1, 1952); the city was closed to foreigners. It was planned to remove from Vladivostok not only foreign consulates, but also the merchant and fish fleet and transfer all regional authorities to Voroshilov (now Ussuriysk). However, these plans were not implemented.


title: Vladivostok

text: During the years of the Khrushchev Thaw, Vladivostok received special attention from state authorities. In 1954, Nikita Khrushchev visited the city for the first time to finally decide whether to secure the status of a closed naval base for him. It was noted that at that time the urban infrastructure was in a deplorable state. In 1959, Khrushchev visited the city again. The result is a decision on the accelerated development of the city, which was formalized by the decree of the Council of Ministers of the Soviet Union on 18 January 1960. During the 1960s, a new tram line was built, a trolleybus was launched, the city became a huge construction site: residential neighborhoods were being erected on the outskirts, and new buildings for public and civil purposes were erected in the center.


title: Vladivostok

text: In 1974, Gerald Ford paid an official visit to Vladivostok, to meet with Leonid Brezhnev, becoming the first President of the United States to visit the Soviet Union. Both sides signed the Anti-Ballistic Missile Treaty, which helped to contain the nuclear arms race between the Soviet Union and the United States during the Cold War.


title: Vladivostok

text: On September 20, 1991, Boris Yeltsin signed decree No. 123 "On the opening of Vladivostok for visiting by foreign citizens", which entered into force on January 1, 1992, ending Vladivostok's status as a closed city.


title: Vladivostok

text: In 2012, Vladivostok hosted the 24th APEC summit. Leaders from the APEC member countries met at Russky Island, off the coast of Vladivostok. With the summit on Russky Island, the government and private businesses inaugurated resorts, dinner and entertainment facilities, in addition to the renovation and upgrading of Vladivostok International Airport. Two giant cable-stayed bridges were built in preparation for the summit, the Zolotoy Rog bridge over the Zolotoy Rog Bay in the center of the city, and the Russky Island Bridge from the mainland to Russky Island (the longest cable-stayed bridge in the world). The new campus of Far Eastern Federal University was completed on Russky Island in 2012.


title: Vladivostok

text: The city is located in the southern extremity of Muravyov-Amursky Peninsula, which is about long and wide.


title: Vladivostok

text: The highest point in the city is Mount Kholodilnik, at . Eagle's Nest Hill is often called the highest point in the city, but with a height of , or according to other sources, it is only the highest point in the city center, not the whole city.


title: Vladivostok

text: Located in the extreme southeast of the Russian Far East, in the extreme southeast of North Asia, Vladivostok is geographically closer to Anchorage, Alaska, US and even Darwin, Australia than it is to the nation's capital of Moscow. Vladivostok is also closer to Honolulu, Hawaii, US than to the city of Sochi in Southern Russia. It also is further east than any area south of it in China and the entire Korean peninsula.


title: Vladivostok

text: Vladivostok has a monsoon-influenced humid continental climate (Köppen climate classification "Dwb") with warm, humid and rainy summers and cold, dry winters. Owing to the influence of the Siberian High, winters are far colder than a latitude of 43 °N, roughly the same latitude as Milwaukee and Perpignan, should warrant given its low elevation and coastal location, with a January average of . Since the maritime influence is strong in summer, Vladivostok has a relatively cold annual climate for its latitude.


title: Vladivostok

text: In winter, temperatures can drop below while mild spells of weather can raise daytime temperatures above freezing. The average monthly precipitation, mainly in the form of snow, is around from December to March. Snow is common during winter, but individual snowfalls are light, with a maximum snow depth of only in January. During winter, clear sunny days are common.


title: Vladivostok

text: Summers are warm, humid and rainy, due to the East Asian monsoon. The warmest month is August, with an average temperature of . Vladivostok receives most of its precipitation during the summer months, and most summer days see some rainfall. Cloudy days are fairly common and because of the frequent rainfall, humidity is high, on average about 90% from June to August.


title: Vladivostok

text: During the summer season, the city is prone to typhoons and tropical storms. Typhoon Sanba struck the city as a tropical storm. In Artyom, near Vladivostok, more than of crops were inundated. Preliminary losses over the region were estimated to be ₽40 million (US$1.29 million). Typhoons can be rare, but tropical storms happen from the Sea of Japan after a typhoon landfall from South Korea and Japan.


title: Vladivostok

text: On average, Vladivostok receives of precipitation per year, but the driest year was 1943, when of precipitation fell, and the wettest was 1974, with of precipitation. The winter months from December to March are dry, and in some years they have seen no measurable precipitation at all. Extremes range from in January 1931 to in July 1939.


title: Vladivostok

text: Legislative authority is vested in the City Council. The new City Council began operations in 2001 and in June that year, deputies of the Duma of the first convocation of Vladivostok began their work. On 17 December 2007, the Duma of the third convocation began. The deputies consist of 35 elected members, including 18 members chosen by a single constituency, and 17 deputies from single-seat constituencies.


title: Vladivostok

text: Vladivostok is the administrative center of the krai. Within the framework of administrative divisions, it is, together with five rural localities, incorporated as Vladivostok City Under Krai Jurisdiction; an administrative unit equal to that of the districts in status. As a municipal division, Vladivostok City Under Krai Jurisdiction is incorporated as Vladivostoksky Urban Okrug.


title: Vladivostok

text: Vladivostok City Duma's history dates from November 21, 1875, when 30 "vowels" were elected. Great changes took place after the 1917 Revolution, when the first general elections were held and women were allowed to vote. The last meeting of the Vladivostok City Duma took place on October 19, 1922, and on October 27 it was officially abolished. In Soviet times, its functions were performed by the City Council. In 1993, by a presidential decree, the Soviets were dissolved and, until 2001, all attempts to elect a new Duma were unsuccessful. The Duma of the city of Vladivostok of the fifth (current) convocation began work in the fall of 2017, consisting of 35 deputies.


title: Vladivostok

text: The head of Vladivostok, on the principles of one-man management, manages the city's administration, which he forms in accordance with federal laws, laws of the Primorsky Territory and the city charter. The city's administrative structure is approved by the City Duma on the proposal of the head, and may include sectoral (functional) and territorial bodies of the administration of Vladivostok.


title: Vladivostok

text: Igor Pushkaryov was the city's mayor from May 2008 to June 2016; previously he was a Federation Council member of Primorsky Krai. On June 27, 2016, Konstantin Loboda, the first deputy mayor, was appointed as the Vladivostok's new acting mayor. On December 21, 2017, Vitaly Vasilyevich Verkeenko was appointed the head of the city.


title: Vladivostok

text: According to the Russian Census of 2010, Vladivostok had a population of over 592,000, with over 616,800 residents in the greater urban area. The Primorsky State Statistics Service reported that for 2016, the total permanent population of the city's urban agglomeration was over 633,167. Since the city's founding its population has actively grown, save for the periods of the Russian Civil War and the demographic crisis after dissolution of the Soviet Union in the 1990s and the beginning of the 2000s. In the 1970s, the population exceeded over 500,000, and in 1992 reached a historical high of over 648,000. The average population density is about 1,832 people/km.


title: Vladivostok

text: In recent years, the population gradually has grown through migration and a rise in the birth rate. In the past five years the population has risen by 30,000. Since 2013, natural growth dynamics added 727 individuals to this figure by 2015's end. By 2020, Vladivostok's population reached over 600,000, as reported by the Russian Federal Statistics Bureau.


title: Vladivostok

text: The city's age distribution includes a large segment of older adults. Overall, the population includes 12.7% who are younger than able-bodied; 66.3% who are able-bodied; and 21% who are older than able-bodied. Vladivostok's population, like that of Russia as a whole, includes a significantly greater number of women over men.


title: Vladivostok

text: According to the Russian census of 2010, Vladivostok's residents include representatives of over seventy nationalities and ethnic groups. Among them, the largest ethnic groups (over 1,000 people) are: ethnic Russians (475,200); Ukrainians (10,474); Uzbeks (7,109); Koreans (4,192); Chinese (2,446); Tatars (2,446); Belarusians (1,642); Armenians (1,635); and Azerbaijanis (1,252).


title: Vladivostok

text: Studies indicate that since 2002 the city's ethnic composition has changed through migration: the share of Uzbeks increased by 14.4 times; the share of Chinese and Tajiks by 5.4 times, the share of Kyrgyz by 8.5 times, and the share of by Koreans by 1.6 times. Over half of the Primorsky Territory's Koreans live compactly in two cities, Vladivostok and Ussuriysk. Over 80% of Primorye Uzbeks live in Vladivostok. Meanwhile, the proportion of Ukrainians, Belarusians, Russians, and Tatars in the city has declined.


title: Vladivostok

text: Vladivostok is regarded as an ethnically diverse city, and remains one of the Russian cities with a large East Asian population. However, today Vladivostok lacks the same multinational diversity it had from the 19th century to the Great Patriotic War, when entire ethnic quarters existed, including the Chinese Millionka, the Korean Slobodka, and the Japanese quarter of Nihonzin Mati. Historical German, French, Estonian, American, and Central Asian diasporas at the start of the 21st century have been little studied.


title: Vladivostok

text: The city's main industries are shipping, commercial fishing, and the naval base. Fishing accounts for almost four-fifths of Vladivostok's commercial production. Other food production totals 11%.


title: Vladivostok

text: A very important employer and a major source of revenue for the city's inhabitants is the import of Japanese cars. Besides salesmen, the industry employs repairmen, fitters, import clerks as well as shipping and railway companies. The Vladivostok dealers sell 250,000 cars a year, with 200,000 going to other parts of Russia. Every third worker in the Primorsky Krai has some relation to the automobile import business. In recent years, the Russian government has made attempts to improve the country's own car industry. This has included raising tariffs for imported cars, which has put the car import business in Vladivostok in difficulties. To compensate, Prime Minister Vladimir Putin ordered the car manufacturing company Sollers to move one of its factories from Moscow to Vladivostok. The move was completed in 2009, and the factory now employs about 700 locals. It is planned to produce 13,200 cars in Vladivostok in 2010.


title: Vladivostok

text: Vladivostok is a link between the Trans-Siberian Railway and the Pacific Sea routes, making it an important cargo and passenger port. It processes both cabotage and export-import general cargo of a wide range. 20 stevedoring companies operate in the port. The cargo turnover of the Vladivostok port, including the total turnover of all stevedoring companies, at the end of 2018 amounted to 21.2 million tons.


title: Vladivostok

text: In 2015, the total volume of external trade seaport amounted to more than 11.8 billion dollars. Foreign economic activity was carried out with 104 countries.


title: Vladivostok

text: Vladivostok is located in the extreme southeast of the Russian Far East, and is the closest city to the countries of the Asia-Pacific with an exotic European culture, which makes it attractive to tourists. The city is included in the project for the development of the Far East tourism "Eastern Ring". Within the framework of the project, the Primorsky Stage of the Mariinsky Theater was opened, and there are plans to open branches of the Hermitage Museum, the Russian Museum, the Tretyakov Gallery and the State Museum of Oriental Art. Vladivostok entered the top ten Russian cities for recreation and tourism according to Forbes, and also took the fourteenth place in the National Tourism Rating.


title: Vladivostok

text: In addition to being a cultural hub, the city also is a tourism hub in the Peter the Great Gulf. The city's resort area is located on the coast of Amur Bay, which includes over 11 sanatoriums. Vladivostok also has a bustling gambling zone, which has over 11 casinos planned to open by 2023. Tigre de Cristal, the city's first casino, was visited by over 80,000 tourists, in less than a year of its opening.


title: Vladivostok

text: In 2017, the city was visited by around 3,000,000 tourists, including 640,000 foreigners, of which over 90% are tourists from Asia, specifically China, South Korea and Japan. Domestic tourism is based on business tourism (business trips to exhibitions, conferences), which accounts for up to 70% of the inbound flow. In Vladivostok, diplomatic tourism is also developed, as there are 18 foreign consulates in the city. There are 46 hotels in the city, with a total fund of 2561 rooms. The vast majority of the travel companies of Primorsky Krai (86%) are concentrated in Vladivostok, and their number was around 233 companies in 2011.


title: Vladivostok

text: The Trans-Siberian Railway was built to connect European Russia with Vladivostok, Russia's most important Pacific Ocean port. Finished in 1905, the rail line ran from Moscow to Vladivostok via several of Russia's main cities. Part of the railway, known as the Chinese Eastern Line, crossed over into China, passing through Harbin, a major city in Manchuria. Today, Vladivostok serves as the main starting point for the Trans-Siberian portion of the Eurasian Land Bridge.Vladivostok is the main air hub in the Russian Far East. Vladivostok International Airport (VVO) is the home base of Aurora, a subsidiary of Aeroflot. The airline was formed by Aeroflot in 2013 by amalgamating SAT Airlines and Vladivostok Avia. The Vladivostok International Airport was significantly upgraded in 2013 with a new -long runway capable of accommodating all aircraft types without any restrictions. The "Terminal A" was built in 2012 with a capacity of 3.5 million passengers per year.


title: Vladivostok

text: It is possible to get to Vladivostok from several of the larger cities in Russia. Regular flights to Seattle, Washington, were available in the 1990s but have been cancelled since. Vladivostok Air was flying to Anchorage, Alaska, from July 2008 to 2013, before its transformation into Aurora airline.Vladivostok is the starting point of Ussuri Highway (M60) to Khabarovsk, the easternmost part of Trans-Siberian Highway that goes all the way to Moscow and Saint Petersburg via Novosibirsk. The other main highways go east to Nakhodka and south to Khasan.


title: Vladivostok

text: On June 28, 1908, Vladivostok's first tram line was started along Svetlanskaya Street, running from the railway station on Lugovaya Street. On 9 October 1912, the first wooden carriages manufactured in Belgium entered service. Today, Vladivostok's means of public transportation include trolleybus, bus, tram, train, funicular and ferryboat. The main urban traffic lines are Downtown—Vtoraya Rechka, Downtown—Pervaya Rechka—3ya Rabochaya—Balyayeva, and Downtown—Lugovaya Street.


title: Vladivostok

text: In 2012, Vladivostok hosted the 24th Summit of the Asia-Pacific Economic Cooperation (APEC) forum. In preparation for the event, the infrastructure of the city was renovated and improved. Two giant cable-stayed bridges were constructed in Vladivostok, namely the Zolotoy Rog Bridge over Golden Horn Bay, and the Russky Bridge from the mainland to Russky Island, where the summit took place. The latter bridge is the longest cable-stayed bridge in the world.


title: Vladivostok

text: There are 114 general education institutions in Vladivostok, with a total number of students of 50,700 people (in 2015). The municipal education system of the city consists of preschool organizations, primary, basic, secondary general education schools, lyceums, gymnasiums, schools with an in-depth study of individual subjects, and centers of additional education.


title: Vladivostok

text: The municipal educational network includes 2 gymnasiums, 2 lyceums, 13 schools with advanced study of individual subjects, one primary school, 2 basic schools, 58 secondary schools, four evening schools, one boarding school, one boarding school. Three Vladivostok schools are included in the Top-500 schools of the Russian Federation. At the municipal level, there is a city system of school olympiads, a city scholarship has been established for outstanding achievements of students.


title: Vladivostok

text: Dozens of colleges, schools and universities provide vocational education in Vladivostok. The beginning of higher education was laid in the city with the founding of the Oriental Institute. At the moment, the largest university in Vladivostok is the Far Eastern Federal University. More than 41,000 students study in it, 5,000 employees work, including 1,598 teachers. It accounts for a large share (64%) of scientific publications among Far Eastern universities.