What Is It?
Anorexia Nervosa is an eating disorder in which a person limits eating, and weighs at least 15 percent less than her ideal weight. It usually is considered a female disorder because at least 90 percent of cases are in young women, but it can occur in men or in older people.
A person with this disorder fears being fat, and may be completely convinced that she is overweight despite what the scale shows or what other people say. To achieve or maintain leanness, she may exercise obsessively or use laxatives. Since a super-restrictive diet requires exquisite control, she may become quite careful, inhibited and controlled in other areas of life. For example, she may retreat from social contacts or may perform ritual behaviors.
The term anorexia nervosa literally translates to “no appetite, caused by nervousness.” However, the disorder is defined not by whether a person feels hunger but by how much weight he or she has lost.
Most people with this disorder do feel hunger, but they disregard it, and diet to the point of starvation. Anorexia Nervosa is most often diagnosed in industrialized societies, where thinness is equated with attractiveness. The problem usually begins in adolescence. In girls, the beginning of menstruation may be delayed or it may stop once it has started if dieting progresses far enough. It affects about three-quarters of a percent of all females in the United States.
The cause of anorexia nervosa is not clear. It is likely a combination of genetic (inherited) and environmental factors. Some of the proposed causes include:
- A variant of depression or anxiety — Anorexia, depression, anxiety and obsessive-compulsive disorder tend to run in families, and many people with anorexia nervosa have symptoms of depression or obsessive-compulsive disorder.
- A consequence of fears about becoming an adult — One such fear may be fear of the sexual experimenting that begins in adolescence.
- Environmental pressures — Images from TV and film and pressure from peers leave the impression that thin is best.
- Difficult family relationships — Although these difficulties have been suggested as a cause of the illness, they may actually develop once the disease has started, because a person with anorexia nervosa may test the patience of those she lives with. People with the disorder describe a feeling of power and control over others through their dieting.
In advanced stages of the illness, the dieting is hard to reverse. At that point, hunger may disappear completely and the pursuit of thinness becomes a way of life. Starvation causes medical complications of its own, such as thyroid problems, anemia and joint pains. Death can occur in the most severe cases, most commonly because of an irregular heartbeat caused by an imbalance of the salts in the bloodstream.
There are two subtypes of anorexia nervosa, a restricting type and a binging/purging type. A person with the restricting type of anorexia diets, fasts and exercises. The binging/purging type involves eating large quantities of food, then vomiting. Many people go back and forth between these two patterns.
Symptoms of anorexia nervosa include:
- Significant weight loss (more than 15 percent of ideal body weight)
- Extreme dieting, including skipping meals or extended fasting
- Obsessive exercise
- Use of laxatives
- Binging and purging
- Distorted self-image; feeling fat despite being thin
- Amenorrhea (stopping of menstrual periods)
- Pale yellow skin; brittle nails and hair; anemia, joint swelling, intolerance to cold
- Poor concentration
- Dehydration, fainting
A mental-health professional, such as a psychiatrist, psychologist or social worker, can diagnose anorexia nervosa based on the history reported by the patient and the family. A pediatrician or primary-care physician may make the diagnosis, too.
The health-care professional will ask about the person’s attitudes toward weight, food and body image, and will check for lower-than-normal body weight and the physical signs of starvation, which include:
- Low blood pressure
- Dry skin
- Enlarged salivary glands
- Lanugo, a very fine type of body hair
- The stopping of periods in a woman
- Dental problems, if there has been regular purging
Other tests may be done, including blood tests and tests of liver, thyroid and kidney function.
How long anorexia nervosa lasts varies. Some people have a single, relatively brief episode after experiencing an isolated stressful event. For others, the problem becomes chronic (long-lasting) and the person’s condition gradually deteriorates. Many people start by restricting food, then later binge and purge. Although the majority of cases go away by late adolescence, a significant number of people have persistent problems with diet and body image into adulthood.
There is no way to prevent anorexia nervosa. It’s helpful to detect the problem as early as possible, so it’s important for parents and health-care providers to be aware of the issue.
Anorexia Nervosa is best treated with a combination of psychotherapy and medication. If medical problems develop because of starvation, those problems may also have to be treated. Some people with anorexia nervosa may have to be hospitalized, either for treatment of medical complications or for treatment of the problematic behavior related to food.
At first, treatment is focused on returning the person’s weight to a safe range, especially when the person’s weight is dangerously low. This is a tremendous challenge because the person with the illness often does not discuss eating as a problem. Health-care providers try to define the problem in a way the person can accept, then work with the person toward common goals.
Once the person acknowledges the problem, a variety of therapy techniques can be helpful. A nutritionist can plan a healthy eating program that promotes slow weight gain. Cognitive behavior therapy encourages the person to recognize flawed thoughts about body image, food and dieting, and helps to control anxiety about eating. Family therapy may be important, both to support and educate family members and to examine negative interactions in the family.
Later, when symptoms are under better control, the person with anorexia nervosa may want to understand the meaning of the symptoms, including how they may have affected important relationships, limited emotional growth and altered self-concept. It may also be possible to look at what underlying problems may have led to the eating disorder in the first place.
There is some evidence that antidepressant medications can help in treating anorexia. Medication may be most effective for people who have symptoms of depression, anxiety or obsessive-compulsive disorder. Health-care providers often prescribe a drug from the class of medication called selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil).
A person’s thinking about food can become distorted enough that it is considered psychotic, and in those cases, treatment may include an antipsychotic medication. Some of the newer antipsychotic drugs, such as olanzapine (Zyprexa), have a side effect that, in this case, is a benefit: It often causes weight gain.
When To Call A Professional
Contact a mental-health professional, a pediatrician or a primary-care physician if you have a question about food restriction, feelings of sadness or anxiety, or persistent problems with body image. A family member may be the first to notice such problems and should contact a health-care provider on behalf of the person having trouble. Severe weight loss or starvation can become a medical emergency, so early treatment is desirable.
Many people have milder forms of anorexia nervosa and are open to treatment, particularly when a variety of approaches are combined. For people who have lost a great deal of weight and have medical complications, aggressive care can reverse a downward course. There is a significant risk of death for people hospitalized for medical complications of anorexia nervosa, especially when they are very resistant to treatment. However, a majority of people with anorexia nervosa have a full or nearly full recovery.
by Harutyun Medina, M.D.
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.