What is anorexia nervosa?

Anorexia nervosa, commonly referred to simply as anorexia, is one type of eating

disorder. More importantly, it is also a psychological disorder. Anorexia is a condition that goes
beyond out-of-control dieting. A person with anorexia often initially begins dieting to lose
weight. Over time, the weight loss becomes a sign of mastery and control. The drive to become
thinner is actually secondary to concerns about control or fears relating to one's body. The
individual continues the endless cycle of restrictive eating, often accompanied by other behaviors
such as excessive exercising or the overuse of diet pills, diuretics, laxatives, and/or enemas in
order to reduce body weight, often to a point close to starvation in order to feel a sense of control
over his or her body. This cycle becomes an obsession and, in this way, is similar to any type of
addiction.

Who is at risk for anorexia?

Approximately 95% of those affected by anorexia are female, but males can develop the
disorder as well. While anorexia typically begins to manifest itself during early adolescence, it is
also seen in young children and adults. In the U.S. and other countries with high economic status,
it is estimated that about one out of every 100 adolescent girls has the disorder. Caucasians are
more often affected than people of other racial backgrounds, and anorexia is more common in
middle and upper socioeconomic groups. According to the U.S. National Institute of Mental
Health (NIMH), an estimated 0.5%-3.7% of women will suffer from this disorder at some point
in their lives.

Many experts consider people for whom thinness is especially desirable, or a professional
requirement (such as athletes, models, dancers, and actors), to be at risk for eating disorders such
as anorexia nervosa.
What causes anorexia?

At this time, no definite cause of anorexia nervosa has been determined. However,
research within the medical and psychological fields continues to explore possible causes.
Studies suggest that a genetic (inherited) component may play a more significant role in
determining a person's susceptibility to anorexia than was previously thought. Researchers are
currently attempting to identify the particular gene or genes that might affect a person's tendency
to develop this disorder, and preliminary studies suggest that a gene located at chromosome
seems to be involved in determining a person’s susceptibility to anorexia nervosa.

Other evidence had pinpointed a dysfunction in the part of the brain, the hypothalamus
(which regulates certain metabolic processes), as contributing to the development of anorexia.
Other studies have suggested that imbalances in neurotransmitter (brain chemicals involves in
signaling and regulatory processes) levels in the brain may occur in people suffering from
anorexia.

Feeding problems as an infant, a general history of under eating and maternal depressive
symptoms tend to be risk factors for developing anorexia. Other personal characteristics that can
predispose an individual to the development of anorexia include a high level of negative feelings
and perfectionism. For many individuals with anorexia, the destructive cycle begins with the
pressure to be thin and attractive. A poor self-image compounds the problem. People who suffer
from any eating disorder are more likely to have been the victim of childhood abuse.

While some professionals remain of the opinion that family discord and high demands
from parents can put a person at risk for developing this disorder, the increasing evidence against
the idea that families cause anorexia has mounted such that professional mental-health
organizations no longer ascribe to that theory. Possible factors that protect against the
development of anorexia include high maternal body mass index as well as personal high self-
esteem.
How is anorexia diagnosed?

Anorexia nervosa can be a difficult disorder to diagnose, since individuals with anorexia often
attempt to hide the disorder.In many cases, the actual diagnosis is not made until medical
complications have developed. The individual is often brought to the attention of a professional
by family members only after marked weight loss has occurred. When anorexics finally come to
the attention of the health-care professional, they often lack insight into their problem despite
being severely malnourished and may be unreliable in terms of providing accurate information.
Therefore, it is often necessary to obtain information from parents or other family members in
order to evaluate the degree of weight loss and extent of the disorder. Health professionals will
sometimes administer questionnaires for anorexia as part of screening for the disorder.

The actual criteria for anorexia nervosa are found in the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-
TR).

There are four basic criteria for the diagnosis of anorexia nervosa that are characteristic:

1. The refusal to maintain body weight at or above a minimally normal weight for age and
height. Maintaining a body weight less than 85% of the expected weight.
2. An intense fear of gaining weight or becoming fat, even though the person is underweight
3. Self-perception that is grossly distorted, excessive emphasis on body weight in self-
assessment, and weight loss that is either minimized or not acknowledged completely.
4. In women who have already begun their menstrual cycle, at least three consecutive
periods are missed (amenorrhea), or menstrual periods occur only after a hormone is
administered

The DSM-IV-TR further identifies two subtypes of anorexia nervosa. In the binge-eating or
purging type, the individual regularly engages in binge eating or purging behavior which
involves self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current
episode of anorexia. In the restricting type, the individual severely restricts food intake but does
not regularly engage in the behaviors seen in the binge-eating type
What are anorexia symptoms and signs (psychological and behavioral)?

Anorexia can have dangerous psychological and behavioral effects on all aspects of an
individual's life and can affect other family members as well.

• The individual can become seriously underweight, which can lead to depression and
social withdrawal.
• The individual can become irritable and easily upset and have difficulty interacting with
others.
• Sleep can become disrupted and lead to fatigue during the day.
• Attention and concentration can decrease.
• Most individuals with anorexia become obsessed with food and thoughts of food. They
think about it constantly and become compulsive about eating rituals. They may collect
recipes, cut their food into tiny pieces, prepare elaborate calorie-laden meals for other
people, or hoard food. Additionally, they may exhibit other obsessions and/or
compulsions related to food, weight, or body shape that meet the diagnostic criteria for an
obsessive compulsive disorder.
• Other psychiatric problems are also common in people with anorexia nervosa, including
affective (mood) disorders, anxiety disorders, and personality disorders.
• Generally, individuals with anorexia are compliant in every other aspect of their life
except for their relationship with food. Sometimes, they are overly compliant, to the
extent that they lack adequate self-perception. They are eager to please and strive for
perfection. They usually do well in school and may often overextend themselves in a
variety of activities. The families of anorexics often appear to be "perfect." Physical
appearances are important to them. Performance in other areas is stressed as well, and
they are often high achievers.
• While control and perfection are critical issues for individuals with anorexia, aspects of
their life other than their eating habits are often found to be out of control as well. Many
have, or have had at some point in their lives, addictions to alcohol, drugs, or gambling.
Compulsions involving sex, exercising, housework, and shopping are not uncommon. In
particular, people with anorexia often exercise compulsively to speed the weight-loss
process.
All of these features can negatively affect one's daily activities. Diminished interest in previously
preferred activities can result. Some individuals also have symptoms that meet the diagnostic
criteria for a major depressive disorder

What are anorexia symptoms and signs (physical)?

Most of the medical complications of anorexia nervosa result from starvation. Few organs are
spared the progressive deterioration brought about by anorexia.

• Heart and circulatory system: Although not life-threatening, an abnormally slow heart
rate (bradycardia) and unusually low blood pressure (hypotension) are frequent
manifestations of starvation and are commonly associated with anorexia. Of greater
significance are disturbances in the heart rhythm (arrhythmia). A reduction in the work
capacity of the heart is associated with severe weight loss and starvation.
• Gastrointestinal complications are also associated with anorexia. Constipation and
abdominal pain are the most common symptoms. The rate at which food is absorbed into
the body is slowed down. Starvation and overuse of laxatives can seriously disrupt the
body's normal functions involved in the elimination process. While liver function is
generally found to be normal, there is evidence of changes in enzyme levels and overall
damage to the liver.
• The glandular (endocrine) system in the body is profoundly affected by anorexia. The
complex physical and chemical processes involved in the maintenance of life can be
disrupted, with serious consequences. Disturbances in the menstrual cycle are frequent,
and secondary amenorrhea (absence of menstrual periods) affects about 90% of
adolescent girls with anorexia. Menstrual periods typically return with weight gain and
successful treatment. Hormonal imbalances are found in men with anorexia as well.
Continual restrictive eating can trick the thyroid into thinking that the body is starving,
causing it to slow down in an attempt to preserve calories.
• Kidney (renal) function may appear normal. However, there are significant changes in
kidney function in many people with anorexia, resulting in increased or decreased
urination or potentially fatal potassium deficiency.
 • Bone density loss (osteopenia or thinning of the bones) is a significant complication of
anorexia, since women acquire 40%-60% of their bone mass during adolescence. Studies
have shown that bone loss can occur fairly rapidly in girls with anorexia. While some
studies have shown that bone density may be restored if overall health improves and
anorexia is successfully treated, other studies suggest that an increased risk for fracture
may persist later in life.
• Anorexics who use a large quantity of laxatives or who frequently vomit are at great risk
for electrolyte imbalance, which can have life-threatening consequences.
• Anemia is frequently found in anorexic patients. In addition to having fewer red blood
cells, people with anorexia tend to have lower numbers of white blood cells, which play a
major role in protecting the body from developing infections. Suppressed immunity and a
high risk for infection are suspected but not clinically proven.
• Physical symptoms, other than the obvious loss of weight, can be seen. Anorexia can
cause a lower body temperature as well as dry, flaky skin that takes on a yellow tinge.
Fine, downy hair grows on the face, back, arms, and legs. Despite this new hair growth,
loss of hair on the head is not uncommon. Nails can become brittle. Frequent vomiting
can erode dental enamel and eventually lead to tooth loss.

How is anorexia treated?

Anorexia may be treated in an outpatient setting or hospitalization may be necessary. For

an individual with severe weight loss that has impaired organ function, hospital treatment must
initially focus on correction of malnutrition, and intravenous feeding or tube feeding that goes
past the mouth may be required. A gain of between 1 to 3 pounds per week is a safe and
attainable goal when malnutrition must be corrected. Sometimes weight gain is achieved using
schedules for eating, decreased physical activity, and increased social activity, either on an
inpatient or outpatient basis.

The overall treatment of anorexia, however, must focus on more than weight gain. There
are a variety of treatment approaches dependent upon the resources available to the individual.
Because of increasing insurance restrictions, many patients find that a short hospitalization
followed by a day treatment program is an effective alternative to longer inpatient programs.
Most individuals, however, initially seek outpatient treatment involving psychological as well as
medical intervention. It is common to engage a multidisciplinary treatment team consisting of a
medical-care provider, a dietician or nutritionist, and a mental-health-care provider.

Beside that, different kinds of psychological therapy have been employed to treat people
with anorexia. Individual therapy, cognitive behavior therapy, group therapy, and family therapy
have all been successful in the treatment of anorexia. In adolescents, research shows that the
Maudsley model of family therapy can be particularly effective in treating this disorder in this
population. In contrast to many past approaches to treatment, the Maudsley model approaches
the family of the individual with anorexia as part of the solution rather than part of the reason
their loved one has the disorder. With ongoing specific guidance from the professional mental-
health team, this approach has the family actively help their loved one eat in a more healthy
manner.

Any appropriate treatment approach addresses underlying issues of control,

perfectionism, and self-perception. Family dynamics are explored. Nutritional education
provides a healthy alternative to weight management for the patient. Group counseling or support
groups often assist the individual in the recovery process. The ultimate goal of treatment should
be for the individual to accept herself/himself and lead a physically and emotionally healthy life.

While no medications have been identified that can definitively reduce the compulsion to
starve themselves, olanzapine (Zyprexa, Zydis) is a medication that is also used as a mood
stabilizer and to treat schizophrenia that may be useful in treating anorexia. This is thought to
help increase weight and to manage some of the emotional symptoms like anxiety and depression
that can accompany anorexia. Some of the selective serotonin reuptake inhibitor (SSRI)
antidepressant drugs have been shown to be helpful in weight maintenance after weight has been
gained and in controlling the mood and anxiety symptoms that may be associated with the
condition
What is the prognosis (outcome) of anorexia?

Anorexia is among the psychiatric conditions that have the highest mortality rate, with an
estimated 6% of anorexia victims dying from complications of the disease. The most common
causes of death in people with anorexia are medical complications of the condition, including
cardiac arrest and electrolyte imbalances. Suicide is also a cause of death in people with
anorexia. In the absence of any coexisting personality disorder, younger individuals with
anorexia tend to do better over time than their older counterparts.

Early diagnosis and treatment can improve the overall prognosis in an individual with
anorexia. Despite most psychiatric medications having little effect on the symptoms that are
specific to anorexia, the improvement in associated symptoms (for example, anxiety and
depression) can have a powerful, positive effect on the improvement that individuals with
anorexia show over time. With appropriate treatment, about half of those affected will make a
full recovery. Some people experience a fluctuating pattern of weight gain followed by a relapse,
while others experience a progressively deteriorating course of the illness over many years, and
still others never fully recover. It is estimated that about 20% of people with anorexia remain
chronically ill from the condition.

As with many other addictions, it takes a day-to-day effort to control the urge to relapse.
Many individuals will require ongoing treatment for anorexia over several years, and some may
require treatment over their entire lifetime. Factors that seem to predict more difficult recovery
from anorexia include vomiting and other purging behaviors, bulimia, and symptoms of
obsessive personality disorder. The longer the disease goes on, the more difficult it is to treat as
well.
Pictures of anorexic people