Anorexia Nervosa

What is anorexia nervosa?
Anorexia nervosa is a life-threatening eating disorder that is characterized by self-starvation and excessive weight loss. The disorder is diagnosed when a person weighs at least 15 percent less than his or her normal body weight. Extreme weight loss in people with anorexia nervosa can lead to dangerous health problems and even death.

The term anorexia literally means "loss of appetite." However, this definition is misleading as people with anorexia nervosa are often hungry but refuse food anyway. People with anorexia nervosa have intense fears of becoming fat and sees themselves as fat even when they are very slender. These individuals may try to correct this perceived "flaw" by strictly limiting food intake and exercising excessively in order to lose weight.

Who gets anorexia nervosa?
People with anorexia nervosa tend to be very high achievers, performing very well in school, sports, work, and other activities. They might stop eating to feel that they have control over some part of their lives, or they might refuse to eat to "rebel" against their loved ones. Anorexia nervosa usually begins around the time of puberty, but it can develop at any time.

Eating disorders are more common in females than in males. The risk of developing an eating disorder is greater in actors, models, dancers, and athletes in sports where appearance and/or weight are important, such as wrestling, gymnastics, and figure skating.

What causes anorexia nervosa?
The exact cause of anorexia nervosa is not known, but research suggests that a combination of certain personality traits, emotions and thinking patterns, as well as biological and environmental factors might be responsible.

People with anorexia nervosa often use food and eating as a way to gain a sense of control when other areas of their lives are very stressful or when they feel overwhelmed. Feelings of inadequacy, low self-esteem, anxiety, anger, or loneliness also might contribute to the development of the disorder. In addition, people with eating disorders might have troubled relationships or have a history of being teased about their size or weight. Pressure from peers and a society that equates thinness and physical appearance with beauty also can have an impact on the development of anorexia nervosa.

Eating disorders also might have physical causes. Changes in hormones that control how the body and mind maintain mood, appetite, thinking, and memory might foster eating disorders. The fact that anorexia nervosa tends to run in families also suggests that a susceptibility to the disorder might be inherited.

How is anorexia nervosa diagnosed?
Identifying anorexia nervosa can be challenging. Secrecy, shame, and denial are characteristics of the disorder. As a result, the illness can go undetected for long periods of time.

If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose anorexia nervosa, the doctor might use various diagnostic tests—such as X-rays and blood tests—to rule out physical illness as the cause of the weight loss, as well as to evaluate the effects of the weight loss on the body’s organs.

If no physical illness is found, the person might be referred to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists may use specially designed interview and assessment tools to evaluate a person for an eating disorder.

• Rapid weight loss over several weeks or months
• Continuing to diet even when thin or when weight is very low
• Having an unusual interest in food, calories, nutrition or cooking
• Intense fear of gaining weight
• Strange eating habits or routines, such as eating in secret
• Feeling fat, even if underweight
• Inability to realistically assess one’s own body weight
• Striving for perfection and being very self-critical
• Undue influence of body weight or shape on self-esteem
• Depression, anxiety, or irritability
• Infrequent or irregular menstrual periods in females
• Laxative, diuretic, or diet pill use
• Frequent illness
• Wearing loose clothing to hide weight loss
• Compulsive exercising
• Feeling worthless or hopeless
• Social withdrawal
• Physical symptoms that develop over time, including: low tolerance of cold weather, brittle hair and nails, dry or yellowing skin, anemia, constipation, swollen joints and a new growth of thin hair over the body

How is anorexia nervosa treated?
Treatment of anorexia nervosa is challenging because most people with the disorder deny they have a problem. Like all eating disorders, anorexia nervosa requires a comprehensive treatment plan that is adjusted to meet the needs of each patient. Goals of treatment include restoring the person to a healthy weight, treating emotional issues such as low self-esteem, correcting distorted thinking patterns, and developing long-term behavioral changes. Treatment most often involves a combination of the following strategies:

Psychotherapy — This is a type of individual counseling that focuses on changing the thinking (cognitive therapy) and behavior (behavioral therapy) of a person with an eating disorder. Treatment includes practical techniques for developing healthy attitudes toward food and weight, as well as approaches for changing the way the person responds to difficult situations.

Medication — Certain antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) might be used to help control anxiety and depression associated with an eating disorder.

Nutrition counseling — This strategy is designed to teach a healthy approach to food and weight, to help restore normal eating patterns, and to teach the importance of nutrition and a balanced diet.

Group and/or family therapy — Family support is very important to treatment success. It is important that family members understand the eating disorder and recognize its signs and symptoms. People with eating disorders might benefit from group therapy, where they can find support, and openly discuss their feelings and concerns with others who share common experiences and problems.

Hospitalization — Hospitalization might be needed to treat severe weight loss that has resulted in malnutrition and other serious mental or physical health complications, such as heart disorders, serious depression and risk of suicide. Intravenous (in the vein) fluids, nasogastric tube feedings or total parenteral nutrition (TPN) might be needed in cases of severe malnutrition. TPN is used for patients who cannot or should not get their nutrition through eating.

What are the complications of anorexia nervosa?
Untreated, anorexia nervosa can lead to:

• Damaged organs, especially the heart, brain, and kidneys
• Drop in blood pressure, pulse, and breathing rates
• Brittle hair and nails
• Lowered body temperature
• Sensitivity to cold
• Loss of hair
• Body hair that becomes fine
• Irregular heart beat
• Thinning of bones (osteoporosis)
• Death from starvation or suicide

What is the outlook for people with anorexia nervosa?
Anorexia nervosa, like other eating disorders, gets worse the longer it is left untreated. The sooner the disorder is diagnosed and treated, the better the outcome. Anorexia nervosa can be treated, allowing the person to return to a healthy weight. However, people with anorexia nervosa often will not admit they have a problem and might resist treatment or refuse to follow the treatment plan.

Although treatment is possible, the risk of relapse is high. Recovery from anorexia usually requires long-term treatment as well as a strong commitment by the individual.

Support of family members and other loved ones can help ensure that the person receives the needed treatment.

Can anorexia nervosa be prevented?
Although it might not be possible to prevent all cases of anorexia nervosa, it is helpful to begin treatment in people as soon as they begin to have symptoms. In addition, teaching and encouraging healthy eating habits and realistic attitudes about food and body image also might be helpful in preventing the development or worsening of eating disorders.

When should I seek help?
If a serious physical illness is present (such as being very underweight), the person must get prompt medical care. However, eating disorders are not necessarily dependent upon a person’s weight. If you suspect that you or someone you know has an eating disorder, seek help immediately. Eating disorders can become increasingly dangerous the longer they go untreated. In severe cases, eating disorders can be fatal.