Anorexia Nervosa

Definition:
Anorexia is characterized by a significant weight loss that has resulted from excessive dieting.  People with anorexia consider themselves to be fat, irrespective of their actual weight.  They often do not recognize that they are thin and even those close to death can often show you areas of their bodies that they still “need” to lose weight from.  The desire to become thin means the person will avoid food, which can result in death.  It is estimated that up to 20% of people with anorexia will die from complications related to the disorder.  Anorexia typically occurs in early to mid-adolescence, and approximately 95% of those diagnoses are female.

The process of eating often becomes an obsession with the development of unusual eating habits such as avoidance of food or meals, selecting only a few foods and eating small portions of these, or weighing food before it is eaten.  Repeated checking of weight and other weight control methods such as excessive exercise or abuse of laxatives is also common. 

The course and outcome varies significantly between people.  Some people may fully recover after one episode; some people have a fluctuating pattern of weight gain and relapse while others may experience deteriorating health over many years. 

Although anorexia focuses on food, the disease is thought to also be a coping mechanism for emotional problems, perfectionism or a desire for control.  It is common for people with anorexia to equate their self-worth with how thin they perceive themselves to be. 

Treatment for anorexia aims to provide the individual with a healthier sense of self, develop healthier eating habits and reverse some of the disorder’s more serious complications. 

The specific cause of anorexia is unknown however it is generally attributed to a combination of psychological, biological and socio-cultural factors.  Diagnosis of anorexia typically involves many tests, including physical exam, laboratory tests, psychological evaluations and other studies such as X-ray or Electrocardiogram (ECG).

Symptoms of Anorexia Nervosa:
There are many symptoms and warning signs of anorexia.  It is common for people with anorexia to also be diagnoses with other mental disorders such as depression, anxiety (especially obsessive-compulsive disorder), personality disorders or drug abuse.

The primary symptoms of anorexia are:

• Resistance to maintain body weight at or above the normal weight for age and height
• Fear of gaining weight or being “fat” – the latter is often considered to be irrational due to the person already being underweight
• Distorted perception of weight or denial of the seriousness of low body weight
• Loss of menstrual periods in girls and women post-puberty 

Warning signs of anorexia are:

• Dramatic weight loss
• Concentration difficulties
• Preoccupation with food or dieting
• Sleep difficulties
• Refusal to eat certain foods
• Dizziness
• Frequent comments about feeling fat or overweight
• Mood swings
• Stomach pains
• Feelings of anxiety about gaining weight or becoming fat
• Denial of hunger
• Constipation
• Development of ritualistic behavior towards food
• Consistent excuses to avoid mealtimes
• Excessive or rigid exercise regimen
• Social isolation or withdrawal from social networks
• Poor circulation (resulting in the individual feeling unusually cold)
• Behaviors that suggest weight loss, dieting or control of food are primary concerns for the individual 

The long-term effects of anorexia:

• Slow heart rate and low blood pressure, which is suggestive of the heart muscle changing.  The risk of heart failure rises as the heart rate and blood pressure decreases. 
• Reduction of bone density
• Lung problems
• Muscle loss and weakness
• Gastrointestinal problems (such as constipation, bloating or nausea)
• Severe dehydration which can result in kidney failure
• Fainting or feeling fatigued
• Kidney problems
• Dry hair and skin
• Hair loss
• Anemia
• Growth of lanugo (a layer of hair that the body produces as insulation against being cold) all over the body (including the face)
• Women with anorexia tend to experience difficulties becoming pregnant or may be infertile. 
• Men with anorexia may display decreased testosterone levels

Treatment for Anorexia Nervosa:

Treatment for anorexia aims to provide the individual with a healthier sense of self, develop healthier eating habits and reverse some of the disorder’s more serious complications.  Given the serious health complications associated with anorexia, it is imperative that treatment is sought immediately.  Unfortunately this can be extremely difficult as many people with anorexia initially refuse treatment or believe they do not need help.  The desire to remain thin outweighs the desire to be healthy. 

Treatment for anorexia typically involves a team approach that includes a variety of professionals including doctors, psychiatrists or psychologists and dietitians.  The most common treatment regime includes:

• Medical care to treat physical conditions associated with anorexia
• Psychotherapy (individual, family or group therapy may all be beneficial) to help the individual deal with behaviors and thoughts that are associated with anorexia
• Nutritional therapy for guidance on a healthy diet
• Hospitalization is common due to the medical complications associated with anorexia

Medications are not used to treat anorexia; however it is common that such treatment is used to treat other psychiatric disorders associated with anorexia (such as depression or anxiety).

Treatment of anorexia utilizes a specific program that involves three main stages:

• Restoring weight that has been lost to severe dieting and purging
• treating psychological disturbances such as distortion of body image, low self-esteem, and interpersonal conflicts
• achieving long-term remission and rehabilitation, or full recovery

Early diagnosis and treatment significantly increases the success rate for treatment.