Anorexia Nervosa

Anorexia nervosa (simply called anorexia) is an eating disorder that occurs when people intentionally starve themselves. It is characterized by extreme weight loss, which the National Institute of Mental Health (NIMH) defines as at least 15 percent below the individual's normal body weight. Persons with anorexia become obsessed with food, weight and body image, resulting in behaviors such as severe food restriction, vomiting after eating, excessive use of laxatives or diet aids and sometimes extreme amounts of exercise.
People with anorexia generally have not learned how to cope with the problems typical of adolescence, growing up and becoming independent. They may restrict food (particularly carbohydrates) to gain a sense of control of their body and to gain approval from others.
According to the NIMH, anorexia affects one of 100 females between the ages of 16 and 18 years; however, 5 to 10 percent of teens diagnosed with anorexia are males. Anorexia affects all socioeconomic groups and a variety of ethnic and racial groups.
Cause of Anorexia
The cause of anorexia nervosa is not known, but a number of factors have been implicated. These include social attitudes toward body appearance; genetics; neurochemical and developmental factors; family or personal history of weight problems; physical illness and/or mental health problems, such as depression or substance abuse ; and lack of age-appropriate emotional development.
Types of Anorexia
There are two subtypes of anorexic behavior:
  • Persons with the restrictor type severely limit their intake of food, especially carbohydrates and fat-containing foods.
  • Those with the bulimic type (also called the binge-eating/purging type ) eat in binges and then vomit and/or take large amounts of laxatives or other medications that clear the intestinal contents
Symptoms of Anorexia
Each individual may experience one or more of the symptoms of anorexia.
  • Low body weight (less than 85 percent of normal weight for height and age)
  • Intense fear of becoming obese, even as the individual is losing weight
  • Distorted view of one's body weight, size or shape; perception of being fat, even when very thin
  • Refusal to maintain minimum normal body weight
  • Excessive physical activity
  • Denial of feelings of hunger
  • Preoccupation with food preparation
  • Bizarre eating behaviors
  • Social withdrawal, irritability, moodiness and/or depression

Persons with anorexia also may have various physical symptoms, which often result from starvation and malnourishment. Other symptoms include:
  • Dry skin that, when pinched and released, stays pinched
  • Dehydration
  • Abdominal pain
  • Constipation
  • Lethargy
  • Fatigue
  • Intolerance to cold temperatures
  • Emaciation
  • Development of fine, downy body hair
  • Yellowing of the skin
  • Absence of three menstrual cycles without another cause

Medical complications that may result from anorexia can be severe and life threatening. Anorexia can affect the heart (fast, slow or irregular heart beat or low blood pressure), blood (anemia), kidneys (highly concentrated or increased production of urine), bones (fractures, bone loss) and hormones (growth retardation or cessation of menstruation).
Diagnosing Anorexia
Parents, other family members, teachers and anyone else who is close to an individual may be able to help identify anorexia, although many affected people initially keep their illness hidden. A detailed physical exam, medical and social history and careful psychiatric evaluation contribute to the diagnosis. Laboratory and other tests, such as X-rays or cardiac evaluations, may be needed.
Treating Anorexia
Early diagnosis and treatment of anorexia are essential to avoid adverse effects on the body. Treatment is individualized and includes one or more of the following approaches.
  • Psychotherapy (individual and/or family) is used to help the person restore normal eating patterns and behaviors to support weight gain and to aid in changing distorted beliefs and thoughts that maintain the restrictive eating.
  • Medications such as antidepressants or other psychiatric drugs can help treat co-existing mental disorders such as depression or anxiety.
  • Nutritional support is needed to help establish weight goals, appropriate foods and regular patterns of eating.

The patient’s family plays a vital supportive role in the treatment process.