Anorexia Nervosa

It is estimated that one half to one percent of women in the United States suffers from anorexia nervosa, which amounts to between 8 and 15 million women. Men can suffer from anorexia as well, but because 90% of the people affected by the condition are women, it is primarily seen as women’s disease. Nonetheless, estimates show that there may be up to a million men who suffer from anorexia as well.

Anorexia nervosa is an eating disorder that is characterized by an extreme fear of gaining weight, an inability or refusal to maintain a healthy body weight, and usually causes a patient to have a distorted self image of his or her own body, often seeing themselves as overweight or imperfect. Patients can become very ill and the disease has the highest mortality rate of any eating disorder and psychiatric disorder.

Symptoms of anorexia may be dramatic but can also be subtle and take years to develop. Some of the most common symptoms include obvious and rapid weight loss, ‘lanugo’ which is fine hair that appears on the face and body, a preoccupation with food and caloric intake, continued dieting despite being underweight, frequent and strenuous exercise, and the use of diet pills and laxatives to prevent weight gain. Patients may become depressed and isolated, and wear large baggy clothes to hide weight loss in if they’ve been confronted about it, or to cover up what the patient sees as an ‘unattractive’ body.

The causes of anorexia are thought to be both biological and environmental. Genetic studies have shown that anorexia can run in families, and have also shown that there are several different genetic and hormonal factors in play. Environmental risk factors and social factors also have been shown to play a large role in the development of anorexia, and professions and social situations where there is pressure to be thin play a large role. Women who have suffered sexual abuse are also at greater risk for the development of anorexia and other eating disorders.

Diagnosis of anorexia is based on symptoms and behavior, although a physician will run several tests of the blood chemistry and functions of the liver, kidneys and thyroid to rule out any other cause of the extreme weight loss. Addison’s disease, Celiac disease and inflammatory bowel disease can cause similar symptoms of weight loss.

While it has undergone some criticism, anorexia is also considered a clinical psychiatric disorder by the American Psychiatric Association, and is defined as having an intense fear of gaining weight, a refusal to maintain a body weight above 85% of normal for age and body type, three consecutive missed periods, a refusal to admit to the seriousness of the weight loss, and an undue influence of body shape and weight on a person’s self image.

Treatment for anorexia relies on three aspects: restoring the person to a healthy weight, treating the psychiatric issues related to the disease, and changing the behaviors that are thought to have led to the disease. Hospitalization may be necessary at the beginning of treatment to rectify any health problems such as heart problems, malnutrition or electrolyte imbalances. Dietary aspects of treatment include supplementation with zinc, essential fatty acids, nutrition counseling, and Medical Nutrition Therapy

Medications

Some research suggests that the use of medicines — such as antidepressants, antipsychotics, or mood stabilizers — may sometimes work for anorexic patients. It is thought that these medicines help the mood and anxiety symptoms that often co-exist with anorexia. Other recent studies, however, suggest that antidepressants may not stop some patients with anorexia from relapsing. Also, no medicine has shown to work 100 percent of the time during the important first step of restoring a patient to healthy weight. So, it is not clear if and how medications can help anorexic patients get better, but research is still happening.

Therapies

Some forms of psychotherapy can help make the psychological reasons for anorexia better. Psychotherapy is sometimes known as “talk therapy.” It uses different ways of communicating to change a patient’s thoughts or behavior. This kind of therapy can be useful for treating eating disorders in young patients who have not had anorexia for a long time.

Individual counseling can help someone with anorexia. If the patient is young, counseling may involve the whole family. Support groups may also be a part of treatment. In support groups, patients, and families meet and share what they’ve been through.

Some researchers point out that prescribing medicines and using psychotherapy designed just for anorexic patients works better at treating anorexia than just psychotherapy alone. Whether or not a treatment works, though, depends on the person involved and his or her situation. Unfortunately, no one kind of psychotherapy always works for treating adults with anorexia.

What should I do if I think someone I know has anorexia?

• If someone you know is showing signs of anorexia, you may be able to help.
• Set a time to talk. Set aside a time to talk privately with your friend. Make sure you talk in a quiet place where you won’t be distracted.
• Tell your friend about your concerns. Be honest. Tell your friend about your worries about her or his not eating or over exercising. Tell your friend you are concerned and that you think these things may be a sign of a problem that needs professional help.
• Ask your friend to talk to a professional. Your friend can talk to a counselor or doctor who knows about eating issues. Offer to help your friend find a counselor or doctor and make an appointment, and offer to go with her or him to the appointment.
• Avoid conflicts. If your friend won’t admit that she or he has a problem, don’t push. Be sure to tell your friend you are always there to listen if she or he wants to talk.
• Don’t place shame, blame, or guilt on your friend. Don’t say, “You just need to eat.” Instead, say things like, “I’m concerned about you because you won’t eat breakfast or lunch.” Or, “It makes me afraid to hear you throwing up.”
• Don’t give simple solutions. Don’t say, "If you'd just stop, then things would be fine!"
• Let your friend know that you will always be there no matter what.

Someone with anorexia may look very thin. With proper treatment many patients can make a full recovery. However, untreated anorexia can lead to dangerous and even lifethreatening malnutrition. This is especially dangerous when patients use extreme measures to lose weight for long periods of time including:

• Making her or himself throw up
• Taking pills to urinate or have a bowel movement
• Taking diet pills
• Not eating or eating very little
• Exercising a lot, even in bad weather or when hurt or tired
• Weighing food and counting calories
• Eating very small amounts of only certain foods
• Moving food around the plate instead of eating it
• Someone with anorexia may also have a distorted body image, shown by thinking she or he is fat, wearing baggy clothes, weighing her or himself many times a day, and fearing weight gain.