Anorexia nervosa

Anorexia nervosa is characterized by a refusal to maintain a minimally normal body weight (based on a person’s age and body size), a distorted body image, an intense fear of gaining weight and amenorrhea (absence of menstruation) in females who have had their first menstrual period. For instance, individuals with anorexia nervosa often believe they are fat despite being extremely underweight.

Anorexia nervosa differs from another eating disorder called bulimia nervosa. Individuals with bulimia nervosa usually maintain a normal body weight or are overweight. To be diagnosed with anorexia nervosa, a person must weigh more than 15 percent below the normal range for their age and body size and exhibit a distorted body image.

Eating (especially a healthy, well-balanced diet) is necessary for normal functioning of all organ systems. Disordered eating habits (e.g., skipping meals) or prolonged dieting (e.g., calorie restriction) may deplete the body of important nutrients. In some cases, such habits may become chronic and may lead to the development of an eating disorder, such as anorexia nervosa.

Anorexia nervosa can be particularly dangerous because it puts a person at risk for malnutrition. Individuals with anorexia nervosa tend to associate their self-worth or self-esteem with the way their bodies look and attempt to control their weight through harmful methods, including starvation and purging.

People with anorexia nervosa typically achieve weight loss by drastically reducing their food intake. Patients often begin by eliminating high-calorie foods from their diet, but most usually end up with a very restricted diet that is sometimes limited to only a few foods.

Additional methods for weight loss include purging methods, such as self-induced vomiting or misusing laxatives and/or diuretics, in addition to increased or excessive exercise (anorexia athletica). Individuals with anorexia nervosa may also rely on diet pills, recreational drugs (e.g., amphetamines, cocaine) and caffeine (e.g., coffee, caffeinated diet drinks) to suppress hunger and boost energy. Prolonged use of these agents may result in tolerance and withdrawal symptoms, which can be exacerbated in low-weight people who use these substances in excess.

Patients with anorexia nervosa often exhibit other types of mental disorders including depression (due in part to being severely underweight) and anxiety disorders, which may also become exacerbated by prolonged starvation. Obsessive-compulsive features, such as chronic calorie counting and hoarding food, are also prominent among people with anorexia nervosa. However, most individuals with anorexia nervosa are only preoccupied with thoughts of food and weight.

Anorexia nervosa is more prevalent in females than males, especially among adolescents and young adults. According to the U.S. Department of Health and Human Services, it ranks as the third most common chronic illness among adolescent girls in the nation.

Anorexia nervosa typically begins during adolescence or early adulthood. However, some reports indicate that its onset can occur during childhood, even before children reach puberty, or later in adulthood. It is more common in industrialized, economically developed nations.

Anorexia nervosa can have severe, life-threatening complications. Prolonged starvation can lead to malnutrition and damage of the vital organs, including the heart and brain. In addition, nutritional deprivation often results in the loss of bone mass (osteoporosis), which may result in brittle bones that break easily. Other complications from malnutrition include amenorrhea, anemia (low red blood cell count), infertility (inability to get pregnant), hair loss and a failure to grow in children or adolescents. In the case of patients who engage in prolonged self-induced vomiting, damage to the teeth, gums and upper gastrointestinal tract can occur. If left untreated, patients with anorexia nervosa may literally starve themselves to death. Limited food intake and purging can also lead to other health problems, such as injuries to the esophagus.

Often, people with anorexia nervosa are in denial and do not recognize or admit that there is a problem and as a result, may become extremely resistant to seeking medical treatment. In such cases, the intervention of family members, teachers or peers may be necessary to ensure that the individual exhibiting symptoms of anorexia nervosa receives proper medical attention.

Anorexia nervosa is an eating disorder that is characterized by an obsession to be thin, relentless and harmful dietary habits (e.g., starvation, purging) and weight loss.

There are two types of anorexia nervosa:

The exact cause of anorexia nervosa is not thoroughly understood. Perhaps part of the explanation for its prevalence in economically developed nations may be the messages the media sends regarding ideal beauty and attractiveness. These messages often promote thinness as the female ideal. In order to be thin or slender, some people achieve and maintain a weight that may not always be healthy for their bodies. In some cases, it is possible to be slender and healthy at the same time. However, it becomes a serious health problem when people use detrimental methods (e.g., starvation) to achieve thinness.

Generally, a combination of various factors is believed to contribute to the development of anorexia nervosa. These include:

In addition, pro-eating disorder Web sites, which encourage eating disorders including anorexia nervosa and bulimia nervosa by offering tips and support, have proliferated on the Internet in recent years. These sites are especially harmful to vulnerable teenagers who view anorexia nervosa or bulimia nervosa as a “lifestyle choice” rather than a serious illness that may result in death. In fact, some experts believe that these sites may interfere with treatment and cause relapse of the eating disorder in many patients.

Excessive weight loss – especially if a person reaches a weight that is less than 85 percent of the ideal weight for their age and height – is the initial sign of anorexia nervosa. In addition, individuals with anorexia nervosa may express an intense fear of gaining weight or exhibit a negative body image (e.g., belief that they are fat despite being extremely thin). They may also exhibit anxious or ritualistic behaviors during mealtimes (e.g., making excuses to avoid eating, playing with food on plate) and/or exercise excessively or compulsively (anorexia athletica). Some individuals with anorexia nervosa also dress in layers or baggy clothes to hide their weight loss.

Physicians may diagnose anorexia nervosa based on the patient’s symptoms and eating habits. During an initial consultation, a physician will record the patient’s weight and perform a thorough physical examination including:

• Checking vital signs, such as heart rate and blood pressure
• Evaluation of patient’s skin, abdomen and teeth
• Neurological examination to evaluate other potential causes of weight loss and/or vomiting, such as liver disease or a brain tumor

• Has the patient recently lost more than 14 pounds (6.35 kg) in a three-month period?
• Does the patient believe they are fat when others say they are too thin?
• Does food dominate the patient’s life?
• Does the patient induce sickness (vomiting) because they fear gaining weight?
• Does weight affect the patient’s self-image?

When anorexia nervosa is diagnosed, a physician may refer the patient for supplementary treatment with a mental and/or behavioral health specialist (typically a psychiatrist for a psychiatric evaluation), nutritionist (a licensed nutrition expert) and/or dentist for the treatment of dental complications, such as tooth and gum decay, which may occur with regular self-induced vomiting (binge-eating/purging-type anorexia nervosa).

The sooner an individual with anorexia nervosa is diagnosed and begins treatment, the better the outcome is likely to be. Due to its complexity, anorexia nervosa usually requires a comprehensive treatment plan, including medical care and monitoring of health complications (e.g., malnutrition), psychological evaluation and dietary counseling.

In severe cases of malnutrition, immediate hospitalization of the patient may be necessary to rehydrate (restore loss of water) and restore electrolyte imbalance through intravenous (into a vein) feeding.

Patients with dental problems (e.g., tooth and gum decay) resulting from binge eating/purging type anorexia nervosa may be referred to the care of a dentist for treatment.

Anorexia nervosa typically requires a multi-disciplinary approach for rehabilitation that may include:

Patients with anorexia nervosa are urged to get regular check-ups with their physician to monitor their overall health and treat any complications, such as bradycardia (reduced heart beat). Sometimes, residential care that involves the patient remaining in a facility that specializes in treating anorexia nervosa may be necessary, especially in the case of chronic relapses or when patients have not been able to reach a significant degree of medical and psychological stability from their initial treatment plan.

Sometimes people with anorexia nervosa are in denial and may refuse to recognize that there is a problem. Oftentimes, they may resist getting and staying in treatment. Family members and other individuals close to the patient are urged to ensure that the person suspected of having anorexia nervosa receives needed care and rehabilitation. For some patients, medical treatment may be long term.

Although anorexia nervosa cannot always be prevented, it can be more effectively managed by taking steps that can reduce chances of a relapse including:

• Attending regular follow-up consultations with a primary care physician, psychotherapist and nutritionist to monitor the eating disorder
• Eating healthy, well-balanced meals
• Following a regular schedule of meals
• Taking vitamin and mineral supplements
• Exercising regularly as recommended by the physician
• Getting proper rest and sleep
• Engaging in activities that boost self-esteem, such as learning a new skill or hobby or joining a local social group
• Learning realistic expectations regarding body and weight. (For example, not accepting some media portrayals of ideal body image.)