Anorexia Nervosa

This condition occurs when a person has a distorted image of her own body and refuses to eat enough to stay healthy for fear of getting fat. A person who periodically gorges on food and then makes herself vomit or takes laxatives and other substances to get rid of the food has bulimia.

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Symptoms

Anorexia can be mild and brief or ongoing and life-threatening. Its onset may be subtle. 

Signs include:

  • Growing focus on food, such as reading about it, hoarding it, concealing it, wasting it, collecting recipes and cooking elaborate meals for others. This tends to get worse as a person gets painfully thin.
  • Anxiety about getting fat, especially in someone who already is thin
  • In women, periods will stop
  • Loss of interest in sex
  • Denial that anything is wrong
  • Lack of concern about the loss of weight
  • Resistance to seeing a doctor or getting treatment
  • Low heart rate, blood pressure and body temperature
  • Swelling from fluid accumulation
  • Fine, soft hair or excessive body and facial hair
  • Depression

Persons with anorexia may either severely cut back how much food they eat or binge on food and then purge. The purging is done by vomiting or taking laxatives. Many also take diuretics. About half the people limit their food and the other half purge. Many persons with an eating disorder also exercise intensely to control their weight.

Anorexia causes many hormone changes. Estrogen and thyroid hormones may be low.

Rapid weight loss - or being more than 25% below ideal weight - can cause life-threatening changes in electrolytes and fluid balances. This can cause heart problems, dehydration and a tendency to faint. Purging and abusing diuretics will make the situation worse. 

Potentially, sudden death from abnormal heart rhythms may occur.

 

Causes and Risk Factors

Many factors lead to anorexia.

Western society puts a lot of pressure on people to be thin. Two out of three teenage girls have taken steps to control their weight, yet only about one percent of girls between the ages of 12 and 18 develop anorexia.

About 95% of the people with this condition are girls or women. It usually affects teens. It mostly affects people in middle and upper socioeconomic classes.

Anorexia is rare in parts of the world where there is a shortage of food.

Many who develop it are intelligent, have high standards for success and achievement, and are usually meticulous, compulsive and obsessive.

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Diagnosis

Diagnosis can usually be made on the basis of severe weight loss (at least 15% of body weight), the stopping of menstrual periods and psychological symptoms (denial of a problem and fears of being fat).

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Treatments

Between 10 to 20% of all people with anorexia die because of its impact on the body, particularly the heart.

Treatment usually has two phases:

Immediate intervention to save the person's life and restore body weight

Long-term therapy to improve psychological functioning and prevent relapse

The first is usually done in a hospital. The person is encouraged to eat. In some cases, they might be fed with a feeding tube passed through the nose and into the stomach.

Longer-term therapy begins after the patient is stabilized. It may include individual, group and family therapy. Consultation with a specialist in eating disorders can be useful. Anti-depressants may be given if the person is depressed. Selective seratonin reuptake inhibitors are useful for preventing relapses.