Anorexia Nervosa

Anorexia Nervosa

Anorexia nervosa is an eating disorder characterized by refusal to stay at even the minimum body weight considered normal for the person's age and height. Other symptoms of the disorder include distorted body image and an intense fear of weight gain. Inadequate eating or excessive exercising results in severe weight loss. Eating disorders frequently develop during adolescence or early adulthood, but some reports indicate their onset can occur during childhood or later in adulthood. Anorexia nervosa is one of the two major types of eating disorders; the other is bulimia.

People with anorexia see themselves as overweight even though they are dangerously thin. The process of eating becomes an obsession to them. Unusual eating habits develop, such as avoiding what they perceive as high caloric food and meals, picking out a few foods and eating only these in small quantities, or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight and many engage in other techniques to control their weight, such as intense and compulsive exercise or purging by means of vomiting and abuse of laxatives, enemas, and diuretics. Girls with anorexia often experience a delayed onset of their first menstrual period.

Eating disorders frequently co-occur with other psychiatric disorders, such as depression, substance abuse, and anxiety disorders. In addition, people who suffer from eating disorders can experience a wide range of physical health complications, including serious heart conditions and kidney failure, that may lead to death. Recognition of eating disorders as real and treatable diseases, therefore, is critically important.

Symptoms

An estimated 0.5 percent to 3.7 percent of females and 0.1 percent to 0.2 percent of males suffer from anorexia nervosa in their lifetime. Symptoms of anorexia nervosa include:
Refusal to maintaining body weight at or above a minimally normal weight for one's age and height

Intense fear of gaining weight or becoming fat, even though one is underweight
Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of low body weight
Infrequent or absent menstrual periods (in females who have reached puberty)

Causes

Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable medical illnesses in which certain maladaptive patterns of eating take on a life of their own.
Dieting to a body weight leaner than required for health is highly promoted by current fashion trends, by sales campaigns for special foods, and in some activities and professions. Researchers are investigating how and why initially voluntary behaviors, such as eating smaller or larger amounts of food than usual, move beyond control for some people and develop into eating disorders.

Studies on the basic biology of appetite control and its alteration by prolonged overeating or starvation have uncovered enormous complexity; in time, their findings may to lead to new pharmacologic treatments for eating disorders. Scientists suspect that multiple genes may interact with environmental and other factors to increase the risk of developing these illnesses.

Treatment

Eating disorders can be treated, and a healthy weight can be restored. The sooner these disorders are diagnosed and treated, the better the outcome is likely to be. Because of their complexity, eating disorders require a comprehensive treatment plan involving medical care and monitoring, psychosocial interventions, nutritional counseling, and, when appropriate, medication management. At the time of diagnosis, the clinician must determine whether the person is in immediate danger and requires hospitalization.

Treatment of anorexia calls for a specific program that involves three main phases: (1) restoring weight lost to severe dieting and purging, (2) treating psychological disturbances such as distortion of body image, low self-esteem, and interpersonal conflicts, and (3) achieving either long-term remission and rehabilitation or full recovery. Early diagnosis and treatment increases the treatment success rate. Use of psychotropic medication in people with anorexia should be considered only after weight gain has been established. Certain selective serotonin reuptake inhibitors (SSRIs) have been shown to be helpful for weight maintenance and for resolving mood and anxiety symptoms associated with anorexia.

The acute management of severe weight loss is usually provided in an inpatient hospital setting, where feeding plans address the person's medical and nutritional needs. In some cases intravenous feeding is recommended. Once malnutrition has been corrected and weight gain has begun, psychotherapy (often cognitive-behavioral or interpersonal psychotherapy) can help people with anorexia overcome low self-esteem and address distorted thought and behavior patterns. Families are sometimes included in the therapeutic process.

People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting into and staying in treatment. Family members or other trusted individuals can be helpful in ensuring that the person with an eating disorder receives needed care and rehabilitation. For some people, treatment may be long-term.

Sources:

American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised. Washington, D.C.: American Psychiatric Association, 2000.
American Psychiatric Association Work Group on Eating Disorders (APAWG). Practice guideline for the treatment of patients with eating disorders (revision). American Journal of Psychiatry, 2000; 157(1 Suppl): 1-39.

Becker AE, Grinspoon SK, Klibanski A, Herzog DB. Eating disorders. New England Journal of MedicineAmerican Journal of Psychiatry, 1999; 340(14): 1092-8.
National Institutes of Health, National Library of Medicine, MedlinePlus, 2006. Anorexia nervosa. http://www.nlm.nih.gov/medlineplus/ency/article/000362.htm
The National Institute of Mental Health