Anorexia Nervosa
What is anorexia nervosa?
Anorexia nervosa (or simply anorexia) is an eating disorder in which
people intentionally starve themselves. It causes extreme weight loss,
which the National Institute of Mental Health (NIMH), part of the National
Institutes of Health (NIH), defines as at least 15 percent below the individual's
normal body weight.
Food and weight become obsessions. Compulsiveness may cause strange eating
rituals or the refusal to eat in front of others. It is not uncommon for
people with anorexia to collect recipes and prepare gourmet feasts for
family and friends, but not partake in the meals themselves. They may
also adhere to strict exercise routines to keep off weight.
What causes anorexia nervosa?
The cause of anorexia nervosa is not known. Anorexia usually begins as innocent
dieting behavior, but gradually progresses to extreme and unhealthy weight
loss. Social attitudes toward body appearance, family influences, genetics,
and neurochemical and developmental factors are considered possible contributors
to the cause of anorexia. Persons who develop anorexia are more likely to
come from families with a history of weight problems, physical illness,
and other mental health problems, such as depression or substance abuse.
Further, often persons with the disorder come from families that are challenged
by appropriate problem solving, being too rigid, overly-critical, intrusive,
and overprotective. Persons with anorexia may also be dependent, immature
in their emotional development, and are likely to isolate themselves from
others. Other mental health problems such as anxiety disorders or affective
disorders are commonly found in persons with anorexia.
Who is affected by anorexia nervosa?
The occurrence of anorexia nervosa has increased over the past 20 years.
It is estimated to occur in one out of every 100 females between the ages
of 16 and 18 years old. Five to 10 percent of teens diagnosed with anorexia
are males. Initially found mostly in upper- and middle-class families, anorexia
is now found in all socioeconomic groups and a variety of ethnic and racial
groups.
What are some common characteristics of persons with anorexia nervosa?
Most people with eating disorders share certain personality traits and use
abnormal eating rituals as a means of handling stress and anxiety. These
personality traits often include, but are not limited to, the following:
- low self-esteem
- feelings of helplessness
- fear of becoming fat
Persons with anorexia nervosa:
- rarely break rules or disobey.
- often keep their feelings to themselves.
- tend to be perfectionists, good students, and excellent athletes.
People with anorexia usually follow the wishes of others, and have not learned
how to cope with the problems typical of adolescence, growing up, and becoming
independent. It is believed that they restrict food - particularly carbohydrates
- to gain a sense of control in some/one area of their lives. Controlling
their weight appears to offer two advantages:
- taking control of their bodies
- gaining approval from others
What are the different types of anorexia?
There are two subgroups of anorexic behavior aimed at reducing caloric intake,
including the following:
- restrictor type - severely limits the intake of food,
especially carbohydrates and fat containing foods.
- bulimia (also called binge-eating/purging type) - eats
in binges and then induces vomiting and/or takes large amounts of laxatives
or other cathartics (medications, through their chemical effects, that
serve to increase the clearing of intestinal contents).
What are the symptoms of anorexia nervosa?
The following are the most common symptoms of anorexia. However, each individual
may experience symptoms differently. Symptoms may include:
- low body weight (less than 85 percent of normal weight for height
and age)
- intense fear of becoming obese , even as individual is losing weight
- distorted view of one's body weight, size, or shape; sees self as
too fat, even when very underweight; expresses feeling fat, even when
very thin
- refuses to maintain minimum normal body weight
- in females, absence of three menstrual cycles without another cause
- excessive physical activity
- denies feelings of hunger
- preoccupation with food preparation
- bizarre eating behaviors
The following are the most common physical symptoms associated with anorexia
- often that result from starvation and malnourishment. However, each individual
may experience symptoms differently. Symptoms may include:
- dry skin that when pinched and released, stays pinched
- dehydration
- abdominal pain
- constipation
- lethargy
- fatigue
- intolerance to cold temperatures
- emaciation
- development of lanugo (fine, downy body hair)
- yellowing of the skin
Persons with anorexia may also be socially withdrawn, irritable, moody,
and/or depressed. The symptoms of anorexia nervosa may resemble other medical
problems or psychiatric conditions. Always consult your physician for a
diagnosis.
How is anorexia nervosa diagnosed?
Parents, family members, spouses, teachers, coaches, and instructors may
be able to identify an individual with anorexia, although many persons with
the disorder initially keep their illness very private and hidden. A detailed
history of the individual's behavior from family, parents, and teachers,
clinical observations of the person's behavior, and, sometimes, psychological
testing contribute to the diagnosis. Family members who note symptoms of
anorexia in a loved one can help by seeking an evaluation and treatment
early. Early treatment can often prevent future problems.
Anorexia, and the malnutrition that results, can adversely affect nearly
every organ system in the body, increasing the importance of early diagnosis
and treatment. Anorexia can be fatal. Consult your physician for more
information.
Treatment for anorexia nervosa:
Specific treatment for anorexia nervosa will be determined by your physician
based on:
- your age, overall health, and medical history
- extent of the symptoms
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the condition
- your opinion or preference
Anorexia is usually treated with a combination of individual therapy, family
therapy, behavior modification, and nutritional rehabilitation. Treatment
should always be based on a comprehensive evaluation of the individual and
family. Individual therapy usually includes both cognitive and behavioral
techniques. Medication (usually antidepressants) may be helpful if the person
with anorexia is also depressed. The frequent occurrence of medical complications
and the possibility of death during the course of acute and rehabilitative
treatment requires both your physician and a nutritionist to be active members
of the management team. Families play a vital supportive role in any treatment
process.
Possible complications of anorexia nervosa:
Medical complications that may result from anorexia include, but are not
limited to, the following:
- cardiovascular (heart)
While it is difficult to predict which anorexic patients might have
life-threatening cardiac consequences that result from their illness,
up to 95 percent of hospitalized anorexic patients have been found to
have low heart rates. Myocardial (heart muscle) damage that can occur
as a result of changes in the heartbeat, or repeated vomiting, may be
life threatening. Common cardiac complications that may occur include
the following:
- arrhythmias (a fast, slow, or irregular heartbeat)
- bradycardia (slow heartbeat)
- hypotension (low blood pressure)
- hematological (blood)
An estimated one-third of anorexic patients have mild anemia (low
red blood cell count). Leukopenia (low white blood cell count) occurs
in up to 50 percent of anorexic patients.
- gastrointestinal (stomach and intestines)
Normal movement in intestinal tract often slows down with very restricted
eating and severe weight loss. Gaining weight and some medications help
to restore normal intestinal motility.
- renal (kidney)
Dehydration often associated with anorexia results in highly concentrated
urine. Polyuria (increased production of urine) may also develop in
anorexic patients when the kidneys ability to concentrate urine decreases.
Renal changes usually return to normal with the restoration of normal
weight.
- endocrine (hormones)
Amenorrhea (cessation of the menstrual cycle) is one of the hallmark
symptoms of anorexia, when a menstrual period is missed for three or
more months without any other underlying cause. Amenorrhea often precedes
severe weight loss and continues after normal weight is restored. Reduced
levels of growth hormones are sometimes found on anorexic patients and
may explain growth retardation sometimes seen in anorexic patients.
Normal nutrition usually restores normal growth.
- skeletal (bones)
Persons with anorexia are at an increased risk for skeletal fractures
(broken bones). When the onset of anorexic symptoms occurs before peak
bone formation has been attained (usually mid to late teens), a greater
risk of osteopenia (decreased bone tissue) or osteoporosis (bone loss)
exists. Bone density is often found to be low in females with anorexia,
and low calcium intake and absorption is common.
Biochemistry and eating disorders:
To understand eating disorders, researchers have studied the neuroendocrine
system, which is made up of a combination of the central nervous and hormonal
systems.
The neuroendocrine system regulates multiple functions of the mind and
body. It has been found that many of the following regulatory mechanisms
may be, to some degree, disturbed in persons with eating disorders:
- sexual function
- physical growth and development
- appetite and digestion
- sleep
- heart function
- kidney function
- emotions
- thinking
- memory
Eating disorders and depression:
Many people with eating disorders also appear to suffer from depression,
and is believed that there may be a link between these two disorders.
For example:
- In the central nervous system, chemical messengers known as neurotransmitters
control hormone production. The neurotransmitters serotonin and norepinephrine,
which function abnormally in people who have depression, have been discovered
to also have decreased levels in both acutely-ill anorexia and bulimia
patients, and long-term recovered anorexia patients.
- Research has shown that some patients with anorexia may respond well
to antidepressant medication that affects serotonin function in the
body.
- People with anorexia, or certain forms of depression, seem to have
higher than normal levels of cortisol, a brain hormone released in response
to stress. It has been shown that the excess levels of cortisol in both
persons with anorexia and in persons with depression are caused by a
problem that occurs in, or near, the hypothalamus of the brain.
- Biochemical similarities have been discovered between people with
eating disorders and obsessive-compulsive disorder (OCD), and patients
with OCD frequently have abnormal eating behaviors.
- The hormone vasopressin is another brain chemical found to be abnormal
in people with eating disorders and OCD. Levels of this hormone are
elevated in patients with OCD, anorexia, and bulimia.
Genetic/environmental factors related to eating disorders:
Because eating disorders tend to run in families, and female relatives
are the most often affected, genetic factors are believed to play a role
in the disorders.
But, other influences, both behavioral and environmental, may also play
a role. Consider these facts from the National Institute of Mental Health:
- According to one recent study, mothers who are overly concerned about
their daughters' weight and physical attractiveness may put their daughters
at increased risk of developing an eating disorder. In addition, girls
with eating disorders often have a father and/or brother(s) who are
overly critical of their weight.
- Although most victims of anorexia and bulimia are adolescent and young
adult women, these illnesses can also strike men and older women.
- Anorexia and bulimia are found most often in Caucasians, but these
illnesses also affect African-Americans and other races.
- People pursuing professions or activities that emphasize thinness
- such as modeling, dancing, gymnastics, wrestling, and long-distance
running - are more susceptible to these disorders.
- In contrast to other eating disorders, one-third to one-fourth of
all patients with binge eating disorder are men. Preliminary studies
also show that the condition occurs equally among African-Americans
and Caucasians.
Prevention of anorexia nervosa:
Preventive measures to reduce the incidence of anorexia are not known at
this time. However, early detection and intervention can reduce the severity
of symptoms, enhance the individual's normal growth and development, and
improve the quality of life experienced by persons with anorexia nervosa.
Encouraging healthy eating habits and realistic attitudes toward weight
and diet may also be helpful.
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