What is anorexia?

Anorexia nervosa, commonly referred to simply as anorexia, is a type of eating disorder. More importantly, it is also a psychological disorder. Anorexia is a condition that goes beyond out-of-control dieting. A person with anorexia initially begins dieting to lose weight. Over time, the weight loss becomes a sign of mastery and control. The drive to become thinner is actually secondary to concerns about control and fears relating to one’s body. The individual continues the endless cycle of restrictive eating often to a point close to starvation in order to feel a sense of control over the body. This cycle becomes an obsession and is similar to any type of drug or substance addiction.

Who is at risk for anorexia?

Approximately 95 percent of those affected by anorexia are female, but males can develop the disorder as well. While anorexia typically begins to manifest itself during early adolescence, it is also seen in young children and adults.

What causes anorexia?

Some experts feel that demands from society and families could possibly be underlying causes for anorexia. For many individuals with anorexia, the destructive cycle begins with the pressure to be thin and attractive. A poor self-image compounds the problem.

Other researchers feel that this disorder can stem from a particular dysfunction often seen in families of anorexia patients. In one particular type of dysfunction, family members become so interdependent that each cannot achieve their identity as an individual. Thus, family members are unable to function as healthy individuals and are dependent on other family member for their identity. In children, part of this dysfunction includes a fear of growing up (especially girls). Restrictive dieting may prevent their bodies from developing in a normal manner, and in their thinking, restricts the maturational process and maintains the parent-child relationship that the family has come to rely on. Other family situations that have been suggested as possibly being related to the development of anorexia nervosa include high parental expectations, poor communications skills and problems with conflict management.

What are the symptoms of anorexia and its physical signs?

Heart and circulatory system

Although not life-threatening an abnormally slow heart rate (bradycardia) and unusually low blood pressure (hypotension) are frequent manifestations of starvation and are commonly associated with anorexia.

Gastrointestinal complications are also associated with anorexia. Constipation and abdominal pain are the most common symptoms. The rate at which food is absorbed into the body is slowed down. Starvation and overuse of laxatives can seriously disrupt the body’s normal functions involved in the elimination process.

The glandular (endocrine) system in the body is profoundly affected by anorexia. The complex physical and chemical processes involved in the maintenance of life can be disrupted, with serious consequences. Disturbances in the menstrual cycle are frequent and can affect not only fertility but also bone density, which is very important to a woman’s health as she ages. Hormonal imbalances are found in men with anorexia as well. Continual restrictive eating can trick the thyroid into thinking that the body is starving, causing it to slow down in an attempt to preserve calories.

Kidney (renal) function may appear normal. However, there are significant changes in kidney function in many people with anorexia, resulting in potassium deficiency, increased urination, or decreased urination. Anorexics who use a large quantity of laxatives or who frequently vomit are at great risk for electrolyte imbalance, which can have life-threatening consequences. Anemia is frequently found in anorexia patients. Suppressed immunity and a high risk for infection are suspected, but not clinically proven.

Physical symptoms, other than the obvious loss of weight, can be seen. Anorexia can cause dry, flaky skin that takes on yellow tinge. Fine, downy hair grows on the face, back arms, and legs. Despite this new hair growth, lose or hair on the head is not uncommon. Nails can become brittle. Frequent vomiting can erode dental enamel and eventually lead to tooth loss.

How is anorexia treated?

Anorexia may be treated in an outpatient setting, or hospitalization may be necessary. For an individual with severe weight loss that has impaired organ function, hospital treatment must initially focus on correction of malnutrition, and intravenous feeding may be required.

Different kinds of psychological therapy have been employed to treat people with anorexia. Individual therapy, cognitive behavior therapy, group therapy, and family therapy have all been successful in treatment of anorexia. Those with anorexia can be treated by a medical doctor, a clinical psychologist, or both, depending upon the progression of the disorder. A psychiatrist with both medical and psychological training is perhaps the best treatment provider. An appropriate treatment approach addresses underlying issues of control and self perception. Nutritional education provides a healthy alternative to weight management for the patient. Group counseling r support groups often assist the individual in the recovery process. The ultimate goal of treatment should be for the individual to accept herself or himself and lead a physically and emotionally healthy life.

What is prognosis (outcome) of anorexia?

Anorexia is among the psychiatric condition with the highest mortality rate, with an estimated six percent of anorexia victims dying from complications of the disease. The most common causes of death in people with anorexia are medical complications of the condition including cardiac arrest and electrolyte imbalances. Suicide is also a cause of death in people with anorexia.

Early diagnosis and treatment can improve the overall prognosis in an individual with anorexia. With appropriate treatment, about half of those affected will make a full recovery. Some people experience a fluctuating pattern of weight gain followed by a relapse, while others experience a progressively deteriorating course of the illness over many years and still others never fully recovery. It is estimated that about 20 percent of people with anorexia remain chronically ill from the condition.

As with many other addictions, it takes a day-to-day effort to control the urge to relapse. Many individuals will require ongoing treatment for anorexia over several years, and some may require treatment over their entire life time.