Anorexia nervosa is a medical and psychological disorder where adolescents have an irrational fear of weight gain. They view themselves as overweight, even when they are dangerously thin; self-worth is equated with thinness.
People dealing with anorexia monitor and restrict their intake of food very closely. For example, they may count the exact number of peas that they consume. Their weight often drops to lower than 85% of what their ideal weight (which is based on age, height, and national norms). They may consume as little as 200 calories a day. It is important to realize that anorexia is not only about drastically reducing caloric intake. It concerns issues of control. By limiting the intake of food, you exact a degree of control over your body. And, this control becomes obsessive. Since obtaining medical and psychiatric help means a loss of some of this control, whenever possible, people with anorexia tend to deny their problems and shy away from health professionals for as long as possible. They often call anorexia their “friend.”
There are two main types of anorexia – binge eating/purging and restricting. In the binge/eating type of anorexia, patients frequently eat excessive amounts of food then vomit or misuse diuretics, laxatives, and enemas. On the other hand, with the restricting form of anorexia, patients dramatically limit the amount of food that they consume. Patients with anorexia may also exercise excessively and move back and forth between the two types, or they may combine the types. Both types are serious illnesses. Anorexia has the highest mortality rate of any psychiatric illness.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSMIV), before a diagnosis of anorexia may be made, the following criteria must be met:
Many people grapple with some of the symptoms of anorexia without actually meeting all the criteria for a diagnosis. So, they are not included in the statistic count (of the disorder). However, if an individual does not meet all of the criteria for anorexia, clinicians may diagnose an Eating Disorder Otherwise not Specified (EDNOS).
Does Anyone Know the Cause of Anorexia?
Researchers do not feel that there is a single cause of anorexia. Rather, it is believed that there are a number of potential causes.
Probably, one of the primary causes is the near-constant societal pressure to be thin. This is particularly true for women. Everywhere you go, there are images of rail-thin models. Further, if your family members tend to diet frequently, focus on appearance, and criticize your looks, you are at greater risk.
There is also believed to be a genetic component. If any of your first-degree relatives have dealt with anorexia, you are more likely to develop it. Other factors that have been associated with anorexia include traumatic events, history of physical or sexual abuse, undergoing a difficult transition (such as beginning college or a new job), constantly striving for perfection, and setting seemingly impossible to attain goals. People with anorexia tend to have a poor self-image, and they often come from over-controlling families where there is little nurturance.
No organic cause for anorexia has been found. Yet, some contend that it is associated with dysfunction in the hypothalamus or imbalances in levels of brain neurotransmitters. It is known that when someone loses an extraordinary amount of weight, a number of the pituitary hormones become too low.
What are the Signs and Symptoms of Anorexia?
With anorexia, you are, quite literally, starving the body. Most of the signs and symptoms of the disorder are directly related to the body’s insufficient and inadequate nourishment. In general, every body system is affected by anorexia. The following are some of the signs and symptoms:
- Slowed heart rate and decreased cardiac output
- Low blood pressure
- Disturbances in heart rhythm
- Abdominal pain
- Esophagitis
- Constipation
- Obviously thin appearance
- An intolerance of cold and feeling cold even when it is not cold
- Fatigue
- Lowered body temperature
- Deficient bone mineralization: osteopenia and osteoporosis
- Swelling of salivary glands (from vomiting)
- Disturbances in the menstrual cycle (which may affect fertility and bone density)
- Inflammation of the liver
- Swollen joints
- Weak muscles
- Slowing down of thyroid function
- Increased or decreased urination (resulting in potassium deficiency)
- Electrolyte imbalance (from excessive use of laxatives or vomiting)
- Anemia
- Dry, flaky skin that has a yellowish tone
- Growth of fine hair on the body
- Loss of hair on head and hair that remains becomes brittle
- Brittle nails
- Erosion of tooth enamel and tooth decay (from frequent vomiting)
- Loss of teeth
- Dizziness
- Kidney stones and kidney failure
People dealing with anorexia tend display a number of emotional and behavioral patterns. These include the following:
- Problems concentrating and possible memory issues causing academic decline
- Flat refusal to eat –maintaining they are not hungry
- Skipping meals
- Reluctance to be weighed
- Change in eating habits
- Difficulty eating in social settings
- Isolation from friends
- Frequent trips to the bathroom after meals
- Change in bowel habits
- Refusal to eat meals with family and friends
- School absence
- Deceptive or secretive behavior
- Distorted body image
- Eating only a few foods – generally those that are very low in fat and calories such as lettuce, carrots, popcorn, and diet soda
- Lack of emotion
- Excessive exercising
- Weighing food
- Counting pieces of food
- Repeatedly weighing yourself
- Spitting food out after chewing
- Cutting food into tiny pieces
- Moving food around the plate instead of eating
- Taking diet pills
- Preparing complex meals for others while refusing to eat
- Looking in the mirror for flaws
- Wearing layered or baggy clothing to hide weight loss
- Thinking about food all the time
- Depression
- Drug use and/or alcohol abuse
- Personality disorders
- Obsessive-compulsive disorder
- Anger
- Moodiness
- Irritability
- Sadness
- Anxiety
- Feeling of hopelessness
- Frequent weighing
- Obsessive thinking about food, meals, and body image
It should not be surprising that people who are dealing with anorexia tend to have a number of medical complications. The most severe complication is sudden death caused by an irregular heartbeat and/or electrolyte imbalances. For example, sudden death may be caused heart arrhythmia triggered by a low blood potassium level. Other complications include the following:
- Significant bone loss (osteopenia and osteoporosis increasing the risk for fractures). This complication may lead to lifelong problems that include stress fractures, spinal fractures, and dowager hump.
- Anemia
- Kidney problems
- Electrolyte abnormities (low blood potassium, sodium, and chloride)
- Heart problems (abnormal heart rhythm, mitral valve prolapse, and heart failure). It is important to know that as the body is starved, the heart muscle shrinks. So, the heart has a reduced ability to pump blood. As their cardiac output diminishes, athletes lose endurance and the capacity to exercise.
- Lung problems, including diminished capacity
- Gastrointestinal problems (Almost all people with anorexia develop problems including abdominal pain and constipation. Because the intestine gradually loses the ability to move food along, during the digestive process, food becomes stuck in their GI tracks.)
- Absence of periods – in females (may ultimately affect ability to become pregnant) Significant weight loss causes the hormones that regulate the menstrual cycle to diminish to levels seen in babies and children. Estrogen, the feminizing hormone, drops to levels seen in young children.
- Lower levels of testosterone in males
How is Anorexia Diagnosed?
In all probability, you do not want to visit your medical provider. You do not wish to acknowledge that you may have anorexia. You don’t think there is anything wrong with you. In fact, you have devoted a good deal of time to trying to hide the signs of the illness from yourself, your family members, and friends. When you finally visit your medical provider, it is, most likely, at the insistence of your parents, a coach, teacher, or a close confidant. Or, you may have developed a serious medical problem that forced you to visit an urgent care provider or hospital emergency room.
Your medical provider will want to review your history. If you are to receive the help that you require, you need to be as detailed and honest as possible.
Your height and weight will be measured, and your vital signs (heart rate, blood pressure and temperature) will be checked. Your body mass will be calculated. Then, you will have a physical exam. Your medical provider will listen to your heart and lungs, examine your skin, and feel your abdomen.
There is a good chance that your medical provider will order several tests. These will include a complete blood count (CBC) and tests that check your levels of electrolytes and protein. In addition, you will almost certainly have a urinalysis as well as tests to evaluate the functioning of your thyroid, kidney, liver, and pituitary gland. Since females have commonly not had menstrual cycles for several months, to rule out pregnancy, a pregnancy test is ordered.
You may have x-rays to check for broken bones, heart problems, and/or pneumonia. If you medical provider suspects that you may have an irregular heartbeat, you will have an electrocardiogram. A DEXA scan may be ordered to determine if your bones have lost mineralization.
How is Anorexia Treated?
Research studies have shown that the earlier anorexia is treated, the better the outcome for the patient. Further, a multidisciplinary team including a primary care physician, psychiatrist and/or psychologist and a nutritionist are needed to effectively treat the patient.
If you are fortunate and obtain treatment early in your battle with anorexia, treatment will be easier and you will have fewer complications. Regrettably, as has been mentioned earlier, people dealing with anorexia tend to avoid medical providers, often until they are confronted with a medical crisis such as an irregular heartbeat or an electrolyte imbalance – both potentially life-threatening. Sometimes, parents or a representative of a school or college will insist that a student begin treatment. If a student refuses to obtain treatment, some colleges place that student on a medical leave. For treatment to succeed, you must want to get better.
The most important initial matter is to become medically stabilized. This means that your vital signs, including temperature, blood pressure, and pulse, must begin to approach normal values. If you have a very slow pulse, low blood pressure, low temperature, or a weight less than 75% if your ideal weight, you may need hospitalization in a medical facility. It often takes up to 7 to 10 days to become medically stable. Hospitals frequently have protocols to help providers and patients with eating disorders understand the care plan. Generally, no exercise is permitted. If you have been severely ill or refuse food, you may require a feeding tube that goes from your nose into your stomach.
In the hospital, a variety of specialists will provide care. They include physicians, psychiatrists, nurses, nutritionists, social workers, and, possibly, child life specialists. These professionals work as a team to assist the patient and her or his family.
Once medically stabilized, you may be told that you would benefit from an admission to a 24-hour residential facility or hospital unit designed to treat people with anorexia. When significant progress is made with the medical issues, including vital signs and weight loss as well as the psychiatric issues, some patients are transferred to partial day programs. There you spend your days in the program and sleep at home.
After discharge from the day program, you will continue to receive care as an outpatient. Typically, you will see your medical doctor, psychiatrist, and/or psychologist, and a nutritionist.
In some less severe cases of anorexia, you may receive all of your care as an outpatient. However you receive your care, it will most likely be delivered by a team of medical providers who are experienced in the care of anorexia.
As often as once each week, a primary care physician will follow you. He/she will monitor your vital signs and electrolyte and hydration levels. To ensure that you are gaining weight, you will be regularly weighed with your back to the scale. Do not expect this provider to tell you what you weigh.
You will also have individual therapy with a psychiatrist or psychologist. Since a psychiatrist is a physician, he/she is able to prescribe medication. If you require medication, such as a SSRI antidepressant, you will probably be advised to undergo therapy with a psychiatrist. If you do not require medication or if your primary care physician may monitor your medication, you may see a psychologist who has received special training in anorexia. You and your family may benefit from family therapy, and you may be told to participate in a group (support) therapy, where you can share your thoughts with other anorexic patients. It is not uncommon for someone dealing with anorexia to participate in several types of therapy each week.
You will have a number of meetings with a dietitian. Working with the dietitian, you will be able to design a food plan for gaining weight. Your goal will be to gain between 0.5 and 2.0 pounds each week. To do this, you should eat 2000 to 3000 calories per day. This should include two to three servings of protein and 30 to 50 grams of fat.
The nutritionist will offer strategies on healthy eating.
Since dehydration and constipation are so prevalent among people with anorexia, it is very important to increase your intake of fluids and dietary bulk. Your nutritionist will give you specific guidelines. Avoid the laxatives that you may have used in the past.
Because people with anorexia require so much lengthy and on-going care, they often end up doing battle with their insurance providers. At the same time, without adequate care, anorexia may continue indefinitely. Even those who receive proper care, often find that they are more vulnerable to relapses during stressful periods.
Additional Recommendations
Anorexia is such a serious, all-consuming illness, it may sometimes seem that you will never improve. In fact, it may appear that society, with its constant emphasis on thinness, is making it impossible for you to recover. Try not to become discouraged. With the proper treatment, about half of those affected make a full recovery. Some experience relapses. It has been estimated that about 20% remain chronically ill with this disorder. The following are a list of suggestions that you may find useful:
- Try to be very honest with your medical providers. If you fail to be a truthful as possible, you will only continue to be ill. For example, if you are still making yourself vomit, you need to use an alkaline mouth rinse after each episode. If not, the enamel on your teeth will keep eroding. Your medical providers can recommend a mouth rinse for you to use.
- Don’t close yourself off from family members and friends. They are trying to be supportive and help you recover.
- There is a good chance that you would benefit from additional vitamin and calcium supplementation. Discuss this with your primary care provider.
- You can no longer continue to deprive your body of the nutrition it requires. Even if it makes you uncomfortable, follow your meal plan. Keep your therapy sessions.
- Don’t weigh yourself at home. Remove the scale.
- Realize that your self-worth and identity are not determined by your weight.
- Socialize with people who are less focused on weight issues and appearances.
- Dramatically reduce your time in front of the mirror.
- Only exercise with your medical provider’s permission.
- Stop referring to anorexia as your friend. Friends don’t threaten your life and well being.
- Avoid the pro-anorexia (Pro-Ana) websites. They are not maintained by credible authorities.
- Attempt to determine your anorexia triggers. For now, see if you can avoid them.
Related Topics
Amenorrhea, Bulimia, Osteopenia, Osteoporosis
