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Anorexia Nervosa

Anorexia Nervosa is a disorder that causes people to see themselves as overweight, though they can become terribly and dangerously thin. Food avoidance and eating processes become obsessive, and the patient develops habits like avoiding meal time with family, picking a few foods and only eating those in miniscule amounts, and weighing and measuring food. Patients will sometimes undertake unusual methods of hiding their disorder. For example, they may buy cookbooks and make gourmet meals for friends but not eat the food. They may check their body weight, repeatedly and engage in compulsive activities like forced vomiting after every meal or abuse of laxatives. Because the patient eats little, the disorder is noticeable by a rapid and persistent loss of weight and extremely low body weight. Patients often become so thin that their ribs show, and their arms and legs are spindly, yet they think they are ‘fat’. Most of the patient population is comprised of young Caucasian girls, though anorexia can strike all ethnic groups and ages. The patient profile is typically that of a perfectionist, a person too good to be true, who never disobeys, does not express anger or strong emotion. They are usually good students, excellent workers and athletes.

Some doctors believe patients restrict food to have control over at least one.phpect of their lives. Because most of their life has been spent following rules, they don’t know how to deal with conflict, adolescence, or making independent decisions. Some think anorexia can be caused by family conflict -- a child tries to draw attention to herself to bring the family back together, resolve a divorce, or other family problem. Others believe that girls may refuse to eat to gain control, and become independent from their mothers. Studies show that people who participate in professions or activities emphasizing that ‘thin is beautiful’ (modeling, acting, dancing and some sports) are more susceptible to eating disorders, and that mothers who are overly concerned about the weight or physical attractiveness of their daughters may put girls at increased risk for an eating disorder. Girls with eating disorders often have fathers and brothers who are overly critical of their weight and of the weight of other women.

What are the symptoms?

Anorexia Nervosa can include primary symptoms of food avoidance and secondary health and mental health symptoms:

Primary Symptoms

• Exhibits unusual behavior around food and at meal time, may leave table early to purge food in the bathroom
• Absence of menstrual cycle in women, low hormonal levels in men
• Suddenly dislikes foods that used to be favorites, religiously examines food labels
• Low blood pressure
• Abnormal number of dental cavities (caused by the acids produced during induced vomiting)
• Skips meals and makes excuses (I ate with a friend, I’m not hungry)
• Reports feelings of ‘being fat’ in spite of weight loss, spends an inordinate amount of time in front of a mirror examining body
• Is abnormally concerned with food, being fat and what foods to eat or avoid
• Excessive, rigid exercise regimen, skeletal and muscular atrophy and loss of fatty tissue
• Uses laxatives, enemas and diuretics often
• Yellow skin tone or blotches on skin (sometimes skin is covered with soft hair – called lanugo)
• Excessive Weight Loss (15% or more below normal body weight)

Possible Secondary Symptoms

• Depression, irritability, low self-esteem
• Shallow breathing, slow pulse and low blood pressure and body temperature
• Brittle and split nails and hair
• Anemia, dizziness, light-headed feeling
• Anxiety or personality disorders
• Substance abuse
• Heart Failure
• Compliant personality, alternating with hostile or angry outbursts, or withdrawal
• Extreme thirst and urination, dehydration
• Swollen joints, weak or brittle bones
• Damage to vital organs
• Dislikes change or new situations, fear of growing up (in children and adolescents), overly dependent on parents and family.

How is it diagnosed and treated?

The biggest challenge in treating anorexia is getting the patient to recognize that their behavior is a problem, NOT a solution to other problems. Specialized treatment and early intervention can ensure that the patient does not endure a lifetime battle with this disorder and with the related health problems it causes. Treatments include:

• Restoring body weight to a healthy level (this may require hospitalization in severe or chronic cases so that diet and nourishment are closely monitored and the patient is taught to eat correctly)
• Family and Group Therapy
• Psychotherapy to treat distorted body image, low self esteem
• Medication (after weight gain has been accomplished) psychotropic medications, Serotonin Reuptake Inhibitors (SSRIs)
• Cognitive behavioral therapy

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