Eating Disorders Eating Disorders
What is Anorexia nervosa?Anorexia Nervosa is a chronic disorder of self starvation which manifests itself in an extreme aversion to food and can cause psychological, endocrine and gynecological problems. A person with anorexia may begin to diet in order to lose just a few pounds. Dieting does not stop here, however, and an abnormal concern with dieting is established. Nobody knows what triggers the disease process, but suddenly, losing five to ten pounds is not enough. The anorectic patient becomes intent on losing weight. It is uncommon for someone who develops the disorder to starve herself until she weighs just 60 or 70 pounds. Throughout the starving process she either denies being hungry or claims to feel full after eating just a few bites. It is also characterized by a disturbed sense of body image.
Who gets Anorexia Nervosa?Anorexia Nervosa almost exclusively affects adolescent white girls (95%). They usually come from middle to upper-middle class families that place heavy emphasis on high achievement, perfection, eating patterns and physical appearance. A newly diagnosed patient is often described by her parents as a "model child," usually because she is obedient, compliant, and a good student. Most researchers agree that the number of patients with anorexia nervosa is increasing. Recent estimates suggest that out of every 200 American girls between the ages of 10 and 20, one will develop anorexia to some degree. Therapists find that persons with anorexia usually lack self-esteem and feel they can gain admiration by losing weight and becoming thin. This disorder is very rare among boys.
While most anorexia nervosa patients are female, about 6 percent are adolescent boys. Some researchers believe that certain characteristics are common to the families of persons who develop the disorder. Researchers describe this family as warm and loving on the surface. Apparently, they often are unable to deal with conflicts within the family. Either they deny that conflicts exist, or they become so overwhelmed by numerous petty conflicts that they are unable to recognize real problems.
What causes Anorexia Nervosa?The cause of anorexia nervosa is still unknown but a combination of psychological, environmental and physiological factors are associated with development of the disorder.
Researchers have discovered that the hypothalamus begins to work improperly after the onset of anorexia. The hypothalamus controls such activities as maintenance of water balance, regulation of body temperature, secretion of the endocrine glands and sugar and fat metabolism. In anorexia patients, this improper functioning may result in lower body temperature and blood pressure, a lack of sexual interest and hormonal changes resulting in amenorrhea and reduced production of thyoid hormone.
Social pressure from peers seem to influence young women and girls to engage in anorectic behaviors. Although this factor is not sufficient for the disease to develop, it creates a proper environment for the expression of the disease in predisposed individuals.
The risk of developing the disorder increases if the person is slightly over weight, if she is pressured about her weight, if she is under emotional stress or if she is a perfectionist, compulsive or highly productive.
How serious is Anorexia Nervosa?If anorexia develops in children and adolescence, less than two thirds sustain recovery. Many studies of groups of anorexic patients have found death rates ranging from 4% to 20%.
It should be noted that the risk of death increases significantly when weight is less than 60% of normal. Some of these studies include death by suicide, which has been estimated to comprise half the deaths in anorexia.
Heart disease is the most common medical cause of death in people with severe anorexia. The heart can develop dangerous abnormal pumping rhythms and slow rhythms known as bradycardia. Blood flow isreduced and blood pressure may drop. In addition, the heart muscles starve, losing size. Cholesterol levels tend to rise.
Anorexia causes reduced levels of reproductive hormones, changes in thyroid hormones, and increased levels of other hormones, such as the stress hormone cortisol. Sterility is a risk in anorexia nervosa, and even after treatment, menstruation never returns in 25% of patients with severe anorexia. Women who conceive before regaining normal weight face a poor reproductive future, with low birth weights, frequent miscarriages, and a high rate of children with birth defects. Children and adolescents with anorexia may also experience retarded growth due to reduced levels of growth hormone.
Loss of minerals in the bone, low estrogen levels, and increased steroid hormones cause osteoporosis, in which bones become porous and subject to fracture. This condition usually occurs in women after menopause, but it is common in younger people with severe anorexia whose bone mineral content is about 25% below normal. Up to two-thirds of children and adolescent girls with anorexia fail to develop strong bones during thecritical growing period, a potentially irreversible condition. Even after recovery from anorexia, bone loss does not reverse rapidly and may never be completely restored. Resumption of menstruation, indicating restored estrogen levels, and weight increase improves the outlook.
What are the symptoms of Anorexia Nervosa?Symptoms of anorexia nervosa involve a refusal to eat, large weight loss, a bizarre preoccupation with food, hyperactivity, a distorted body image and cessation of menstruation. Although the symptoms can be corrected if the patient is diagnosed and treated in time, about 10-15 percent of anorexia nervosa patients die, usually after losing at least half their normal body weight.
Psychological symptoms such as social withdrawal, obsessive-compulsiveness and depression often precede or accompany anorexia nervosa. While normal females can give an accurate estimate of their body weight, anorectic patients tend to perceive themselves as markedly larger than they really are. When questioned, most feel that their emaciated state (70-80 lbs.) is either "just right" or "too fat".
Physical symptoms also occur in cases of extreme starvation. These include loss of head hair, growth of fine body hair, constipation, intolorence of cold temperatures, low pulse rate, low blood pressure, a yellow discoloration of the skin and a loss of subcutaneous fat.
The cessation of menstruation and the absence of ovulation will not resume until endocrine balance is restored. Ovulation is suppressed because production of certain necessary hormones decreases.
What will confirm a diagnosis of Anorexia Nervosa?There are many things which will confirm a diagnosis of anorexia nervosa such as:
A refusal to maintain body weight over a minimal normal weight for age and height or failure to make expected weight gain during period of growth, leading to body weight 15% below that expected.
Intense fear of gaining weight or becoming fat, even though underweight.
Disturbance in the way in which one's body weight, size or shape is experienced.
In females, abscence of at least three menstrual cycles when otherwise expected to occur.
How is Anorexia Nervosa treated?Treatment for anorexia nervosa is usually threefold, consisting of nutrional therapy, individual psychotherapy and family counseling. A team made up of pediatricians, psychiatrists, social workers and nurses often administers treatment. Some physicians hospitilize anorexia patients until they are nutritionally stable.
The most urgent concern of the physician is getting the patient to eat and gain weight. This is accomplished by gradually adding calories to the patient's daily intake. If she is hospitalized, privileges are sometimes granted in return for weight gain.
Weight gain is encouraged in an atmosphere in which the patient feels in control of her situation, and in which she wants to gain weight. That is why the hospital staff makes every effort to ensure that the patient does not feel overwhelmed and powerless.
Individual psychotherapy is necessary in the treatment of anorexia to help the patient understand the disease process and its effects. Therapy focuses on the patient's relationship with her family, friends, and the reasons she may have fallen into a pattern of self-starvation. As a patient begins to learn more about her condition, she is often more willing to try to help herself recover.
The third aspect of treatment is family therapy. It examines how the patient and her parents relate to each other. Persons with anorexia often become a source of family tension because refusals to eat cause frustration in the parents. The goal of family therapy is to help family members relate more effectively to one another, to encourage more mature thinking in the anorectic patient and to help all family members work together for the well-being of the patient and the family unit.
In treating anorexia nervosa, it is extremely important to remember that immediate success does not guarantee a permanent cure. Sometimes after a return to a normal weight, patients suffer relapses. Follow-up therapy lasting three to five years is recommended if the patient is to be completely cured.
Where can someone get help for Anorexia Nervosa?Anyone can get help for anorexia nervosa from any of the following voluntary organizations:
American Anorexia Nervosa Association, Inc.
133 Cedar Lane
Teaneck, NJ 07666
National Anorexic Aid Society, Inc. (NAAS)
P.O. Box 29461
Columbus, OH 43229
Anorexia Nervosa and Associated Disorders (ANAS)
550 Frontage Road, Suite 2020
Northfield, IL 60093