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What
is anorexia nervosa?
Anorexia nervosa is a serious, often chronic, and life-threatening
eating disorder defined by a refusal to maintain minimal body
weight within 15 percent of an individual's normal weight.
Other essential features of this disorder include an intense
fear of gaining weight, a distorted body image, and amenorrhea
(absence of at least three consecutive menstrual cycles when
they are otherwise expected to occur). In addition to the
classic pattern of restrictive eating, some people will also
engage in recurrent binge eating and purging episodes. Starvation,
weight loss, and related medical complications are quite serious
and can result in death. People who have an ongoing preoccupation
with food and weight even when they are thin would benefit
from exploring their thoughts and relationships with a therapist.
The term anorexia literally means loss of appetite, but this
is a misnomer. In fact, people with anorexia nervosa ignore
hunger and thus control their desire to eat. This desire is
frequently sublimated through cooking for others or hiding
food that they will not eat in their personal space. Obsessive
exercise may accompany the starving behavior and cause others
to assume the person must be healthy.
Who
develops anorexia nervosa?
Like all eating disorders, anorexia nervosa tends to occur
in pre- or post-puberty, but can develop at any major life
change. Anorexia nervosa predominately affects adolescent
girls and young adult women, although it also occurs in men
and older women. One reason younger women are particularly
vulnerable to eating disorders is their tendency to go on
strict diets to achieve an "ideal" figure. This
obsessive dieting behavior reflects today's societal pressure
to be thin, which is seen in advertising and the media. Others
especially at risk for eating disorders include athletes,
actors, dancers, models, and TV personalities for whom thinness
has become a professional requirement. For the person with
anorexia nervosa, the satisfaction of control achieved over
weight and food becomes very important if the rest of their
life is chaotic and emotionally painful.
How
many people suffer from anorexia nervosa?
Conservative estimates suggest that one-half to one percent
of females in the U.S. develop anorexia nervosa. Because more
than 90 percent of all those who are affected are adolescent
and young women, the disorder has been been characterized
as primarily a woman's illness. It should be noted, however,
that males and children as young as seven years old have been
diagnosed; and women 50, 60, 70, and even 80 years of age
have fit the diagnosis.
How
is the weight lost?
People with anorexia nervosa usually lose weight by reducing
their total food intake and exercising excessively. Many persons
with this disorder restrict their intake to fewer than 1,000
calories per day. Most avoid fattening, high-calorie foods
and eliminate meats. The diet of persons with anorexia nervosa
may consist almost completely of low-calorie vegetables like
lettuce and carrots, or popcorn.
What
are the common signs of anorexia nervosa?
The hallmark of anorexia nervosa is a preoccupation with food
and a refusal to maintain minimally normal body weight. One
of the most frightening aspects of the disorder is that people
with anorexia nervosa continue to think they look fat even
when they are bone-thin. Their nails and hair become brittle,
and their skin may become dry and yellow. Depression is common
in patients suffering from this disorder. People with anorexia
nervosa often complain of feeling cold (hypothermia) because
their body temperature drops. They may develop lanugo (a term
used to describe the fine hair on a new born) on their body.
Persons
with anorexia nervosa develop strange eating habits such as
cutting their food into tiny pieces, refusing to eat in front
of others, or fixing elaborate meals for others that they
themselves don't eat. Food and weight become obsessions as
people with this disorder constantly think about their next
encounter with food. Generally, if a person fears he or she
has anorexia nervosa, a doctor knowledgeable about eating
disorders should make a diagnosis and rule out other physical
disorders. Other psychiatric disorders can occur together
with anorexia nervosa, such as depression and obsessive-compulsive
disorder.
What
are the causes of anorexia nervosa?
Knowledge about the causes of anorexia nervosa is inconclusive,
and the causes may be varied. In an attempt to understand
and uncover the origins of eating disorders, scientists have
studied the personalities, genetics, environments, and biochemistry
of people with these illnesses. Certain personality traits
common in persons with anorexia nervosa are low self-esteem,
social isolation (which usually occurs after the behavior
associated with anorexia nervosa begins), and perfectionism.
These people tend to be good students and excellent athletes.
It does seem clear (although this may not be recognized by
the patient), that focusing on weight loss and food allows
the person to ignore problems that are too painful or seem
unresolvable.
Eating
disorders also tend to run in families, with female relatives
most often affected. A girl has a 10 to 20 times higher risk
of developing anorexia nervosa, for instance, if she has a
sibling with the disease. This finding suggests that genetic
factors may predispose some people to eating disorders. Behavioral
and environmental influences may also play a role. Stressful
events are likely to increase the risk of eating disorders
as well. In studies of the biochemical functions of people
with eating disorders, scientists have found that the neurotransmitters
serotonin and norepinephrine are decreased in those with anorexia,
which links them with patients suffering from depression.
People with anorexia nervosa also tend to have higher than
normal levels of cortisol (a brain hormone released in response
to stress) and vasopressin (a brain chemical found to be abnormal
in patients with obsessive-compulsive disorder).
Are
there medical complications?
The starvation experienced by persons with anorexia nervosa
can cause damage to vital organs such as the heart and brain.
Pulse rate and blood pressure drop, and people suffering from
this illness may experience irregular heart rhythms or heart
failure. Nutritional deprivation causes calcium loss from
bones, which can become brittle and prone to breakage. In
the worst-case scenario, people with anorexia can starve themselves
to death. Anorexia nervosa is among the psychiatric conditions
having the highest mortality rates, killing up to six percent
of its victims.
Is
treatment available?
Luckily, most of the complications experienced by persons
with anorexia nervosa are reversible when they restore weight.
People with this disorder should be diagnosed and treated
as soon as possible because eating disorders are most successfully
treated when diagnosed early. Some patients can be treated
as outpatients, but some may need hospitalization to stabilize
their dangerously low weight. Weight gain of one to three
pounds per week is considered safe and desirable. The most
effective strategies for treating a patient have been weight
restoration within ten percent of normal, and individual,
family, and group therapies.
To
help people with anorexia nervosa overcome their disorder,
a variety of approaches are used. Some form of psychotherapy
is needed to deal with underlying emotional issues. Cognitive-behavioral
therapy is sometimes used to change abnormal thoughts
and behaviors. Group therapy is often advised so
people can share their experiences with others. Family
therapy is important particularly if the individual is
living at home and is a young adolescent. A physician or advanced-practice
nurse is needed to prescribe medications that may
be useful in treating the disorder. Finally, a nutritionist
may be necessary to advise the patient about proper diet and
eating regimens. Where support groups are available,
they can be beneficial to both patients and families.
What
about prevention?
New research findings are showing that some of the ‘traits"
in individuals who develop anorexia nervosa are actual "risk
factors’ that might be treated early on. For example,
low self esteem, body dissatisfaction, and dieting may be
identified and interventions instituted before an eating disorder
develops. Advocacy groups have also been effective in reducing
dangerous media stories, such as teen magazine articles on
"being thin" that may glamorize such risk factors
as dieting.
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