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Anorexia Nervosa

Definition


Disease: Anorexia Nervosa Anorexia Nervosa
Category: Psychiatric diseases
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Disease Definition:

Anorexia nervosa is an eating disorder that causes people to obsess about their weight and the food they eat. People with anorexia nervosa attempt to maintain a weight that's far below normal for their age and height. To prevent weight gain or to continue losing weight, people with anorexia nervosa may starve themselves or exercise excessively.

Anorexia nervosa isn't really about food. It's an unhealthy way to try to cope with emotional problems. When someone has anorexia nervosa, he/she often equates thinness with self-worth.

Anorexia nervosa can be difficult to overcome. But with treatment, a person can gain a better sense of who he/she is, returns to healthier eating habits and reverses some of anorexia's serious complications.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Some people with anorexia lose weight mainly through severely restricting the amount of food they eat. They may also try to lose weight by exercising excessively. Others with anorexia engage in binging and purging, similar to bulimia. They control calorie intake by vomiting after eating or by misusing laxatives, diuretics or enemas.


No matter how weight loss is achieved, anorexia has a number of physical, emotional and behavioral signs and symptoms.


Physical Anorexia Symptoms
Physical signs and symptoms of anorexia include:

 

  • Extreme weight loss
  • Thin appearance
  • Abnormal blood counts
  • Fatigue
  • Insomnia
  • Dizziness or fainting
  • A bluish discoloration of the fingers
  • Brittle nails
  • Hair that thins, breaks or falls out
  • Soft, downy hair covering the body
  • Absence of menstruation
  • Constipation
  • Dry skin
  • Intolerance of cold
  • Irregular heart rhythms
  • Low blood pressure
  • Dehydration
  • Osteoporosis
  • Swelling of arms or legs

 

Emotional and Behavioral Anorexia Symptoms
Emotional and behavioral characteristics associated with anorexia include:

 

 

  • Refusal to eat
  • Denial of hunger
  • Excessive exercise
  • Flat mood, or lack of emotion
  • Social withdrawal
  • Irritability
  • Preoccupation with food
  • Reduced interest in sex
  • Depressed mood
  • Possible use of herbal products or diet aids

 

Anorexia Red Flags to Watch for
It may be hard to notice signs and symptoms of anorexia because people with anorexia often go to great lengths to disguise their thinness, eating habits or physical problems.
If somebody is concerned that a loved one may have anorexia, he/she should watch for these possible red flags:

 

  • Skipping meals
  • Making excuses for not eating
  • Eating only a few certain "safe" foods, usually those low in fat and calories
  • Adopting rigid meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing
  • Cooking elaborate meals for others but refusing to eat
  • Repeated weighing of themselves
  • Frequent checking in the mirror for perceived flaws
  • Complaining about being fat
  • Not wanting to eat in public

 

Like other eating disorders, anorexia can take over one's life. A person may think about food all of the time, spend hours agonizing over options in the grocery store and exercise to exhaustion. He/she also may have a host of physical problems that make him/her feel generally miserable, such as dizziness, constipation, fatigue and frequently feeling cold. He/she may be irritable, angry, moody, sad, anxious and hopeless. A person might visit pro-anorexia Web sites, referring to the disease as his/her "friend," cover up in layers of heavy clothing, and try to subsist on a menu of lettuce, carrots, popcorn and diet soda.
A person should get help if he/she thinks that they're experiencing any of the above-mentioned problems or he/she has an eating disorder. A person should entrust a confidant who he/she can talk to about what's going on, in case he/she is hiding anorexia from loved ones.

Unfortunately, many people with anorexia don't want treatment, at least initially. Their desire to remain thin overrides concerns about their health. If there is a loved one having anorexia, a person should urge him/her to talk to a doctor.

Causes:

It's not known specifically what causes some people to develop anorexia. As with many diseases, it's likely a combination of biological, psychological and sociocultural factors.


Biological Factors: Some people may be genetically vulnerable to developing anorexia. Young women with a biological sister or mother with an eating disorder are at higher risk, for example, suggesting a possible genetic link. Studies of twins also support that idea. However, it's not clear specifically how genetics may play a role, although researchers have discovered an area on chromosome 1 that appears to be associated with an increased susceptibility to anorexia nervosa.
It may also be that some people have a genetic tendency toward perfectionism, sensitivity and perseverance, all traits associated with anorexia. There's also some evidence that serotonin — one of the brain chemicals involved in depression — may play a role in anorexia.

Psychological Factors: People with anorexia may have psychological and emotional characteristics that contribute to anorexia. They may have low self-worth, for instance. They may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. They may have an extreme drive for perfectionism, which means they may never think they're thin enough.

Sociocultural Factors: Modern Western culture often cultivates and reinforces a desire for thinness. The media are splashed with images of thin models and actors. Success and worth are often equated with being thin. Peer pressure may fuel the desire to be thin, particularly among young girls. However, anorexia and other eating disorders existed centuries ago, suggesting that sociocultural values aren't solely responsible.


Certain risk factors increase the risk of anorexia, including:


Being female:
Anorexia is more common in girls and women. However, boys and men have been increasingly developing eating disorders, perhaps because of growing social pressures.


A young age:
Anorexia is more common among teenagers. Still, people of any age can develop this eating disorder, though it's rare in people older than 40. Teenagers may be more susceptible because of all of the changes their bodies go through during puberty. They also may face increased peer pressure and may be more sensitive to criticism or even casual comments about weight or body shape.


Genetics:
Researchers have found an area on chromosome 1 that appears to be linked to an increased risk of anorexia nervosa. Additionally, anorexia nervosa runs in families, another factor that suggests a genetic component. Women with a first-degree relative — a parent, sibling or child — who had the disease have a dramatically increased risk of developing anorexia nervosa.


Weight changes:
When people lose or gain weight — on purpose or unintentionally — those changes may be reinforced by positive comments from others if weight was lost, or by negative comments if there was a weight gain. Such changes and comments may trigger someone to start dieting to an extreme.


Transitions:
Whether it's a new school, home or job, a relationship breakup, or the death or illness of a loved one, change can bring emotional distress and increase the risk of anorexia nervosa.


Sports, work and artistic activities:
Athletes, actors and television personalities, dancers, and models are at higher risk of anorexia. For some, such as ballerinas, ultrathinness may even be a professional requirement. Sports associated with anorexia include running, wrestling, figure skating and gymnastics. Professional men and women may believe they'll improve their upward mobility by losing weight, and then take it to an extreme. Coaches and parents may inadvertently raise the risk by suggesting that young athletes lose weight.


Media and society:
The media, such as television and fashion magazines, frequently feature a parade of skinny models and actors. But whether the media merely reflect social values or actually drive them isn't clear-cut. In any case, these images may seem to equate thinness with success and popularity.

Complications

Complications:

Anorexia can have numerous complications. At its most severe, it can be fatal. Death may occur suddenly — even when someone is not severely underweight. This may result from abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body.
Complications of anorexia include:

 

 

  • Death
  • Anemia
  • Heart problems, such as mitral valve prolapse, abnormal heart rhythms and heart failure
  • Bone loss, increasing risk of fractures later in life
  • In females, absence of a period
  • In males, decreased testosterone
  • Gastrointestinal problems, such as constipation, bloating or nausea
  • Electrolyte abnormalities, such as low blood potassium, sodium and chloride
  • Kidney problems

 

If a person with anorexia becomes severely malnourished, every organ in the body can sustain damage, including the brain, heart and kidneys. This damage may not be fully reversible, even when the anorexia is under control.
In addition to the host of physical complications, people with anorexia also commonly have other mental disorders as well. They may include:

 

  • Depression
  • Anxiety disorders
  • Personality disorders
  • Obsessive-compulsive disorders
  • Drug abuse

Treatments:

When a person has anorexia, he/she may need several types of treatment. If the affected person's life is in immediate danger, he/she may need treatment in a hospital emergency department for such issues as a heart rhythm disturbance, dehydration, electrolyte imbalances or psychiatric problems.


Here's a look at what's commonly involved in treating people with anorexia:


Medical Care
Because of the host of complications anorexia causes, a person may need frequent monitoring of vital signs, hydration level and electrolytes, as well as related physical conditions. In severe cases, people with anorexia may initially require feeding through a tube that's placed in their nose and goes to the stomach (nasogastric tube). A primary care doctor may be the one who coordinates care with the other health care professionals involved. Sometimes, though, it's the mental health provider who coordinates care.


Restoring a Healthy Weight
The first goal of treatment is getting back to a healthy weight. One cannot recover from an eating disorder without restoring an appropriate weight and learning proper nutrition. A dietitian can offer guidance on a healthy diet, including providing specific meal plans and calorie requirements that will help people meet their weight goals. The family will also likely be involved in helping the patient to maintain healthy-eating habits.


Psychotherapy
Individual, family-based and group therapy may all be beneficial.


Individual therapy: This type of therapy can help people deal with the behavior and thoughts that contribute to anorexia. One can gain a healthier self-esteem and learn positive ways to cope with distress and other strong feelings. A type of talk therapy called cognitive behavioral therapy (CBT) is commonly used but lacks strong evidence that it's superior to other forms of therapy for treating anorexia nervosa. A mental health provider can help assess the need for psychiatric hospitalization or day treatment programs.
 

Family-based therapy: This therapy begins with the assumption that the person with the eating disorder is no longer capable of making sound decisions regarding his or her health and needs help from the family. An important part of family-based therapy is that the family is involved in making sure that healthy-eating patterns are followed. This type of therapy can help resolve family conflicts and muster support from concerned family members. Family-based therapy can be especially important for children with anorexia who still live at home.

Group therapy: This type of therapy gives a way to connect to others facing eating disorders, and informal support groups may sometimes be helpful. However, one should be careful with informal groups that aren't led by a mental health professional. For some people with anorexia, support groups might result in competitions to be the thinnest person there.


Medications
There are no medications specifically designed to treat anorexia because they've shown limited benefit in treating this eating disorder. However, antidepressants or other psychiatric medications can help treat other mental disorders a person may also have, such as depression or anxiety.


Hospitalization
In cases of medical complications, psychiatric emergencies, severe malnutrition or continued refusal to eat, hospitalization may be needed. Hospitalization may be on a medical or psychiatric ward. Some clinics specialize in treating people with eating disorders. Some may offer day programs or residential programs, rather than full hospitalization. Specialized eating disorder programs may offer more intensive treatment over longer periods of time. Also, even after hospitalization ends, ongoing therapy and nutrition education are highly important to continued recovery.


Treatment Challenges in Anorexia
Some cases of anorexia are much more severe than others. Less severe cases may take less time for treatment and recovery. One of the biggest challenges in treating anorexia is that people may not want treatment, may think they don't need it or may be concerned about weight gain. And, some people with anorexia promote it as a lifestyle choice. They don't consider it an illness. Pro-anorexia (pro-ana) Web sites can be found on the Internet, and some even offer tips on which foods to avoid and how to fight hunger pangs.
Even if people do want to get better, the pull of anorexia can be difficult to overcome. Anorexia is often an ongoing, lifelong battle.

Although symptoms may subside, people remain vulnerable and may have a relapse during periods of high stress or during triggering situations. For example, anorexia symptoms may subside during pregnancy only to return once the baby has been delivered. Ongoing therapy or periodic appointments during times of stress may be helpful.

Prognosis:

Not Available

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