Anorexia

Anorexia nervosa is a type of eating disorder in which people can literally starve themselves to death. People with anorexia eat very little even though they are already thin. They have an intense and overpowering fear of body fat and weight gain, with repeated dieting attempts and excessive weight loss.

Those with anorexia are often characterized as perfectionists and overachievers who appear to be in control. In reality, they suffer from low self-esteem and overly criticize themselves. They are also very concerned about pleasing others.

Anorexia affects from 0.5 percent to 1 percent of the female adolescent population, with an average age of onset between 14 and 18 years. An estimated 0.5 percent to 3.7 percent of females suffer from anorexia nervosa in their lifetime.

Warning Signs of Anorexia

Family members and friends might notice some of anorexia's warning signs.

Specific warning signs of this eating disorder in a person can include the following:

• Eating only "safe" foods, usually those low in calories and fat
• Having odd rituals, such as cutting food into small pieces
• Spending more time playing with food than eating it
• Cooking meals for others without eating
• Engaging in compulsive exercising
• Dressing in layers to hide weight loss
• Spending less time with family and friends, becoming more isolated, withdrawn, and secretive.

• Resistance to maintaining body weight at or above a minimally normal weight for age and height
• Intense fear of gaining weight or becoming fat, even though underweight
• Undue influence of body weight or shape on self-evaluation
• Disturbance in the way in which one's body weight or shape is experienced
• Denial of the seriousness of the current low body weight
• Infrequent or absent menstrual periods (in females who have reached puberty).

Long-Term Signs of Anorexia

Anorexia signs in someone who has had the condition for a long time can include:

• Slow heart rate and low blood pressure
• Brittle hair and nails
• Dry skin (which may become yellow, and develop a covering of soft hair called lanugo)
• Mild anemia
• Brain damage
• Swollen joints
• Reduced muscle mass
• Light-headedness
• Osteoporosis
• Heart failure, especially in those who use drugs to stimulate vomiting, bowel movements, or urination.

Presently, there is no universally accepted, standard treatment for anorexia. Because of its complexity, anorexia requires a comprehensive treatment plan, involving:

• Medical care and monitoring
• Psychosocial interventions
• Nutritional counseling
• Medication (when appropriate).

Ideally, this integrated approach to anorexia treatment would include the skills of nutritionists, mental health professionals, endocrinologists, and other physicians.

Families and friends offering support and encouragement can also play an important role in the success of an anorexia treatment program.

Strategies for Treating Anorexia

Treatment is most successful when the condition is diagnosed early. The longer abnormal eating behaviors persist, the more difficult it is to overcome anorexia and its effects on the body.

Anorexia treatment calls for a specific program that involves three main phases:

• Restoring weight lost to severe dieting and purging
• Treating psychological disturbances, such as poor body image, low self-esteem, and interpersonal conflicts
• Achieving long-term remission and rehabilitation or full recovery.

Early Treatment

The first goal for the treatment of anorexia is to ensure the person's physical health, which involves restoring a healthy weight. Reaching this goal may require hospitalization. As part of this early treatment, feeding plans address the person's medical and nutritional needs. In some cases, intravenous feeding is recommended.

Psychotherapy

Once malnutrition has been corrected and weight gain has begun, psychotherapy (often cognitive-behavioral or interpersonal psychotherapy) can help people with anorexia overcome low self-esteem and address distorted thought and behavior patterns. Behavioral therapy also has been effective in helping a person return to healthy eating habits.

Family therapy may be part of treatment for anorexia, during which parents help their child learn to eat again and maintain healthy eating habits on his or her own.

Supportive group therapy may follow, and self-help groups within communities may provide ongoing support as part of treatment.

Medications

Use of psychotropic medication in treating anorexia should be considered only after weight gain has been established. Certain selective serotonin reuptake inhibitors (SSRIs) have been shown to be helpful for weight maintenance and for resolving mood and anxiety symptoms associated with anorexia.

Prognosis With Anorexia Treatment

The course and outcome of anorexia nervosa vary among individuals: some fully recover after a single episode; some have a fluctuating pattern of weight gain and relapse. Others experience a chronically deteriorating course of the illness over many years.

The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15 to 24 in the general population. The most common causes of death are complications of the disorder, such as cardiac arrest or electrolyte imbalance, and suicide.

Anorexia Research

Doctors and scientists conducting research on anorexia are focused on understanding and treating this eating disorder. Current areas of research include appetite control biology, hormones, genetics, and the brain. Scientists are also looking for ways to better treat anorexia, as well as preventing it from ever developing.