What is anorexia nervosa?

Causes and Symptoms

Anorexia nervosa is an eating disorder characterized by a body
weight at or below 85 percent of normal and an intense fear of weight gain that
leads to restrictive eating to the point of self-starvation. Anorexia nervosa is
typically a physical manifestation of underlying emotional conflicts such as
guilt, anger, and poor self-image and is often characterized by
obsessive-compulsive symptoms about weight and body image. According to the
National Association of Anorexia Nervosa and Associated Disorders, anorexia
nervosa is the third most common chronic condition among adolescents.
Approximately 85 to 90 percent of people with anorexia are female.

Anorexia nervosa often occurs following a successful dieting experience, and
frequent dieting may contribute to the development of the disorder. Dieters may
experience positive feedback regarding weight loss and feel compelled to continue
losing weight.

Although the term “anorexia” means “loss of appetite,” individuals with anorexia
continue to experience hunger but ignore or resist the body’s normal craving for
food. Individuals with anorexia frequently identify specific areas of the body
that they believe are “fat,” despite their emaciated condition. Anorexia is
characterized by extreme body-image distortions. Secrecy and ritual eating habits
may be signs of anorexia nervosa. Sufferers often lie to family and friends to
avoid eating meals and may eat only a set diet at a specific time of day.

Common comorbid conditions in individuals with anorexia nervosa include
obsessive-compulsive disorder, depression,
anxiety
disorders, and social phobia. Many people with anorexia are
high achievers, exhibiting perfectionist or “people-pleasing” personalities. In
addition, a strong correlation exists between anorexia nervosa and athletic
activities that emphasize the physique, such as ballet, figure skating,
gymnastics, cheerleading, and dance. People with anorexia may demonstrate
additional obsessive-compulsive behaviors such as weighing themselves and/or
examining themselves in the mirror several times per day, being overly concerned
with calorie or fat content, exercising compulsively, and maintaining unusually
consistent eating patterns.

Anorexia nervosa is frequently a symptom of depression, and the accompanying weight loss can be seen as a cry for help. Eating disorders tend to run in families, particularly those that equate thinness with success and happiness. The condition may also occur as a result of a traumatic situation such as death, divorce, pregnancy, or sexual abuse.

Symptoms and resulting physical conditions include amenorrhea ,
the abnormal interruption or absence of menstrual discharge, which can occur when
body fat drops below 23 percent. Anorexia nervosa may also be characterized by a
distended abdomen as a result of a buildup of abdominal fluids and the slowing of
the digestive system.

Resulting malnutrition can impair the immune system and cause
anemia or decreased white blood
cell counts. Brain and central nervous system functions may
also be affected, resulting in forgetfulness, attention deficits, and confusion.
Individuals with anorexia frequently experience fatigue, apathy, irritability, and
extreme emotions.

Additional symptoms can include thyroid abnormalities, fainting spells, irregular
heartbeat, brittle nails, hair loss, dry skin, cold hands and feet,
hypotension (low blood pressure), infertility, broken blood
vessels in the face, and the growth of downy body hair called lanugo as the body
attempts to insulate itself because of the loss of natural fat.

The occurrence of eating disorders in adolescents is especially dangerous because
the condition can retard growth and delay or interrupt puberty. Anorexia nervosa
can also result in the erosion of heart muscle, which lowers the heart’s capacity
and can lead to congestive heart failure. Individuals with
anorexia may experience musculoskeletal problems such as muscle spasms, atrophy,
and osteoporosis as a result of potassium and calcium
deficiencies. In extreme cases, patients may also experience organ failure and
cardiac complications that can result in sudden death.

Treatment and Therapy

Treatment of anorexia nervosa generally consists of medical treatment, including
electrolyte balance, and diagnosing and addressing any related health problems,
such as heart problems, depression, and osteoporosis; individual psychotherapy;
and nutrition counseling, as most people with anorexia need to focus away from
weight loss and toward nutritional gain and health.

Research indicates that eating disorders are one of the psychological problems
least likely to be treated, and anorexia nervosa has the highest mortality rate of
all psychosocial problems. The National Institute of Mental Health estimates that
one in ten anorexia cases ends in death from starvation, suicide, or
medical complications such as metabolic collapse, heart attacks, or kidney
failure.

Psychologists play a vital role in the successful treatment of eating disorders and are integral members of the multidisciplinary team that may be required to provide patient care. As part of this treatment, a physician may be called on to rule out medical illnesses and determine that the patient is not in immediate physical danger. A nutritionist may be asked to help assess and improve nutritional intake.

It is frequently necessary first to treat the acute physical symptoms associated
with anorexia nervosa. Patients with severe cases of anorexia—characterized by
weight that is 75 to 80 percent below ideal body weight—benefit from treatment in
a controlled environment that allows medically supervised feeding to achieve a
target rate of weight gain. Less severe cases can be effectively treated on an
outpatient basis.

During the initial phase of supervised feeding, the patient may receive a
low-calorie diet to avoid overwhelming low-functioning organs. Patients who do not
comply with the recommended diet may receive caloric supplements and, in serious
cases, intravenous feeding or nasogastric intubation.

Successful treatment also involves resolution of underlying emotional conflicts
through individual counseling or cognitive behavioral therapy and may also include
use of antidepressants.

Anorexia nervosa is extremely difficult to treat, with a fatality rate of 5 percent to 10 percent within ten years. Nearly half of all sufferers never recover fully from the condition.

Perspective and Prospects

Anorexia is a multifaceted problem that has physical, genetic, emotional, and
cultural components. The lifetime prevalence of anorexia nervosa among adolescents
in the United States is 0.3 percent, and the incidence of anorexia among
adolescent girls has risen each decade since 1930.

Most eating disorders were not recognized as illnesses until the late nineteenth
century. Conditions such as anorexia nervosa gained the attention of medical
professionals during the 1960s and beyond as a result of the media’s obsession
with thinness.

The media are prime contributors to this trend. Television and magazines send
confusing messages to young consumers, such as depicting painfully thin models
promoting high-fat snacks. In 2012, the average fashion model weighed about 23
percent less than the average woman. Of American elementary school girls who read
magazines, nearly 70 percent say that the pictures influence their concept of the
ideal body shape. In addition, the media frequently portray overweight people as
having a lower socioeconomic status and competency than people who are thin.

It appears likely that the incidence of eating disorders will continue to escalate
as the media persist in depicting models with a body image that is significantly
below a normal and healthy body weight.

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