About anorexia nervosa

What is anorexia nervosa?

Anorexia nervosa facts

  • Anorexia nervosa is a a psychiatric condition, which is part of a group of eating disorders.
  • The cause of anorexia has not been definitively established, but self-esteem and body-image issues, societal pressures, and genetic factors likely each play a role.
  • Anorexia affects females far more often than males and is most common in adolescent females.
  • Anorexia tends to affect the middle and upper socioeconomic classes and Caucasians more often than less advantaged classes and ethnic minorities in the United States.
  • The disorder affects about 1% of adolescent girls and about 0.3% of males in the U.S.
  • People with anorexia tend to show compulsive behaviors, may become obsessed with food, and often show behaviors consistent with other addictions in their efforts to overly control their food intake and weight.
  • Men with anorexia are more likely to also have other psychological problems; affected women tend to be more perfectionistic and be more displeased with their bodies.
  • Children and adolescents with anorexia are at risk for a slowing of their growth and development.
  • The extreme dieting and weight loss of anorexia can lead to a potentially fatal degree of malnutrition.
  • Other possible complications of anorexia include heart-rhythm disturbances, digestive abnormalities, bone density loss, anemia, and hormonal and electrolyte imbalances.
  • Given the prevalence of denial of symptoms by individuals with anorexia, gathering information from loved ones of the anorexia sufferer is important in the diagnosis and treatment of the disorder.
  • Most medications are much better at treating symptoms that are associated with anorexia than addressing the specific symptoms of anorexia themselves.
  • The treatment of anorexia must focus on more than just weight gain and often involves a combination of individual, group, and family psychotherapies in addition to nutritional counseling.
  • The Maudsley model of family therapy, in which the family actively participates in helping their loved one achieve a more healthy weight, is considered the most effective method of family therapy for treating anorexia in adolescents.
  • The prognosis of anorexia is variable, with some people making a full recovery. Others experience a fluctuating pattern of weight gain followed by relapse or a progressively deteriorating course over many years.
  • Helping people understand the unrealistic and undesirable nature of media representations of excessive thinness as beautiful is one way to help prevent anorexia.
  • As with many other illnesses with addictive symptoms, it takes a day-to-day effort to control the urge to relapse, and treatment may be needed on a long-term basis.
  • Increased understanding of the causes and treatments for anorexia remain the focus of ongoing research in the effort to improve the outcomes of individuals with this disorder.

What is anorexia nervosa?

Anorexia nervosa, commonly referred to simply as anorexia, is one type of eating disorder. It is also a psychological disorder. Anorexia is a condition that goes beyond concern about obesity or out-of-control dieting. A person with anorexia often initially begins dieting to lose weight. Over time, the weight loss becomes a sign of mastery and control. The drive to become thinner is actually secondary to concerns about control and/or fears relating to one's body. The individual continues the ongoing cycle of restrictive eating, often accompanied by other behaviors such as excessive exercising or the overuse of diet pills to induce loss of appetite, and/or diuretics, laxatives, or enemas in order to reduce body weight, often to a point close to starvation in order to feel a sense of control over his or her body. This cycle becomes an obsession and, in this way, is similar to an addiction.



What are the symptoms for anorexia nervosa?

The physical signs and symptoms of anorexia nervosa are related to starvation. Anorexia also includes emotional and behavioral issues involving an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat.

It may be difficult to notice signs and symptoms because what is considered a low body weight is different for each person, and some individuals may not appear extremely thin. Also, people with anorexia often disguise their thinness, eating habits or physical problems.

Physical symptoms

Physical signs and symptoms of anorexia may include:

  • Extreme Weight loss or not making expected developmental weight gains
  • Thin appearance
  • Abnormal blood counts
  • Fatigue
  • Insomnia
  • Dizziness or fainting
  • Bluish discoloration of the fingers
  • Hair that thins, breaks or falls out
  • Soft, downy hair covering the body
  • Absence of menstruation
  • Constipation and Abdominal pain
  • Dry or yellowish skin
  • Intolerance of cold
  • Irregular heart rhythms
  • Low blood pressure
  • Dehydration
  • Swelling of arms or legs
  • Eroded teeth and calluses on the knuckles from induced Vomiting

Some people who have anorexia binge and purge, similar to individuals who have bulimia. But people with anorexia generally struggle with an abnormally low body weight, while individuals with bulimia typically are normal to above normal weight.

Emotional and behavioral symptoms

Behavioral symptoms of anorexia may include attempts to lose weight by:

  • Severely restricting food intake through dieting or fasting
  • Exercising excessively
  • Bingeing and self-induced Vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products

Emotional and behavioral signs and symptoms may include:

  • Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them
  • Frequently skipping meals or refusing to eat
  • Denial of hunger or 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 spitting food out after chewing
  • Not wanting to eat in public
  • Lying about how much food has been eaten
  • Fear of gaining weight that may include repeated weighing or measuring the body
  • Frequent checking in the mirror for perceived flaws
  • Complaining about being fat or having parts of the body that are fat
  • Covering up in layers of clothing
  • Flat mood (lack of emotion)
  • Social withdrawal
  • Irritability
  • Insomnia
  • Reduced interest in sex

When to see a doctor

Unfortunately, many people with anorexia don't want treatment, at least initially. Their desire to remain thin overrides concerns about their health. If you have a loved one you're worried about, urge her or him to talk to a doctor.

If you're experiencing any of the problems listed above, or if you think you may have an eating disorder, get help. If you're hiding your anorexia from loved ones, try to find a person you trust to talk to about what's going on.



What are the causes for anorexia nervosa?

The exact cause of anorexia is unknown. As with many diseases, it's probably a combination of biological, psychological and environmental factors.

  • Biological. Although it's not yet clear which genes are involved, there may be genetic changes that make some people at higher risk of developing anorexia. Some people may have a genetic tendency toward perfectionism, sensitivity and perseverance — all traits associated with anorexia.
  • Psychological. Some people with anorexia 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 causes them to think they're never thin enough. And they may have high levels of anxiety and engage in restrictive eating to reduce it.
  • Environmental. Modern Western culture emphasizes thinness. Success and worth are often equated with being thin. Peer pressure may help fuel the desire to be thin, particularly among young girls.



What are the treatments for anorexia nervosa?

Anorexia may be treated in an outpatient setting, or hospitalization may be necessary. For an individual with severe weight loss that has impaired organ function, hospital treatment must initially focus on correction of malnutrition, and intravenous feeding or tube feeding that goes past the mouth may be required. A gain of between 1 to 3 pounds per week is a safe and attainable goal when malnutrition must be corrected. Sometimes weight gain is achieved using schedules for eating, decreased physical activity, and increased social activity, either on an inpatient or outpatient basis. For individuals who have suffered from anorexia for several years, the goals of treatment may need to be achieved more slowly in order to prevent the anorexia sufferer from relapsing as a result of being overwhelmed by treatment.

The overall treatment of anorexia, however, must focus on more than weight gain. There are a variety of treatment approaches dependent upon the resources available to the individual. Many patients find that a short hospitalization followed by participation in a day treatment program is an effective alternative to longer inpatient programs. Most individuals, however, initially seek outpatient treatment involving psychological as well as medical intervention. It is common to engage a multidisciplinary treatment team consisting of a medical-care professional, a dietician or nutritionist, and a mental-health-care professional.

Different kinds of psychological therapy are employed to treat people with anorexia. Individual therapy, cognitive behavior therapy, group therapy, and family therapy have all been successful in the treatment of anorexia. In adolescents, research shows that the Maudsley model of family therapy can be particularly effective in treating this disorder in this population. In contrast to many past approaches to treatment, the Maudsley model approaches the family of the individual with anorexia as part of the solution rather than part of the reason their loved one has the disorder. With ongoing specific guidance from the professional mental-health team, this approach has the family actively help their loved one eat in a healthier manner.

Any appropriate treatment approach addresses underlying issues of control, perfectionism, and self-perception. Family dynamics are explored. Nutritional education provides a healthy alternative to weight management for the patient. Group counseling or support groups may assist the individual in the recovery process. The ultimate goal of treatment should be for the individual to accept herself/himself and lead a physically and emotionally healthy life.

While no medications have been identified that can definitively reduce the compulsion to starve oneself, olanzapine (Zyprexa, Zydis), risperidone (Risperdal), and quetiapine (Seroquel) are medications that are also used as mood stabilizers and to treat schizophrenia that may be useful in treating anorexia. These medications may also help increase weight and to manage some of the emotional symptoms like anxiety and depression that can accompany anorexia. Some of the selective serotonin reuptake inhibitor (SSRI) antidepressant drugs, like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro), have been shown to be helpful in weight maintenance after weight has been gained, as well as having beneficial effects on the mood and anxiety symptoms that may be associated with the condition.



What are the risk factors for anorexia nervosa?

Anorexia is more common in girls and women. However, boys and men have increasingly developed eating disorders, possibly related to growing social pressures.

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

Certain factors increase the risk of anorexia, including:

  • Genetics. Changes in specific genes may put certain people at higher risk of anorexia. Those with a first-degree relative — a parent, sibling or child — who had the disorder have a much higher risk of anorexia.
  • Dieting and starvation. Dieting is a risk factor for developing an eating disorder. There is strong evidence that many of the symptoms of anorexia are actually symptoms of starvation. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.
  • 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 stress and increase the risk of anorexia.



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