Anorexia nervosa, commonly referred to simply as anorexia, is a type of eating disorder that involves a psychological disorder. Persons with this disorder may have an intense fear of weight gain, even when they are underweight.
Anorexia is a condition that goes beyond out-of-control dieting. A person with anorexia 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 fears relating to one's body.
The individual continues the endless cycle of restrictive eating, often accompanied by other behaviors such as excessive exercising or the overuse of diuretics, laxatives, and/or enemas in order to reduce body weight, often to a point close to starvation in order to feel a sense of control over the body. This cycle becomes an obsession and, in this way, is similar to any type of addiction.
CAUSES
There is by far no definite cause of anorexia nervosa.
Some experts suggest that demands from society and families could possibly be the underlying causes for anorexia. For many individuals with anorexia, the destructive cycle begins with the pressure to be thin and attractive. A poor self-image compounds the problem.
Other researchers feel that this disorder can stem from a particular dysfunction often seen in families of anorexia patients. In one particular type of dysfunction, family members become so interdependent that each cannot achieve their identity as an individual. Thus, family members are unable to function as healthy individuals and are dependent on other family members for their identity.
In children, part of this dysfunction includes a fear of growing up (especially girls). Restrictive dieting may prevent their bodies from developing in a normal manner and, in their thinking, restricts the maturational process and maintains the parent-child relationship that the family has come to rely on.
Other family situations that have been suggested, but not proved, as possibly being related to the development of anorexia nervosa include high parental expectations, poor communications skills, and problems with conflict management.
Some studies also suggest that a genetic component may play a role in determining a person's susceptibility to anorexia. Researchers are currently attempting to identify the particular gene or genes that might affect a person's tendency to develop this disorder.
Although no organic cause for anorexia has been identified, some evidence points to a dysfunction in the part of the brain (hypothalamus) that regulates certain metabolic processes. Other studies have suggested that imbalances in neurotransmitter (brain messenger chemicals involved in signaling processes) levels in the brain may occur in people suffering from anorexia.
Anorexia nervosa usually occurs in adolescence or young adulthood. It is more common in females. The eating disorder is seen mainly in Caucasian women who are high academic achievers and who have a goal-oriented family or personality.
SIGNS AND SYMPTOMS
Anorexia can have dangerous psychological and behavioral effects on all aspects of an individual's life and can affect other family members as well.
People with anorexia may severely limit the amount of food they eat, or eat and then make themselves throw up. They may also use water pills (diuretics) and laxatives to lose weight.
Most individuals with anorexia nervosa do not recognize that they have an eating disorder.
Behaviors that may be noticed in a person with anorexia include:
· Cutting food into small pieces
· Exercising compulsively
· Going to the bathroom right after meals
· Quickly eating large amounts of food
· Restricting the amount of food eaten
· Using laxatives, enemas, or diuretics inappropriately in an effort to lose weight
Symptoms may include:
· Blotchy or yellow skin
· Confused or slow thinking
· Dental cavities due to self-induced vomiting
· Depression
· Dry mouth
· Extreme sensitivity to cold (wearing several layers of clothing to stay warm)
· Fine hair
· Low blood pressure
· No menstruation
· Poor memory or poor judgement
· Significant weight loss (15% or greater below normal weight)
· Wasting away of muscle and loss of body fat
TREATMENT
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 may be required. A gain of between 1-3 pounds per week is a safe and attainable goal when malnutrition must be corrected.
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. Because of increasing insurance restrictions, many patients find that a short hospitalization followed by 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. A multidisciplinary treatment team is common engaged, consisting of a medical-care provider, a dietician or nutritionist, and a mental-health-care provider.
Different kinds of psychological therapy have been employed to treat people with anorexia. Individual therapy, cognitive behavior therapy, group therapy, and family therapy have all been successful in treatment of anorexia.
An appropriate treatment approach addresses underlying issues of control and self-perception. Family dynamics are explored, and often the family is included in the treatment plan. Nutritional education provides a healthy alternative to weight management for the patient.
Group counseling or support groups often 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 themselves, some of the selective serotonin reuptake inhibitor (SSRI) antidepressant drugs have been shown to be helpful in weight maintenance after weight has been gained and in controlling mood and anxiety symptoms that may be associated with the condition.
PREVENTION
In some cases, prevention may not be possible. Encouraging healthy, realistic attitudes toward weight and diet may be helpful. Sometimes, counseling can help.
