What is anorexia nervosa?

Quick Answer
Self-induced malnutrition resulting in a body weight 15 percent or more below normal for age and height, and, in women, characterized by the absence of three or more consecutive menstrual periods.
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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.

Bibliography

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Brumburg, Joan Jacobs. Fasting Girls: The History of Anorexia Nervosa. Rev. ed. New York: Vintage Books, 2000. Print.

Costin, Carolyn. The Eating Disorder Sourcebook. 3rd ed. New York: McGraw-Hill, 2007. Print.

Dallas, Mary Elizabeth. "Brain 'Pacemaker' May Help Ease Tough-to-Treat Anorexia." HealthDay. HealthDay, 7 Mar 2013. Web. 22 May 2013.

Gordon, Richard A. Eating Disorders: Anatomy of a Social Epidemic. 2nd ed. Malden: Blackwell Scientific, 2000. Print.

Herpertz-Dahlmann, Beate, et al. "Day-Patient Treatment after Short Inpatient Care versus Continued Inpatient Treatment in Adolescents with Anorexia Nervosa (ANDI): A Multicentre, Randomised, Open-Label, Non-Inferiority Trial." Lancet 383.9924 (2014): 1222–29. Print.

Lucas, Alexander R. Demystifying Anorexia Nervosa: An Optimistic Guide to Understanding Healing. Rev. ed. New York: Oxford UP, 2008. Print.

Parker, James N., and Philip M. Parker, eds. The 2002 Official Patient’s Sourcebook on Binge Eating Disorder. San Diego: Icon Health, 2002. Print.

Rogge, Timothy, et al. "Anorexia Nervosa." MedlinePlus. US Natl. Lib. of Medicine, 10 Mar. 2014. Web. 19 Aug. 2014.

Yager, Joel, et al. "Guideline Watch (August 2012): Practice Guideline for the Treatment of Patients with Eating Disorders, 3rd Edition." PsychiatryOnline. American Psychiatric Assoc., Aug. 2012. Web. 19 Aug. 2014.

Zipfel, Stephan, et al. "Focal Psychodynamic Therapy, Cognitive Behaviour Therapy, and Optimised Treatment as Usual in Outpatients with Anorexia Nervosa (ANTOP Study): Randomised Controlled Trial." Lancet 383.9912 (2014): 127–37. Print.

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