What is anorexia nervosa?

Anorexia nervosa is a serious, chronic, and potentially life-threatening eating disorder defined by a refusal to maintain minimal body weight within 15 percent of an individual's normal weight. Other essential features of this disorder include an intense fear of gaining weight, a distorted body image, and denial of the seriousness of the illness.

There are two types of anorexia. In the restricting subtype, people maintain their low body weight purely by restricting their food intake and, possibly, by excessive exercise. Individuals with the binge eating/purging subtype also restrict their food intake, but also regularly engage in binge eating and/or purging behaviors such as self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Many people move back and forth between subtypes during the course of their illness.

People with anorexia often ignore hunger signals and thus control their desire to eat. One of the keys to this illness is the extreme need for control. People with anorexia often view eating as “giving in” to their body. Often they may cook for others and be preoccupied with food and recipes, yet they will not eat.

Who develops anorexia?

Like all eating disorders, anorexia tends to occur in pre-puberty or adolescence, but can develop at any time throughout the lifespan. Anorexia affects adolescent girls, young adult women, boys, men, older women and younger girls. One reason younger women are particularly vulnerable to eating disorders is their tendency to go on strict diets to achieve an “ideal” figure. This obsessive dieting behavior reflects today's societal pressure to be thin, which is seen in advertising and the media. Others especially at risk for eating disorders include athletes, actors, dancers, models, and TV personalities for whom thinness has become a professional requirement.

People with anorexia often mention that the sense of control they develop over eating and weight helps them feel as if other aspects of their life are under control. The presence of depression and anxiety disorders, an overly detatched or enmeshed family and/or family substance abuse may increase the risk of a youth developing anorexia.

How many people suffer from anorexia nervosa?

Estimates suggest that approximately one percent of females in the U.S. develop anorexia nervosa. Because more than 90 percent of all those who are affected are adolescent and young women, the disorder has been characterized as primarily a woman's illness. It should be noted, however, that males and children as young as seven years old have been diagnosed; and women 50, 60, 70, and even 80 years of age have fit the diagnosis. Some of these individuals will have struggled with eating, shape or weight in the past but new onset cases can also occur.

How is the weight lost?

People with anorexia nervosa usually lose weight by reducing their total food intake and exercising excessively. Many persons with this disorder restrict their calorie intake, avoid fattening, high-calorie foods, and often eliminate meats. The diet of persons with anorexia may consist almost completely of low-calorie foods and or beverages like lettuce and carrots, popcorn, and diet soft drinks.

What are the common signs of anorexia nervosa?

The hallmark of anorexia is a preoccupation with food and a refusal to maintain minimally normal body weight. One of the most frightening aspects of the disorder is that people with anorexia nervosa continue to think they look fat even when they are bone-thin. Their nails and hair become brittle, and their skin may become dry and yellow. They often complain of feeling cold (hypothermia) because their body temperature drops. They may develop lanugo (a term used to describe the fine hair on a new born) on their body.

Persons with anorexia develop odd and ritualistic eating habits such as cutting their food into tiny pieces, refusing to eat in front of others, or fixing elaborate meals for others that they themselves don't eat. Food and weight become obsessions as people with this disorder constantly think about their next encounter with food. Generally, if a person or their family fears he or she has anorexia, a counselor knowledgeable about eating disorders should make a diagnosis and rule out other disorders. Other psychiatric disorders can occur together with anorexia, such as depression, anxiety disorders and substance abuse disorders.

What are the causes of anorexia nervosa?

Although the precise causes of anorexia nervosa are unknown, we do know that it is caused by a combination of genetic and environmental factors. Certain personality traits common in persons with anorexia are perfectionism, high anxiety, and low self-esteem.

Eating disorders also tend to run in families, with female relatives most often affected. Relatives of someone with anorexia nervosa are over 10 times more likely to have an eating disorder themselves than relatives of someone without anorexia nervosa. The heritability of anorexia nervosa has been estimated to be over 50%. In studies of the biochemical functions of people with eating disorders, scientists have found that the neurotransmitters serotonin and norepinephrine are decreased and cortisol levels are increased in those with anorexia who are at a low weight.

Are there medical complications?

The starvation experienced by persons with anorexia nervosa can cause damage to vital organs such as the heart, kidneys, and brain. Pulse rate and blood pressure drop, and people suffering from this illness may experience irregular heart rhythms or heart failure. Nutritional deprivation along with purging causes electrolyte abnormalities such as low potassium and low sodium. Nutritional deprivation also leads to calcium loss from bones, which can become brittle and prone to breakage (osteoporosis). Nutritional deprivation also leads to decreased brain volume. In the worst-case scenario, people with anorexia can starve themselves to death. Anorexia nervosa has the highest mortality rate of any psychiatric illness. The most frequent causes of death are suicide and complications of the malnutrition associated with the disorder.

Is treatment available?

Recovery is possible. About half of individuals fully recover from the illness, a small percentage continue to suffer from anorexia, and the remainder develop other eating disorders.

Luckily, most of the complications experienced by persons with anorexia are reversible when they restore their weight. People with this disorder should be diagnosed and treated as soon as possible because eating disorders are most successfully treated when diagnosed early. Some patients can be treated as outpatients, but some may need hospitalization to stabilize their dangerously low weight. It should be noted that most people with anorexia will not voluntarily come to treatment, therefore, it will be important to spend early sessions developing rapport.

To help people with anorexia nervosa overcome their disorder, a variety of approaches are used. Some form of psychotherapy is needed to deal with underlying emotional issues. Cognitive-behavioral therapy is sometimes used to change unhealthy thoughts and behaviors. Group therapy is often advised so people can share their experiences with others. Family therapy is important particularly if the individual is living at home and is a child or young adolescent. Brief Therapy with Eating Disorders by Barbara McFarland is an excellent primer for therapists.