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Q: Could you please tell me what to look for when I suspect anorexia nervosa?
A: Anorexia nervosa is a psychological eating disorder in which a person refuses to eat adequately--in spite of hunger--and loses enough weight to become emaciated. The illness usually begins with a normal weight-loss diet. The person eats very little and refuses to stop dieting after a reasonable weight loss. The body perception is distorted; person sees self as "fat" when weight is normal or much less. Involved individuals are mostly female adolescents and young adults. Although more common in females, may also occur in males. The person continues to feel fat, even when emaciated, and there is a cessation of menstrual periods.
Causes for the disease are unknown. However,some possibilities include family and internal conflicts (sexual conflicts); phobia about putting on weight; changes in fashion (slimness is identified with beauty); and depression or personality disorder. Risk for acquiring the disease increases with peer pressure to be thin, history of being slight overweight, perfectionistic, or compulsive, as well as with overachieving personalities, psychological stress. In addition, the disease is more frequent in athletes, models, actresses, ballet dancers, and cheerleaders.
Treatment consists in psychotherapy or counseling for the patient and family, hospitalization during crises for intravenous or tube feeding, and sometimes with psychiatric hospitalization for at least 2 to 3 weeks. The goal of treatment is for the patient to establish healthy eating patterns to regain normal weight. The patient can accomplish this with behavior-modification training supervised by a qualified professional. In addition, lithium or other antidepressants may be prescribed by the physician. No activity restrictions are necessary, but overexertion is to be avoided. Furthermore, a controlled refeeding program is to be established., and vitamin and mineral supplements may be prescribed.
Complications are caused because of the patient's resistance to treatment, electrolyte disturbances or irregular heartbeat, which may be life-threatening, osteoporosis, suicide. The disease is treatable if the patient recognizes the emotional disturbance, wants help and cooperates in treatment. Without treatment, this can cause permanent disability or even death. Persons with anorexia nervosa have a high rate of attempted suicide due to low self-esteem. Therapy may continue over several years. Relapses are common, especially when stressful situations occur.
Updated: 09/12/99
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