ANOREXIA NERVOSA

DEFINITION

Anorexia nervosa is an eating disorder that occurs primarily among girls and women. It is characterized by a fear of gaining weight, self-starvation, and a distorted view of body image. The condition is usually brought on by emotional disorders that lead a person to worry excessively about the appearance of his or her body. There are generally two types of anorexia: one is characterized by strict dieting and exercising; the other type includes binging and purging. Binging is the act of eating abnormally large amounts of food in a short period of time. Purging is the use of vomiting or other methods, such as laxatives, to empty the stomach. An individual who suffers from anorexia is called anorexic.

DESCRIPTION

Anorexia nervosa was first classified as a psychiatric (mental) disorder in 1980 and has since become a growing problem in the United States. The number of cases has doubled since 1970, and experts now estimate that 0.5 to 1 percent of all white females may be anorexic. About 90 percent of all anorexics are female, although the number of males with the disorder is growing. The most common age at which the disorder first appears is fourteen to eighteen years. However, anorexia nervosa may begin later in life; some cases of the disorder have been documented in infants. Studies indicate that the disorder is increasing among women of all races and social classes in the United States.

Anorexia nervosa is a very dangerous disorder. It has a very high rate of mortality (death). In addition, it can cause some serious long-term health effects. These effects include a reduced rate of growth, dental problems, constipation, stomach rupture, anemia (see anemia entry), loss of kidney function, heart problems, and osteoporosis (weakening of the bones; see osteoporosis entry).

CAUSES

The exact cause of anorexia nervosa is not known. However, a combination of factors are believed to contribute to the disorder.

Social Influences

American society places high value on thinness among women. Many consider being thin an essential part of beauty and young girls often think that they must be slender to be attractive. Being thin is also equated with social success. Images of girls and women in mass media (magazines, television, and movies) have been blamed, in part, for reinforcing such stereotypes. Some girls become anorexic as a form of copy-cat behavior. They imitate the actions of other women whom they admire. Extreme dieting may be one of these behaviors.

Occupational Goals

Some occupations traditionally expect women be slender. Dancers, fashion models, gymnasts, and actresses are often expected to be very thin. A young girl who aims for these careers may decide to pursue an extreme weight-loss program.

Genetic and Biological Factors

Anorexia nervosa seems to run in some families. Women whose mothers or sisters have the disorder are more likely to develop the condition than those who do not have relatives with anorexia nervosa.

Psychological Factors

One factor possibly leading to anorexia nervosa is the way a person looks at the world. Many theories have been developed to explain how an individual's view of the world may lead to the disorder. Anorexia nervosa has been interpreted as:

• A fear of growing up. By becoming anorexic, a young girl may be able to remain a child.

Dancers, gymnasts, and other female athletes often feel pressure to be very thin. The pressure sometimes leads to eating disorders such as anorexia nervosa. (© 1996

P. Stocklein

. Reproduced by permission of

Custom Medical Stock Photo

.)

• Reaction to sexual assault or abuse.
• A desire to remain weak and passive in the belief that men will find this attractive.
• A drive to be perfect in every part of life, whether it be school work or weight control.
• Response to family problems.
• Biological or psychological problems caused by incorrect feeding experiences at an early age.

SYMPTOMS

The symptoms of anorexia nervosa vary widely. In some people, they are very severe. In others, they are quite mild. In most cases, anorexics tend to have very thin bodies, dry or yellowish skin, and very low blood pressure. Young girls often have amenorrhea (pronounced a-men-uh-REE-uh), the failure to menstruate. They may also experience abdominal pain, constipation, and lack of energy. Chills, the growth of downy body hair, and damaged tooth enamel (from vomiting) are other symptoms of the condition.

DIAGNOSIS

Anorexia nervosa is often difficult to diagnose for a number of reasons. Most people with the disorder deny that they have a problem. They may not get professional help until a family member intervenes and takes them to a doctor.

A physical examination and medical history will be conducted by the physician. Other possible causes for symptoms must first be ruled out. Brain tumors, diseases of the digestive tract, and other conditions can produce symptoms similar to those of anorexia nervosa. Blood tests, urinalysis, and other tests can be used to eliminate other possibilities.

Some psychiatric conditions also produce symptoms like those of anorexia nervosa. Doctors may use certain written tests to distinguish between these disorders and anorexia nervosa. The Eating Attitudes Test and the Eating Disorder Inventory are two such tests.

TREATMENT

Treatment of anorexia nervosa is often quite complicated. The patient may have to deal with immediate problems as well as long-range ones. A variety of professional helpers may be needed. They may include psychiatrists or psychologists, dietitians, and medical specialists in other areas. Treatment is often difficult because of a patient's attitude. He or she may refuse to take the steps necessary to be cured of the disorder.

Hospital Treatment

Serious cases of anorexia nervosa may require hospital treatment. Some symptoms that may lead to hospitalization include:

Anorexia nervosa is characterized by a fear of gaining weight, self-starvation, and a distorted self-image. (© 1993

B. Bodine

. Reproduced by permission of

Custom Medical Stock Photo

.)

• A weight of 40 percent or more below normal, or weight loss of 30 pounds or more over a three-month period
• Severely disturbed metabolism (body reactions by which energy is produced)
• Severe binging and purging
• Signs of mental disorders
• Severe depression or risk of suicide
• Family crisis

Hospital treatment has two objectives. First, the patient is given the opportunity to eat on a more normal schedule. In extreme cases, it may be necessary to force-feed the patient. Second, he or she is provided with group or individual counseling. The purpose of counseling is to help the patient understand the reasons for his or her disorder.

Outpatient Treatment

Patients whose health is not seriously at risk can be treated on an out-patient basis. Outpatient services are provided in a hospital or doctor's office. The patient comes in for help but then goes home after the session is over. Most outpatient services for anorexics involve counseling. The counseling can be done on an individual basis or in groups. In some cases family therapy can be helpful. Family therapy helps relatives of the anorexic to understand their role in the patient's problems.

Medications

Drugs can sometimes by used to treat the psychological aspect of anorexia nervosa. They may help patients become less depressed, less anxious, and better able to think clearly about his or her problems.

PROGNOSIS

According to the best estimates available, about half of all anorexics make a good physical and social recovery. About three-quarters gain weight. On a long-term basis, about 10 percent of all anorexics eventually die from the disorder. The most frequent causes of death are starvation, imbalances of chemicals in the body, heart failure, and suicide.

PREVENTION

Anorexia nervosa is likely to remain a problem until overall changes in society occur. As long as thinness is an ideal, anorexics will exist. Educational programs in the schools and discussions at home can help young people to think about and develop positive attitudes toward food, weight control, and body image.

FOR MORE INFORMATION

Books

Hall, Lindsey, and Monika Ostroff. Anorexia Nervosa: A Guide to Recovery. Carlsbad, CA: Gurze Design & Books, 1998.

Hornbacher, Marya. Wasted: A Memoir of Anorexia and Bulimia. New York: Harpercollins, 1999.

Robbins, Paul R. Anorexia and Bulimia. Hillside, NJ: Enslow Publishers, 1998.

Organizations

American Anorexia/Bulimia Association. 165 West 46th Street, Suite 1108, New York, NY 10036. (212) 575–6200.

Anorexia Nervosa and Related Eating Disorders. PO Box 5102, Eugene, OR 97405. (541) 344–1144.

Center for the Study of Anorexia and Bulimia. 1 W. 91st Street, New York, NY 10024. (212) 595–3449.

Eating Disorder Awareness & Prevention. 603 Steward St., Suite 803, Seattle, WA 98101. (206) 382–3587.

National Association of Anorexia Nervosa and Associated Disorders. Box 7, Highland Park, IL 60035. (708) 831–3438.

National Eating Disorders Organization. 6655 South Yale Avenue, Tulsa, OK 74136. (918) 481–4044.

National Institute of Mental Health Eating Disorders Program. Building 10, Room 3S231. 9000 Rockville Pike, Bethesda, MD 20892. (301) 496–1891.

Web sites

"Anorexia." Healthtouch.com [Online] http://www.healthtouch.com/level1/leaflets/115207/115207.htm (accessed on June 15, 1999).

Anorexia Nervosa and Related Eating Disorders, Inc. [Online] http://www.anred.com (accessed on June 15, 1999).

"A Teen Guide to Eating Disorders." [Online] http://kidshealth.org (accessed on October 5, 1999).

"Understanding Eating Disorders." [Online] http://www.ndmda.org (accessed on June 15, 1999).