Anorexia nervosa is an eating disorder in which a person has an aversion to food that results in starvation and an inability to stay at the minimum body weight considered healthy for their age and height.
Persons with this disorder may have an intense fear of weight gain, even when they are underweight. Not eating enough food or exercising too much results in severe weight loss.
The exact causes of anorexia nervosa are unknown. Genetics and social attitudes towards body appearance may play a role. Some experts have suggested that conflicts within a family may contribute to this eating disorder.
Anorexia is eight times more common in people who have relatives with the disorder.
Risk factors include:
Being female
Eating and gastrointestinal problems during early childhood
Childhood anxiety
Increased concern or attention to weight and shape
Negative self-image
Accepting societal attitudes towards thinness
Perfectionism and other personality traits
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 have a goal-oriented family or personality.
Symptoms:
A person with anorexia may severely limit the amount of food they eat, or eat and then make themself throw up. They may also use diuretic (water) pills 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 may include:
Going to the bathroom right after meals
Quickly eating large amounts of food
Compulsive exercising
Cutting food into small pieces
Restricting how much food they eat
Inappropriate use of laxatives, enemas, or diuretics (water pills) in an effort to lose weight
Symptoms may include:
Extreme weight loss (15% or greater below the expected weight)
Wasting away of muscle and loss of body fat
Poor memory or poor judgement
Confused or slow thinking
Very sensitive to cold (wearing several layers of clothing to stay warm)
A diagnosis of anorexia nervosa is not made until other causes of weight loss are ruled out. For example, extreme weight loss could be due to celiac disease , inflammatory bowel disease, Addison's disease , and many other metabolic, endocrine, digestive, or nervous system disorders.
Tests will be done to help determine the cause of weight loss or to determine what damage the weight loss has caused cause. They may include:
The biggest challenge in treating anorexia nervosa is having the person recognize that their eating behavior is itself a problem, not a solution to other problems. However, most persons with anorexia nervosa deny that they have an eating disorder. Individuals often enter treatment when their condition is fairly advanced.
The goal of treatment is first to restore normal body weight and eating habits, and then attempt to resolve psychological issues.
A hospital stay may be needed if:
The person has lost a lot of weight (below 30% of their ideal body weight for their age and height)
Weight loss continues despite treatment
Medical complications, such as heart rate problems, changes in mental status, low potassium levels, or mental status problems, develop
The person has severe depression or thinks about committing suicide
Other treatment may include:
Antidepressant drug therapy for depression
Behavioral therapy
Psychotherapy
Supportive care
Severe and life-threatening malnutrition may require feedings through a vein.
Anorexia nervosa is a serious and potentially deadly medical condition. By some estimates, it leads to death in 10% of cases. Experienced treatment programs have a good success rate in restoring normal weight, but relapse is common.
Women who develop this eating disorder at an early age have a better chance of complete recovery. However, most people with anorexia will continue to prefer a lower body weight and be preoccupied with food and calories to some extent. Weight management may be difficult, and long-term treatment may be necessary to help maintain a healthy body weight.
Complications:
Complications can be severe. A hospital stay may be needed.
Thyroid gland deficiencies which can lead to cold intolerance and constipation
Appearance of fine baby-like body hair (lanugo)
Bloating or edema
Decrease in white blood cells which leads to increased susceptibility to infection
Osteoporosis
Tooth erosion and decay
Seizures related to fluid shifts due to excessive diarrhea or vomiting
Calling your health care provider:
Talk to your doctor if your child is restricting his or her food intake, over-exercising, or is excessively preoccupied with weight. Getting early medical help before abnormal patterns are established can reduce the severity of an eating disorder.
Prevention:
In some cases, prevention may not be possible. Encouraging healthy, realistic attitudes toward weight and diet may be helpful. Sometimes, counseling can help.
References:
American Psychiatric Association. Treatment of patients with eating disorders, third edition. American Psychiatric Association. Am J Psychiatry. 2006 Jul;163(7 Suppl):4-54.
Berkman ND, Lohr KN, Bulik CM. Outcomes of eating disorders: a systematic review of the literature. Int J Eat Disord. 2007 May;40(4):293-309.
Bulik CM, Berkman ND, Brownley KA, Sedway JA, Lohr KN. Anorexia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord. 2007 May;40(4):310-20.
Marcus MD. Eating disorders. In: Goldman L, Ausiello D. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders; 2007:chap 238.
Morris J, Twaddle S. Anorexia nervosa. BMJ. 2007 Apr 28;334(7599):894-8.
Schmidt U, Lee S, Beecham J, et al. A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders. Am J Psychiatry. 2007 Apr;164(4):591-8.
Review Date: 6/28/2008 Reviewed By: Timothy A. Rogge, MD, private practice in Psychiatry, Kirkland, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
