Anorexia Nervosa

What Is Anorexia Nervosa?

Anorexia nervosa is a mental-health illness. People with this disorder have a severe preoccupation with food and body image. They don't eat, diet excessively, or otherwise eat far too little to maintain health. Despite being underweight, they often have anxiety concerning the belief that they are overweight and continue to try to lose weight. While the condition is more common in girls and women compared to boys and men, it is now believed to affect more boys and men than previously thought. Statistics indicate that anorexia most often starts between 13-30 years of age. How many children and adolescents are afflicted with an eating disorder have steadily increased in the United States since the 1950s. The long-term effects and medical complications generated by this psychiatric illness can be severe and even fatal.

Bulimia nervosa is another eating disorder that involves a preoccupation with food and body image. Symptoms of people with bulimia tend to be that they are of normal weight, binge eat within a discrete period of time, and have trouble controlling the urge to binge. They then try to make up for (undo) the binge in a negative way, by behaviors like self-induced vomiting, misuse of medications, fasting, or exercising excessively.

As opposed to anorexia, the definition of binge eating disorder is recurring episodes of eating unusually excessive amounts of food, along with a sense of feeling out of control, at least weekly over three or more months. It may also involve strong feelings of embarrassment and guilt. Binge eating disorder is much less common than pure overeating and is often associated with many more physical and mental-health problems.

What Are Risk Factors and Causes of Anorexia Nervosa?

There are several psychological, genetic, biological, developmental, and social factors that may predispose people to developing this condition. Anorexia nervosa may be encouraged because of our society's emphasis on (sometimes even extreme) weight loss and thinness, especially for women.

  • Genetic vulnerabilities for developing anorexia nervosa may occur.
  • Some evidence suggests differences in the pattern of brain chemicals in those who get anorexia.
  • A history of feeding problems as an infant, a tendency toward under-eating, or having a mother who has depression seem to be risk factors for developing anorexia.
  • Anorexia is more common among teenage boys or girls and women who participate in gymnastics, wrestling, ballet, modeling, or horse jockeying, in which being thin is thought to be a benefit.
  • While Caucasian women in the United States are more often assessed as having anorexia, the ethnic gap in the frequency of developing anorexia seems to be lessening.
  • Having high self-esteem and a mother with a higher body mass index (BMI) appear to be associated with the prevention of anorexia.
  • People who suffer from the distractibility, impulsivity, and/or hyperactivity of attention deficit hyperactivity disorder (ADHD) are vulnerable to developing anorexia and other eating disorders.

What Are the Signs and Symptoms of Anorexia Nervosa?

Individuals with anorexia nervosa have an intense fear of weight gain or becoming fat and/or might view themselves as being highly overweight despite the fact that they might be severely underweight.

Anorexia nervosa sufferers may use one or more of the following unhealthy ways to lose weight.

  • Under-eating/extreme dieting
  • Excessive and/or compulsive exercise
  • Vomiting
  • Laxative abuse
  • Diuretic abuse (medications that increase the amount of urination)
  • Use of appetite-suppressant medicines

Usually, people try to keep these behaviors secret. For example, if eating with others, a person with anorexia may move food around on their plate or place some food in a napkin to hide it. They may also stay busy serving food or cleaning up rather than actually eating. If confronted about these behaviors, the individual may deny or refuse to discuss them. Anorexia sufferers may also use social isolation in an effort to avoid scrutiny of their eating.

Some of the following signs and physical effects may also be brought about by starvation or by weight-reduction methods:

When Should Someone Call the Doctor About Anorexia Nervosa?

There are no home remedies for anorexia nervosa. Any person who displays symptoms of this condition (undereating, inducing vomiting, or abusing laxatives in an attempt at weight loss) needs medical and psychiatric help. Some specialists are adept at treating these very challenging patients. This eating disorder can cause severe medical complications or death if not treated.

Anorexia nervosa can result in life-threatening medical symptoms. The following signs and symptoms indicate the need for emergency evaluation:

  • Suicide is a major cause of death in people with anorexia nervosa. Any person with severe depression or suicidal thoughts or statements needs to be brought to the hospital's emergency department immediately. Call 911 for an ambulance if you believe there is even a remote possibility of imminent suicide.
  • Fainting
  • Dizziness
  • Confusion
  • Shortness of breath
  • Profuse vomiting or diarrhea
  • Blood in vomit or diarrhea
  • Chest pain
  • Abdominal pain
  • Weakness
  • Severe dehydration
  • Often the doctor may choose to admit a person with anorexia to the hospital for a variety of medical or psychiatric reasons.
    • The illness may result in a number of negative effects on the body (cardiac and endocrine systems, electrolytes) from starvation, vomiting, diuretic, laxative abuse, or appetite-suppressant abuse.
    • Complications of anorexia can also include developing water-electrolyte imbalance, low body temperature, anemia, and osteoporosis.
    • Outpatient treatment of anorexia nervosa is often unsuccessful. Someone with this disease may need prolonged treatment (including cognitive, behavioral, medication, and counseling or some combination) in a structured hospital environment or special inpatient eating disorders program to have their best chance of survival.

Anorexia Treatment

Antidepressants

Selective Serotonin Reuptake Inhibitors

Selective serotonin reuptake inhibitor (SSRI) medications affect the levels of serotonin in the brain. For many people, these medications are the first choice to treat depression. Examples of these medications are:

  • fluoxetine (Prozac, Prozac Weekly, Sarafem),
  • sertraline (Zoloft),
  • paroxetine (Paxil, Paxil CR),
  • escitalopram (Lexapro),
  • fluvoxamine, and
  • citalopram (Celexa).

What Specialists Treat Anorexia Nervosa?

Specialists who may diagnose and treat anorexia nervosa include primary-care providers, psychiatrists, clinical psychologists, psychoanalysts, psychiatric nurses and nurse practitioners, social workers, nutritionists, and mental-health physician assistants.

How Do Health-Care Professionals Diagnose Anorexia Nervosa?

Medical assessment must include height and weight measurements, vital signs (temperature, pulse, blood pressure and respiratory rate), blood and urine tests, an electrocardiogram (EKG/ECG), and a thorough history and physical exam.

  • Criteria used to diagnose anorexia nervosa include the following signs and symptoms:
    • Refusal to maintain body weight at or above a minimally normal weight for age and height
    • Intense fear of gaining weight, of obesity, or consistent behavior that prevents weight gain even though the sufferer is severely underweight
    • Disturbance in the way one pictures or otherwise experiences his or her body weight or shape; undue influence of body weight or shape on one's feeling of self-esteem; denying the seriousness of one's current low body weight
    • There are two subtypes of anorexia: restricting and binge-eating/purging subtypes.
      • The restricting type of anorexia refers to the sufferer refraining from recurrent binging or purging such that weight loss is mostly achieved through dieting, fasting, and/or excessive exercise.
      • The binge-eating/purging type of anorexia is described as engaging in binging or purging (making oneself vomit or misusing laxatives, diuretics, or enemas).
    • Atypical anorexia nervosa often refers to people who have some symptoms of anorexia, like all the criteria for the disorder except for weight criteria, anorexia without amenorrhea, or anorexia with no fear of gaining weight. Determining the diagnosis of anorexia nervosa is difficult. A variety of acute and chronic medical and psychiatric conditions can have the same signs and symptoms. A physician must rule out the other illnesses, using a history of symptoms, physical examination, and laboratory tests.

Are There Home Remedies for Anorexia Nervosa?

  • Recognizing that a problem may exist is essential.
  • Rarely are people aware of this problem themselves because this disease is defined by a distorted view of their own body image or weight. A family member or friend must recognize the possibility of a medical or psychiatric problem.
  • A person with anorexia nervosa often resists questioning and is extremely secretive, usually denying any problem and making excuses for weight loss or eating habits. If pressed on the subject, the person may become angry or withdrawn, further complicating attempts by others to help.
  • If you think a friend or family member has a problem, get that person to a physician, even if she or he strongly resists cooperating.
  • There is no home remedy.

What Is the Treatment for Anorexia Nervosa?

Treatment often can be very challenging because an anorexia sufferer will often refuse to cooperate and will resist participation in any treatment program. A coordinated team of specialists is needed to handle all the medical and psychological components of this illness.

  • Initially, treatment must focus on stabilizing any life-threatening complications of starvation. In severe cases, the medical team will assist in regaining weight, possibly using nutrition replacement through an IV or feeding tube.
  • The team must educate the person about the facts of the disease and its medical complications, as well as teach proper nutritional requirements.
  • Psychiatric treatment uses interpersonal psychotherapy, cognitive behavioral therapy, sometimes using dialectical behavior therapy and psychotherapeutic methods within a comprehensive treatment plan that often also includes attending group therapy, support group meetings, and family therapy.
  • Sometimes doctors will use medications, like antidepressants (including serotonergic antidepressants, also called SSRIs) or antipsychotic drugs to treat emotional symptoms that often accompany anorexia, but such programs have shown only mixed results that they work.
  • Family and support networks should be actively involved in the treatment and recovery for the individual with anorexia.

What Is the Follow-up for Anorexia Nervosa?

Treatment of anorexia nervosa often takes years, during which time close follow-up with a doctor is essential.

What Is the Prognosis for Anorexia Nervosa?

  • Death from the medical complications of anorexia or from suicide can be as high as 18%. Having the disease for a long time heightens the risk of death or severe complications.
  • About half of those affected will make a full recovery.
  • Some people will develop chronic relapses.
  • Coexisting psychiatric conditions may worsen the prognosis.
Reviewed on 11/21/2017

REFERENCES:

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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, D.C.: American Psychiatric Association, 2000.

American Psychiatric Association. "DSM-5 proposed revisions will include binge eating disorder and revisions to other eating disorders criteria." News Release Embargoed For Release Until 2/10/10, Arlington, Virginia.

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Raevuori, A., H.W. Hoek, E. Susser, J. Kaprio, A. Rissanen, et al. "Epidemiology of Anorexia Nervosa in Men: A Nationwide Study of Finnish Twins." PLoS One 4.2 (2009).

Santonastaso, P., et al. "Typical and atypical restrictive anorexia nervosa: weight history, body image, psychiatric symptoms and response to outpatient treatment." International Journal of Eating Disorders 42 (2009): 464-470.

Walsh, B.T., A.S. Kaplan, E. Attia, M. Olmsted, M. Parides, et al. "Fluoxetine after weight restoration in anorexia nervosa." Journal of the American Medical Association 295.22 (2006): 2605-2612.

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