Anorexia Nervosa

Anorexia Nervosa is an eating disorder. It occurs when a person's obsession with dieting and exercise leads to excessive weight loss. People are generally considered anorexic when they refuse to maintain their body weight at or above 85% of their expected weight. Anorexia can be fatal.

It often leads to a number of serious medical problems including:
  • Amenorrhea (loss of periods)
  • Osteoporosis
  • Cardiac abnormalities

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Sex: Female
  • Age: Adolescence or early adulthood
  • Low self-esteem
  • Feelings of helplessness
  • Perfectionism
  • Fear of becoming overweight
  • Familial pressure to be thin
  • Families that are overprotective, rigid, under-involved, or in conflict
  • Family history of eating disorders
  • Emotional stress
  • Mood disorders such as depression or generalized anxiety
  • Personality disorders
  • Susceptibility to social and fashion trends emphasizing or glamorizing thinness

Symptoms

Symptoms may include:
  • Excessive weight loss
  • Obsession with food, calories, and fat content
  • Dieting even when thin
  • Intense fear of gaining weight, even when underweight
  • Distorted self-image of excess weight despite evidence to the contrary
  • Undo influence of body weight or shape on self-evaluation
  • Loss of menstrual periods (secondary amenorrhea) or delay in menarche (onset of periods)
  • Excessive exercising
  • Feeling cold, especially hands and feet
  • Being secretive about food
  • Hair loss and/or growth of fine hair on the body
  • Fainting or severe lightheadedness
  • Constipation
  • Depression and/or anxiety
  • Heart palpitations

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. There will also be psychological tests, and possibly lab tests. Findings may include:
  • Excessive loss of body fat
  • Loss of muscle mass
  • Low heart rate
  • Low blood pressure, particularly when standing
  • Decreased bone density
  • Signs of sluggish metabolism

Treatment

The goal of treatment is to get you back to a healthy weight and keep you there. A healthy weight is above 85%, but not necessarily to 100%, of your ideal weight. To achieve this, your intake of calories is gradually increased to between 1500 and 3500 per day. This can be accomplished through a number of interventions, including:

Cognitive-behavioral Therapy (CBT)

Therapists help you develop a healthier and more realistic self-image. The therapist will help you find new ways to think about your body and your diet.

Interpersonal Therapy

This can help you understand and cope with concerns about your relationships.

Family Therapy

Complex family behaviors and attitudes often play a role in eating disorders. Many patients cannot recover unless their families recognize their roles in the problem and make changes. All families need to understand the disorder and support the patient.

Antidepressants

In some cases, anorexic patients benefit from a combination of psychotherapy and antidepressant medication. In particular, selective serotonin reuptake inhibitors (such as Zoloft) are used.

Addressing Nutritional Status and Loss of Bone Density

Medications and supplements may include:
  • Vitamins and minerals to maintain adequate nutrition
  • Hormone replacement to resume menstruation and prevent bone loss
Hospitalization

Patients are usually hospitalized if:
  • Weight loss is 25-30% below their ideal body weight
  • There are signs of serious physical or emotional deterioration

Prevention

There are no guidelines for preventing anorexia nervosa. Early detection and treatment has been more successful than prevention.