The key feature of anorexia nervosa is self-imposed starvation resulting from a distorted body image and an intense and irrational fear of gaining weight, even when obviously emaciated. An anorexic patient is preoccupied with her body size, describes herself as "fat," and commonly expresses dissatisfaction with a particular aspect of her physical appearance. Although the term anorexia suggests that the patient's weight loss is associated with a loss of appetite, this is rare.
Anorexia nervosa and bulimia nervosa can occur simultaneously. In anorexia nervosa, the refusal to eat may be accompanied by compulsive exercising, selfinduced vomiting, or abuse of laxatives or diuretics.
Anorexia occurs in 5% to 10% of the population; more than 90% of those affected are females. It occurs primarily in adolescents and young adults but also may affect older women and, occasionally, males.
The cause of anorexia nervosa is unknown. Researchers in neuroendocrinology are seeking a physiologic cause but have found nothing definite. Clearly, social attitudes that equate slimness with beauty play some role in provoking this disorder; family factors also are implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over life or to protect oneself from dealing with issues surrounding sexuality.
Signs and symptoms
One important sign that someone may be suffering from anorexia nervosa is grossly distorted body image, meaning that the person feels they are overweight and, in fact, appear thin. Other symptoms may include unnatural fear of weight gain, compulsive exercising, self-starvation, loss of energy, and, in girls who have started menstruating, amenorrhea, or absence of at least three consecutive menstrual cycles. Those with anorexia nervosa may begin to appear emaciated.
Over time, the disorder may cause serious health problems including sudden death, congestive heart failure, dental problems, growth retardation, stomach rupture, swelling of the salivary glands, anemia, abnormalities of the blood, loss of kidney function and osteoporosis.
Appropriate treatment aims to promote weight gain or control the patient's compulsive binge eating and purging and to correct malnutrition and the underlying psychological dysfunction. Hospitalization in a medical or psychiatric unit may be required to improve the patient's precarious physical state. Hospitalization may be as brief as 2 weeks or may stretch from a few months to 2 years or longer.
A team approach to care - combining aggressive medical management, nutritional counseling, and individual. group, or family psychotherapy or behavior modification therapy - is the best approach. Treatment is difficult, and results may be discouraging. Many clinical centers are now developing inpatient and outpatient programs specifically for managing eating disorders.
Treatment may include behavior modification (privileges depend on weight gain); curtailed activity for physical reasons (such as arrhythmias); vitamin and mineral supplements; a reasonable diet, with or without liquid supplements; subclavian, peripheral, or enteral hyperalimentation (enteral and peripheral routes carry less risk of infection); and group, family, or individual psychotherapy.
Supportive care by health care providers, structured behavioral therapy, psychotherapy, and anti-depressant drug therapy are some of the methods that are used for treatment. Severe and life-threatening malnutrition may require intravenous feeding.
Preventive measures to reduce the incidence of anorexia are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the child's normal growth and development, and improve the quality of life experienced by children or adolescents with anorexia nervosa. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.
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