Definition Anorexia nervosa is an eating disorder in which a person refuses to maintain a healthy weight for his or her age and height. It is a self-imposed starvation resulting from a distorted body image. Anorexia nervosa occurs most often in females between the ages of 12 and 21, but may occur in older women and men.
What are the signs and symptoms of the disease? A person with anorexia nervosa may:
What are the causes and risks of the disease? No one knows what causes anorexia nervosa. Some experts believe that anorexia nervosa is a response to social attitudes that equate beauty with being thin. There is also evidence that anorexia nervosa runs in families and can be inherited.
Anorexia can cause dehydration and malnutrition, which can lead to:
fatigue
hair loss
marked reduction in bone density
dental cavities
electrolyte imbalances, which are abnormalities in the salt balance in the body
This disorder also can cause serious heart problems, including:
an irregular heartbeat
decreased oxygen availability
heart failure
sudden death
What can be done to prevent the disease? While it may not be possible to prevent the onset of this disorder, it is very important to recognise the early signs and begin treatment as soon as possible. The longer the disease goes on, the more difficult it is to treat.
How is the disease diagnosed? A psychiatrist or psychologist can diagnose anorexia by interviewing the person and his or her family to identify the signs and symptoms of the disorder.
What are the long-term effects of the disease? If anorexia progresses too far, it can cause serious illness and even death.
Someone suffering from this disorder may have trouble developing healthy relationships. The person also may be limited in the ability to succeed at school and work.
What are the treatments for the disease? The goals of treatment are to promote weight gain, and to correct malnutrition and the underlying psychological problem. A team approach is most effective. This includes:
aggressive medical management
nutritional counselling
individual, group, and family psychotherapy
behaviour modification therapy
Unless the affected person's weight is less than 75% of normal, treatment can take place outside of the hospital.
For an adolescent with this disease, a combination of cognitive behavioural therapy and family therapy are the most effective. Cognitive therapy helps individuals identify and question the reality of their beliefs about eating and their weight. For instance, the belief that it is healthy to be very thin. The therapist would help the individual understand that by staying so thin he or she is actually damaging the body. Behavioural therapy is designed to help change the behaviours that keep the illness going. For instance, being around food may make the person anxious and he or she may avoid food or leave the dinner table after only a few minutes. A therapist may recommend sitting at the dinner table with food in front of the individual for several hours. This may help overcome the fears about food. While in treatment, the individual will be asked to sign a food contract and to comply with this contract or lose privileges.
A person who becomes dangerously thin will need to be hospitalised. Some people become so malnourished that they need to be fed through tubes to stay alive. While they are in the hospital they will have strict rules about eating. In order to earn more privileges they will have to eat a certain amount of food each day and gain a certain amount of weight each week. They may not be allowed to go to the bathroom alone because they may try to throw up the food they have eaten.
For adolescents, family therapy is usually necessary. Family members need to learn about the illness and what they can do to help their loved ones recover. Sometimes anorexia nervosa can develop in response to family problems that need to be addressed before recovery can begin.
Unless the person has another psychiatric disorder, such as depression, drugs are rarely useful in treating anorexia nervosa. Sometimes, a drug called cyproheptadine is used because it can stimulate appetite, but it is usually not effective because most people with this disorder do feel hungry. They just choose not to eat.
What are the side effects of the treatments? There are no side effects to psychotherapy for anorexia.
What happens after treatment for the disease? Individuals who recover from anorexia need to be aware that this illness can recur.
How is the disease monitored? Most individuals will not need to remain in therapy after they have recovered from this disorder. But it may be helpful for them to have periodic checkups with their therapist.
Author: Michael Johnson, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
