Eating disorders

What is anorexia nervosa?

Translated literally, anorexia nervosa means "loss of appetite for nervous reasons." This is misleading because the person has lost the ability to allow herself to satisfy her appetite. Anorexics ignore their hunger and in doing so, control their desire to eat. Specifically, anorexia nervosa is a serious, chronic and often life-threatening eating disorder. It is defined by a patient's refusal to maintain normal body weight within 15 percent of his or her individual body weight.¹

Inherent in anorexia—and in nearly all eating disorders—is is low self-esteem and a tremendous need to control surroundings and emotions. Anorexia is a unique reaction to a series of internal and external conflicts; it is a negative way of coping with these struggles. The satisfaction of control over weight and food becomes important when seemingly everything else is emotionally painful.

Those with anorexia may be particularly sensitive about being seen as fat or they may have an intense fear of gaining weight. It should be noted, though, that not all people with anorexia have this fear. Some may be afraid of losing control over the amount of food they eat and they may want to control their emotions and their reactions. Other features of anorexia include a distorted body image and the absence of at least three consecutive menstrual periods when they are otherwise expected to occur.²

A low self-esteem and a need for acceptance—often the result of physical, sexual, or emotional abuse—will lead them to obsessive dieting and starvation as a means to control not only their weight, but also their feelings and actions concerning the attached emotions.³ Anorexics and those with an ongoing preoccupation with food and weight can benefit greatly from psychotherapy, group therapy, and behavior modification—therapy designed to explore thoughts and relationships, particularly thoughts and feelings surrounding food and eating. Tests can be conducted to rule out other physical disorders and to detect other psychiatric disorders such as obsessive-compulsive disorder and depression which often occur with anorexia.

Some anorexics believe they do not deserve to derive any pleasure out of life. As a result, they will deprive themselves of any situations offering pleasure, including eating.

What are the signs and symptoms of anorexia?

Those with anorexia may exhibit some of the following behaviors and symptoms:

Obsessive/excessive exercise Brittle nails and hair Dry, yellow skin Development of fine hair on the body Depression, anger, irritability, rapid mood shifts Feeling cold/hypothermia Complaining of bloating or unusual fullness after eating only a small amount Excessive weight loss and an ongoing belief they are fat, even when they are rail thin Wearing baggy clothes to hide weight loss Obvious fear and anxiety before eating and guilt after eating

Hiding, hording or stashing food they will not eat Obsessive calorie and fat gram counting Starvation and restriction of food; skipping meals Repeatedly weighing oneself Denial of hunger Self-induced vomiting Use of laxatives, diet pills and diuretics to attempt to control weight A persistent concern with body image Cutting food into very tiny pieces, moving food around the plate, or throwing out food Collecting recipes and cooking elaborate meals for others they will not eat themselves

Anorexia is associated with emotional changes and changes in relationships with friends or with family members. In the early stages of weight loss, the anorexic may appear jubilant and may seem to feel better about herself. She may seem overly cheerful, self-confident and outgoing. However, as starvation progresses, she may become depressed, anxious, irritable and angry. She may experience rapid mood shifts. Sometimes mood may appear dull or flat, and she may seem extremely withdrawn or aloof. Deterioration in relationships may occur as others express concern. Anorexics may become overly dependent on family members and express a deep fear that others will stop caring for them if recovery occurs.⁴

How do anorexics lose weight?

It isn't uncommon for people with anorexia to experience recurrent periods of bulimia—binge eating and purging. Starvation, weight loss and medical complications arising are serious can cause damage to the heart and brain. Pulse and blood pressure drop. Anorexics can often experience irregular heart rhythms and heart failure. Malnutrition and deprivation can result in the calcium loss from bones, making them brittle and prone to breakage. In the worst cases, anorexics can starve themselves to death.

There can be a number of ways anorexics can appear to eat. The most common is that anorexics attempt to maintain control over food intake. In many cases, they will appear to eat normal meals, with only small periods during which they restrict food intake. They may occasionally eat junk food or candy, drink lots of tea or coffee, or smoke. They may deny they are hungry and make excuses to avoid having to eat. They may hide food or claim they've already eaten. Some may attempt to purge food by making themselves vomit or by taking laxatives.⁵

Anorexics achieve weight loss by restricting their total food intake—sometimes to less than 1,000 calories per day — and exercising excessively. Many avoid high-calorie, fattening foods and some refuse to eat meat. Some anorexics may restrict their diets to low-calorie vegetables (e.g., lettuce and carrots) and popcorn.⁶

Who's at risk?

Like other eating disorders, anorexia nervosa tends to occur pre- or post-puberty, but it can develop at any major life change. While it predominately affects teenage girls and young adult women, anorexia is also seen in adolescent boys, men and older women. One reason anorexia is more common in girls is that girls will often go on "strict" diets in order to achieve the "ideal" figure they see in advertising and the media. They feel an overwhelming societal pressure to be thin. Others at risk include athletes (i.e. gymnasts, figure skaters, runners, wrestlers), actors, dancers, and models.⁷

Who's at risk for developing anorexia? Common in anorexics is low self-esteem, social isolation, and perfectionism. Anorexics tend to be excellent athletes and very strong academically. Focusing on weight loss and food allows them a distraction from other problems that appear too painful or without resolution.

Research has shown that anorexia runs in families, with females most often affected. This suggests that there are genetic factors that predispose some people to the disease. Stressful events, behavioral influences and environmental influences also play a role. In studies of anorexics, scientists have found decreased levels of the neurotransmitters serotonin and norepinephrine, consistent with patients suffering from clinical depression. Scientists also found that anorexics also tend to have higher levels of cortisol, a hormone released in response to stress.⁸

How can I help?

Family members and friends of anorexics can provide much needed help and support in a number of ways.

• Learn about anorexia nervosa and find out what you can about treatment options.
• Discuss your concerns with the person involved. Include specific behaviors you've noticed in your discussion.
• Encourage the person to talk with her health care provider, physician or mental health professional. Offer to go with her to the appointment.
• If the person denies the problem or refuses professional help, suggest she talk to another trusted adult such as a parent, sibling, friend, clergy, or teacher.
• Be responsible and exercise your own best judgment if the person in question is a minor.
• Be patient and understanding, but be firm. Dealing successfully with anorexia takes time.
• Do not attempt to blame yourself or the other person for this illness. Anorexia is no one's fault.
• Try to avoid controlling the person's weight, eating or appearance.
• Accept the person as she is and try to focus on feelings, strengths and positives.
• Don't forget your own needs. Consider getting literature and attending a support group.

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5. Anorexia Nervosa. Something Fish Website on Eating Disorders.
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