Anorexia generally affects females, but can affect males as well. And while anorexia typically begins to manifest itself during early adolescence, it is also seen in young children and adults.
At this time, no definite cause of anorexia nervosa has been determined. However, research within the medical and psychological fields continues to explore
possible causes.
Some experts feel that possible underlying causes can relate to demands from society and the family. For many individuals with anorexia, the destructive cycle begins with the pressure to be thin and
attractive. A poor self-image compounds the problem.
Other researchers feel that this disorder can stem from a particular dysfunction often seen in families of anorexia patients. In this particular type of dysfunction, family members become so
interdependent that each cannot achieve their identity as an individual. Thus, family members are unable to function as healthy individuals and are dependent on other family members for their identity.
Part of this dysfunction includes a fear of growing up by the children of these families, especially girls. Restrictive dieting may prevent their bodies from developing in a normal manner, and, in
their thinking, restricts the maturational process and maintains the parent-child relationship that the family has come to rely on.
Although no organic cause for anorexia has been identified, some evidence points to a dysfunction in the part of the brain (hypothalamus) which regulates certain metabolic processes.
Anorexia nervosa is a complicated disorder to diagnose. Individuals with anorexia often attempt to hide the disorder. Denial and secrecy frequently
accompany other symptoms. It is unusual for an individual with anorexia to seek professional help because the weight loss itself is not viewed as a problem. The actual diagnosis is not made until there
are other medical complications. The individual is often brought to the attention of a professional by family members only after a marked weight loss has occurred. When anorexics finally come to the
attention of the health professional, they often lack insight into their problem and may be unreliable in terms of providing accurate information. Therefore, it is often necessary to obtain information
from parents or other family members in order to evaluate the degree of weight loss and extent of the disorder.
The actual criteria for anorexia nervosa are found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
There are four basic criteria in the diagnosis of anorexia. First, there is the individual's refusal to maintain body weight at or above a minimally normal weight for age and height. Body weight
less than 85% of the expected weight is considered minimal. Second, there is an intense fear of gaining weight or becoming fat, even though the person is underweight. Additionally, self-perception is
grossly distorted and weight loss is not acknowledged. Finally, in women who have already begun their menstrual cycle (postmenarchal), at least three consecutive periods are missed (amenorrhea), or
menstrual periods occur only after a hormone is administered.
The DSM-IV further identifies two subtypes. In the Binge- Eating/Purging Type, the individual regularly engages in binge-eating or purging behavior which involves self-induced vomiting or the misuse
of laxatives, diuretics, or enemas during the current episode of anorexia. In the Restricting Type, the individual severely restricts food intake, but does not engage in the behaviors seen in the
Binge-Eating Type.
Anorexia can have dangerous effects on all aspects of an individual's life. It can affect other family members as well. Being seriously
underweight can lead to Sleep can become disrupted and lead to fatigue during the day. Attention and concentration can decrease. All of these features can negatively affect one's daily activities.
Diminished interest in previously preferred activities can result. Some individuals also have symptoms that meet the criteria for a Major Depressive Disorder.
Most individuals with anorexia become obsessed with food and thoughts of food. They think about it constantly and become compulsive about eating rituals. They may collect recipes or hoard food.
Additionally, they may exhibit other obsessions and/or compulsions related to food, weight, or body shape that meet the criteria for an Obsessive-Compulsive Disorder.
Generally, individuals with anorexia are compliant. Sometimes, they are overly compliant, to the extent that they lack adequate self- perception. They are eager to please and strive for perfection.
They usually do well in school and may often overextend themselves in a variety of activities. The families of anorexics often appear to be "perfect." Physical appearances are important to them.
Performance in other areas is stressed as well, and they are often high achievers.
While control and perfection are critical issues for individuals with anorexia, aspects other than their eating habits are often found to be out of control as well. Many have, or have had at some
point in their lives, addictions to alcohol, drugs, or gambling. Compulsions involving sex, exercising, housework, and shopping are not uncommon.
Most of the medical complications of anorexia nervosa result from starvation. Few organs are spared the progressive deterioration brought about by anorexia.
Although not life-threatening, abnormally slow heart action (bradycardia) and unusually low blood pressure (hypotension) are frequent manifestations of starvation and are commonly associated
with anorexia. Of greater significance are disturbances in the heart rate (arrhythmia). A reduction in the work capacity of the heart is associated with severe weight loss and starvation.
Gastrointestinal complications are also associated with anorexia. abdominal pain are the most common symptoms. The rate at which food is absorbed into the body is slowed down. Starvation and
overuse of laxatives can seriously disrupt the body's normal functions involved in the elimination process. While liver function is generally found to be normal, there is evidence of enzyme changes and
overall damage to the liver.
The glandular (endocrine) system in the body is profoundly affected by anorexia. The complex physical and chemical processes involved in the maintenance of life can be disrupted, with serious
consequences. Disturbances in the menstrual cycle are frequent and can affect not only child-bearing but also bone density growth, which is very important to a woman's health as she ages. Hormonal
imbalances are found in men with anorexia as well. Continual restrictive eating can trick the thyroid into thinking that the body is starving, causing it to slow down in an attempt to preserve
calories.
Kidney (renal) function may be thought to be normal. However, there are significant changes in many patients, resulting in potassium deficiency, increased urination, or decreased urination.
Anorexics who use a large quantity of laxatives or who frequently vomit are at great risk for electrolyte imbalance, which can have life-threatening consequences.
Anemia is frequently found in anorexic patients. Suppressed immunity and a high risk for infection are suspected, but not clinically proven.
Physical symptoms, other than the obvious loss of weight, can be seen. Anorexia can cause dry, flaky skin that takes on a yellow tinge. Fine, downy hair grows on the face, back, arms, and legs.
Despite this new hair growth, loss of hair on the head is not uncommon. Nails can become brittle. Frequent vomiting can erode dental enamel and eventually lead to tooth loss.
Treatment of anorexia must focus on more than weight gain. In fact, weight gain should be secondary to the more serious underlying issues facing the
anorexic. Some individuals recover fully after a single episode. Some experience a fluctuating pattern of weight gain followed by a relapse. Others experience a progressively deteriorating course of
the illness over many years and still others never fully recover. As with many other addictions, it takes a day-to-day effort to control the urge to relapse.
There are a variety of treatment approaches. Treatment typically depends primarily on the resources available to the individual.
For those individuals whose weight loss has become so severe or has seriously impaired other body systems, hospitalization may be necessary. Because of increasing insurance restrictions, many
patients find that a short hospitalization followed by a day treatment program is an effective alternative to longer inpatient programs. Most individuals, however, initially seek outpatient treatment
involving psychological as well as medical intervention.
Patients can be treated by a medical doctor, a clinical psychologist, or both, depending upon the progression of the disorder. A psychiatrist with both medical and psychological training is perhaps
the best treatment provider. An appropriate treatment approach addresses underlying issues of control and self-perception. Family dynamics are explored, and often the family is included in the
treatment plan. Nutritional education provides the patient a healthy alternative to weight management. Group counseling or support groups often assist the individual in the recovery process. The
ultimate goal of treatment should be for the individual to accept herself and lead a physically and emotionally healthy life.
