Anorexia nervosa (anorexia)
Anorexia nervosa (often just called anorexia) is a serious eating disorder in which people have an abnormally low body weight and big fear of “becoming fat”. They severely restrict the amount of their food, and might control calorie intake by vomiting after eating, misusing diet pills, laxatives, etc. and exercising excessively. Although some anorexic people binge and purge, the condition should not be confused with bulimia. People with bulimia often have a normal or above normal weight – in contrast to anorexic patients who have an extremely low weight. Quite a few people recover from anorexia although the patient and her/his family have to work hard to overcome the disease.
The eating disorder includes physical and emotional symptoms and issues related to an unrealistic perception of body weight, and a very strong fear of putting on weight.
Physical symptoms may include:
- Low blood pressure
- Bluish fingers
- Thin hair or hair loss
- Soft, fine hair covering the body
- In females: no menstruation anymore
- In males: decreased testosterone
- Dry skin
- Yellowish or blotchy skin
- Intolerance of cold
- Swollen arms or legs
Emotional signs may include:
- Extreme dieting
- Excessive sports
- Getting rid of food by vomiting and abusing medications or herbal products, e.g. laxatives, enemas, diet aids, etc.
- Refusal to eat
- Denial of hunger
- Fear of „becoming fat“
- Lying about intake of food
- Lack of emotion
- Withdrawal from partner, friends and family
- Reduced interest in sex
If any of the above symptoms occur, it’s important to talk to a doctor because anorexia often takes over the life of the affected person and can even become life-threatening. However, in the beginning quite a few people deny having an eating disorder and don't want to be treated. Their desire to remain thin is stronger than their concern about their health.
The exact cause of the eating disorder is unknown. But a combination of biological, psychological and environmental factors may play a role:
- Biological factor: There might be genetic changes that make a person more vulnerable to anorexia. Genetic tendencies toward perfectionism, sensitivity and perseverance are traits related with anorexia.
- Psychological factor: There are a few emotional characteristics that might contribute to anorexia, e.g. obsessive-compulsive personality traits in young women that make it easier to stick to strict diets, or an extreme drive for perfectionism.
- Environmental: In modern Western societies, success and worth are often equated with being skinny. Among young girls, peer pressure might fuel the desire to lose weight and become extremely thin.
In addition, severe trauma or emotional stress, e.g. sexual abuse or death of a family member, during prepuberty or puberty may also lead to anorexia.
Anorexia may have lots of complications and – in the worst case – might be fatal. Death may occur unexpected, even if the affected person isn’t extremely underweight. Death might be caused by abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes (minerals, e.g. calcium, sodium, etc.) that maintain the balance of fluids in the body.
Other complications due to anorexia might be:
- Heart problems (abnormal heart rhythms, heart failure, etc.)
- Damaged organs, including brain, heart, kidneys (might not be completely reversible)
- Teeth problems
- Alcohol abuse
- Substance abuse
- Other eating disorders
It’s often a big step for a person with anorexia to recognize she/he has an eating disorder and needs professional help.
Before treatment starts, the physician has to rule out other possible causes for the weight loss. During physical exam, blood pressure and heart rate are checked, as well as electrolyte levels, liver and kidney function, bone density and possible heart irregularities. The patient also has to answer questions about eating habits and his/her feelings during psychological exam.
In almost all cases, therapy involves a combination of psychological therapy and individual advice on eating and nutrition to help the patient gain weight in a safe way. Usually, general practitioners, psychiatrists, dietitians and specialist nurses take care of the person with anorexia.
Individual, family and group therapies are normally an integral part of treatment in order to cope with strong emotions, build healthy self-esteem, resolve problems within the family, create support for the patient as well as interact with other patients with the same disorder. However, there is no medication that can treat anorexia – only anxiety and depression.
Most patients are allowed to go home between appointments, but severe cases are treated in hospital or special eating disorder clinics. They might be put on a feeding tube and intravenous fluids if their weight is too low or if they are dehydrated. If they continue to refuse to eat, they might have to stay in a hospital for intensive treatment.
- Reducing risk of harm caused by anorexia
- Encouraging weight gain
- Encouraging healthy diet
- Reducing other related complications and problems
- Helping the patient become both physically and mentally stronger
It may take years of therapy until a patient fully recovers. However, relapses are not unusual, e.g. a woman may relapse if she tries to lose weight after pregnancy. A few patients need lifelong treatment to overcome anorexia.
It’s not possible to prevent anorexia completely. A doctor might identify early signs of the condition during routine checkup and prevent the development of full-blown illness. If a family member or friend notices worrying dieting habits, low self-esteem and dissatisfaction with appearance in a person, he/she should talk to the affected person, e.g. about healthier behavior or therapy options.