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Anorexia Nervosa

Definition:
Anorexia nervosa is an eating disorder. It occurs when a person's obsession with dieting and exercise leads to excessive weight loss. People are generally considered anorexic when they refuse to maintain their body weight at or above 85 percent of their ideal body weight. Anorexia can be fatal.

Anorexia often leads to a number of serious medical problems including:

  • Amenorrhea (loss of periods)
  • Osteoporosis
  • Cardiac abnormalities – these may sometimes be fatal
Causes:

The cause of anorexia nervosa is not known. It appears that hereditary and environmental factors play a role.

Risk Factors:

A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for anorexia nervosa include the following:

  • Sex: Female
  • Age: Adolescence or early adulthood
  • Low self-esteem
  • Feelings of helplessness
  • Perfectionism
  • Fear of becoming overweight
  • Familial pressure to be thin
  • Families that are overprotective, rigid, under-involved, or in conflict
  • Family history of eating disorders
  • Emotional stress
  • Mood disorders such as depression or generalized anxiety disorder
  • Personality disorders
  • Susceptibility to social and fashion trends emphasizing or glamorizing thinness
Symptoms:

Symptoms may include:

  • Excessive weight loss
  • Obsession with food, calories, and fat content
  • Dieting even when thin
  • Intense fear of gaining weight, even when underweight
  • Distorted self-image of being overweight despite evidence to the contrary
  • Basing self-evaluation heavily on body weight or shape
  • Loss of menstrual periods (secondary amenorrhea) or delay in menarche (onset of periods)
  • Excessive exercising
  • Feeling cold, especially hands and feet
  • Being secretive about food
  • Hair loss and/or growth of fine hair on the body
  • Fainting or severe lightheadedness
  • Constipation
  • Depression and/or anxiety
  • Heart palpitations
Diagnosis:

The doctor will ask about your symptoms and medical history, and perform a physical exam. There will also be psychological tests, and possibly lab tests. Findings may include:

  • Excessive loss of body fat
  • Loss of muscle mass
  • Low heart rate
  • Low blood pressure, particularly when standing
  • Decreased bone density
  • Signs of sluggish metabolism
Treatment:
The goal of treatment is to get you back to a healthy weight and keep you there. A healthy weight is above 85 percent, but not necessarily to 100 percent, of your ideal weight. To achieve this, your intake of calories is gradually increased to between 1,500 and 3,500 per day. This can be accomplished through a number of interventions, including the following:

Cognitive-Behavioral Therapy (CBT)
Therapists help you develop a healthier and more realistic self-image. The therapist will help you find new ways to think about your body and your diet.

Interpersonal Therapy
This can help you understand and cope with concerns about your relationships.

Family Therapy
Complex family behaviors and attitudes often play a role in eating disorders. Many patients cannot recover unless their families recognize their roles in the problem and make changes. All families need to understand the disorder and provide support.

Antidepressants
In some cases, anorexic patients benefit from a combination of psychotherapy and antidepressant medication. In particular, selective serotonin reuptake inhibitors (such as sertraline [Zoloft] or fluoxetine [Prozac]) are used. Used alone, antidepressant therapy is not an effective treatment for anorexia.

Addressing Nutritional Status and Loss of Bone Density
Medications and supplements may include:
  • Vitamins and minerals to maintain adequate nutrition
  • Hormone replacement to resume menstruation and prevent bone loss
Hospitalization
Hospitalization may be necessary if:
  • Weight is 25–30% below ideal body weight
  • There are signs of serious physical or emotional deterioration
Prevention:
There are no guidelines for preventing anorexia nervosa. Early detection and treatment has been more successful than prevention.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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