Anorexia

(Anorexia Nervosa)
  • Definition

    Anorexia is an eating disorder. It occurs when a person's obsession with diet and exercise leads to extreme weight loss. The disorder is considered if a person refuses to maintain a body weight at or above 85% of their ideal body weight. It can be fatal.
  • Causes

    The cause of anorexia is not known. It appears that genetics and environment play a role.
  • Risk Factors

    Anorexia is more common in females, and during adolescence or early adulthood. Factors that increase your risk for anorexia include:
    • Low self-esteem
    • Feelings of helplessness
    • Perfectionism
    • Fear of becoming overweight
    • Pressure to be thin
    • Families that are overprotective, rigid, not involved, or in conflict
    • Family history of eating disorders
    • Emotional stress
    • Mood disorders, such as depression or generalized anxiety disorder
    • Personality disorders
    • Influenced by 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
    • Body dysmorphia—distorted self-image of being overweight despite evidence of the opposite
    • Basing self-evaluation heavily on body weight or shape
    • Loss of menstrual periods or delay in the beginning 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 light-headedness
    • Constipation
    • Depression and/or anxiety
    • Heart palpitations
    Anorexia often leads to a number of serious medical problems including:
    Body Dysmorphia
    Anorexia
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  • Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam and psychological evaluation will be done.
    Other tests may include:
    • Blood teststo look for chemical imbalances
    • Electrocardiogram (EKG)—to check your heart's electrical activity
    • Bone density tests
  • Treatment

    The goal of treatment is to get you return you to a healthy weight and to help you maintain that weight. A healthy weight is above 85% of your ideal weight. To achieve this, your intake of calories is gradually increased. This can be accomplished through a number of interventions, including the following:
    Nutritional Consultation
    A dietitian may be consulted to help you learn more about the components of a healthy diet. The dietician will also talk to you about reasonable weight goals and calorie goals.
    Therapy
    Therapy can help address harmful thought patterns, improve eating behavior, and increase self-esteem. There are many different types of therapy. Work with your doctor and therapists to determine which therapy may be best for you. You may use more than one therapy or try different therapies before you find one that works best for you. Some therapy options include:
    • Cognitive behavioral therapists—To 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—To help you understand and cope with concerns about your relationships.
    • Family therapy—Families often play a role in eating disorders. Many people cannot recover unless their families are involved in the changes. All families need to understand the disorder to provide the appropriate support.
    Antidepressants
    In some cases, people with anorexia benefit from a combination of psychotherapy and antidepressant medication. In particular, selective serotonin reuptake inhibitors (SSRIs) 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 periods and prevent bone loss
    Hospitalization
    Hospitalization may be necessary if:
    • Weight is more than 25% below ideal body weight
    • There are signs of serious physical or emotional deterioration
  • Prevention

    There are no guidelines to prevent anorexia. Early detection and treatment is the best option.
  • RESOURCES

    National Association of Anorexia Nervosa and Associated Disorders http://www.anad.org

    National Eating Disorders Association http://www.nationaleatingdisorders.org

    CANADIAN RESOURCES

    Canadian Mental Health Association http://www.cmha.ca

    National Eating Disorder Information Center http://www.nedic.ca

    References

    Anorexia nervosa. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 20, 2013. Accessed July 22, 2013.

    Anorexia nervosa fact sheet. Office on Women's Health website. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/anorexia-nervosa.html. Updated July 16, 2012. Accessed July 22, 2013.

    Casper RC. How useful are pharmacological treatments in eating disorders? Psychopharmacol Bulletin. 2002;36:88-104.

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