Anorexia Nervosa (Anorexia)

(Anorexia)

Definition

Anorexia nervosa is an eating disorder [2]. It occurs when a person's obsession with diet and exercise [3] leads to excessive weight loss. Anorexia is considered when someone refuses to maintain a body weight at or above 85% of their ideal body weight. It can be fatal.

Causes

The cause of anorexia nervosa is not known. It appears that genetics 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 [4]
Mood disorders such as depression [5] or generalized anxiety disorder [6]
Personality disorders
Susceptibility to social and fashion [7] 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 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 [8] on the body
Fainting or severe light-headedness
Constipation [9]
Depression [5] and/or anxiety [10]
Heart palpitations

Anorexia often leads to a number of serious medical [11] problems including:

Amenorrhea [12] (loss of periods)
Osteoporosis [13]
Cardiac problems—can be fatal

Body Dysmorphia

Anorexia

Diagnosis

The doctor will ask about your symptoms and medical [11] history. A physical exam will be done. There will also be psychological tests. There may be lab tests. Findings may include:

Excessive loss of body fat
Loss of muscle [14] mass
Low heart [15] rate
Low blood pressure, particularly when standing
Decreased bone [14] 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% of your ideal weight. To achieve this, your intake of calories is gradually increased to 1,500 to 3,500 per day. This can be accomplished through a number of interventions, including the following:

Cognitive-Behavioral Therapy (CBT) [16]

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 [17].

Family Therapy

Families often play a role in eating disorders. Many patients cannot recover unless their families are involved in the 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 [18]
Hormone replacement to resume menstruation and prevent bone [14] loss

Hospitalization

Hospitalization may be necessary if:

Weight is 25% to 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.

RESOURCES:

National Association of Anorexia Nervosa and Associated Disorders
http://www.anad.org/ [19]

National Eating Disorders Association
http://www.nationaleatingdisorders.org/ [20]

CANADIAN RESOURCES:

About Kids Health
http://www.aboutkidshealth.ca/ [21]

Canadian Mental Health Association
http://www.ontario.cmha.ca/ [22]

References:

Anorexia Nervosa. National Eating Disorders Association website. Available at: http://www.nationaleatingdisorders.org/p.asp?WebPage_ID=286 [23]. Accessed June 19, 2008.

Anorexia Nervosa. The National Women's Health Information Center website. Available at: http://www.womenshealth.gov/faq/easyread/anorexia-etr.htm [24]. Accessed June 19, 2008.

Beers MH, Fletcher AJ, et al. The Merck Manual of Medical Information—Home Edition. 2nd ed. Whitehouse Station, NJ: Simon and Schuster, Inc;2003.

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

Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. 8th ed. St. Louis, MO: Mosby;2006.

Goldman L. Cecil Textbook of Medicine. 22nd ed. Philadelphia, PA: Saunders;2004.

Lenders JW, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet. 2005;20-26,665-675.

Lock J, le Grange D, Dare C, et al. Treatment Manual for Anorexia Nervosa. New York, NY: Guilford Press;2000.

Last reviewed November 2007 by Theodor B. Rais MD [25]

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 [11] 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 [26] provider prior to starting any new treatment or with any questions you may have regarding a medical [11] condition.