Anorexia Nervosa: Symptoms, Causes
and Treatment

A person with anorexia nervosa, often called anorexia, has an intense fear of gaining weight. Someone with anorexia thinks about food a lot and limits the food she or he eats, even though she or he is too thin. Anorexia is more than just a problem with food. It's a way of using food or starving oneself to feel more in control of life and to ease tension, anger, and anxiety. An anorexic:

• has a low body weight for her or his height
• resists keeping a normal body weight
• has an intense fear of gaining weight
• thinks she or he is fat even when very thin
• misses three (menstrual) periods in a row – for girls/women who have started having their periods

Symptoms

Someone with anorexia may look very thin. She or he may use extreme measures to lose weight by:

• making her or himself throw up
• taking pills to urinate or have a bowel movement
• taking diet pills
• not eating or eating very little
• exercising a lot, even in bad weather or when hurt or tired
• weighing food and counting calories
• moving food around the plate instead of eating it

Someone with anorexia may also have a distorted body image, shown by thinking she or he is fat, wearing baggy clothes, weighing her or himself many times a day, and fearing weight gain.

Anorexia can also cause someone to not act like her or himself. She or he may talk about weight and food all the time, not eat in front of others, be moody or sad, or not want to go out with friends.

Other effects may include the following:

• Stunted growth
• Endocrine disorder, leading to cessation of periods in girls (amenorrhea)
• Decreased libido; impotence in males
• Starvation symptoms, such as reduced metabolism, slow heart rate (bradycardia), hypotension, hypothermia and anemia
• Abnormalities of mineral and electrolyte levels in the body
• Thinning of the hair
• Growth of lanugo hair over the body
• Constantly feeling "cold"
• Zinc deficiency
• Reduction in white blood cell count
• Reduced immune system function
• Pallid complexion and sunken eyes
• Creaking joints and bones
• Collection of fluid in ankles during the day and around eyes during the night
• Tooth decay
• Constipation
• Dry skin
• Dry or chapped lips
• Poor circulation, resulting in common attacks of 'pins and needles' and purple extremities
• In cases of extreme weight loss, there can be nerve deterioration, leading to difficulty in moving the feet
• Headaches
• Brittle fingernails
• Bruising easily

Causes

There is no single known cause of anorexia. But some things may play a part:

• Culture. Women are under constant pressure to fit a certain ideal of beauty. Seeing images of flawless, thin females everywhere makes it hard for women to feel good about their bodies. More and more, men are also feeling pressure to have a perfect body.

• Families. If you have a mother or sister with anorexia, you are more likely to develop the disorder. Parents who think looks are important, diet themselves, or criticize their children's bodies are more likely to have a child with anorexia.

• Life changes or stressful events. Traumatic events like rape as well as stressful things like starting a new job, can lead to the onset of anorexia.

• Personality traits. Someone with anorexia may not like her or himself, hate the way she or he looks, or feel hopeless. She or he often sets hard-to-reach goals for her or himself and tries to be perfect in every way.

• Biology. Genes, hormones, and chemicals in the brain may be factors in developing anorexia.

The treatment of this disorder is often difficult; some individuals are notoriously difficult to help. This is because of the disorder's insidious nature, which wreaks havoc not only with the body, but just as seriously with the individual's negative self-perception.

Usually starvation is not an immediate concern of most individuals who present with this disorder, but body weight and nutrition should be thoroughly evaluated at the onset of therapy. A complete medical examination is usually warranted to evaluate the patient's health and medical status. Underweight individuals often suffer from medical complications.

If a person who suffers from anorexia is in any danger to him or herself through lack of eating (e.g., starvation), immediate hospitalization should be considered.

A recent clinical review has suggested that psychotherapy is an effective form of treatment and can lead to restoration of weight, return of menses among female patients, and improved psychological and social functioning when compared to simple support or education programs. However, this review also noted that there are only a small number of randomized controlled trials on which to base this recommendation, and no specific type of psychotherapy seems to show any overall advantage when compared to other types. Family therapy has also been found to be an effective treatment for adolescents with anorexia and in particular, a method developed at the Maudsley Hospital is widely used and found to maintain improvement over time.

It is important to note that many recovering underweight people often harbor a hateful dislike for those who they feel to be robbing them of their treasured emaciation. Often when well-meaning friends or relatives compliment the recoverer on how much healthier they look, the recoverer's mind replaces "healthy" with "fat".

Drug treatments, such as SSRI or other antidepressant medication, have not been found to be generally effective for either treating anorexia, or preventing relapse although it has also been noted that there is a lack of adequate research in this area. It is common, however, for antidepressants to be prescribed, often with the intent of trying to treat the associated anxiety and depression.

Supplementation with 14mg/day of zinc is recommended as routine treatment for anorexia nervosa due to a study showing a doubling of weight regain after treatment with zinc was begun. The mechanism of action is hypothesized to be an increased effectiveness of neurotransmission in various parts of the brain, including the amygdala, after adequate zinc intake begins resulting in increased appetite.

There are various non-profit and community groups that offer support and advice to people who have anorexia.