Commonly Asked Questions: Anorexia Nervosa

Who Has It?

Approximately 90 percent of the people diagnosed with Anorexia are female. It is a condition that is seen primarily in North America and Europe. It is rarely diagnosed in children before puberty or adults over age 40. In fact, Anorexia is most commonly diagnosed in females ages 13 to 21.

What are the Symptoms?

If you are wondering whether someone you know may have Anorexia, here are some critical characteristics to look for.

Body Weight Below Minimum Expectations for a Person's Age and Height

Health practitioners use the general rule of thumb of 85 percent of the expected weight for a person's height and age as a minimum weight standard. These figures are usually taken from publications such as the Metropolitan Life Insurance Height and Weight Tables or pediatric growth charts.

People with Anorexia typically go to extreme measures in order to lose weight. One sub-group, called the Restricting Type, attempts to lose weight through extreme dieting. When they eat, it is typically only very low calorie foods. They may also stop eating entirely for extended periods of time or exercise several times a day in order to burn off calories.

Another sub-group, the Binge-Eating /Purging Type, may also attempt to lose weight through diet or exercise regimens. However, these people also occasionally eat excessive amounts of high-calorie foods and may attempt to purge any food they have eaten. Purging means to try to eliminate any recently eaten food from the body. Purging includes such activities as self-induced vomiting, misuse of laxatives, enemas, and diuretics (medications that make one urinate).

While the person with this subtype of Anorexia may eat in binges more than once a week, they continue to succeed in their attempts to lose weight to the point that they become dangerously thin.

Intense Fear of Gaining Weight or Becoming Fat

While many of us are concerned, or even fearful, about becoming overweight, individuals with Anorexia seem to be consumed by this fear. In addition, their success in losing weight often makes them more fearful of gaining it back in the future.

Distorted Views of Body Weight and Shape

Some people believe that many thin people are just trying to attract attention or compliments when they complain about being "too fat." This kind of thinking is dangerous when it comes to dealing with Anorexia.

Regardless of how thin they are, people with Anorexia are sincere when they say that they believe they are too fat. They might admit that they are thin in most places but are troubled by a "flabby tummy" or "sagging thighs." They focus on these "imperfections" and ignore the thinner parts of their body.

Along with their fear of becoming fat, people with Anorexia are often obsessive about checking their weight or body shape. They may weigh themselves, look at themselves in a mirror while unclothed, or measure parts of their body several times a day.

Failure to Menstruate

Because people with Anorexia eat so little, and in a very real sense can be starving themselves, they often have a host of related health problems.

One of the most common problems is the failure to menstruate (have a period). Women diagnosed with Anorexia have typically missed at least three consecutive menstrual cycles. For girls who are approaching puberty, Anorexia typically causes menarche (first period) to be delayed by months, years, or until they gain weight.

These menstrual problems are typically caused by very low levels of the hormone estrogen in the blood due to malnutrition and low body weight.

Are There Other Effects on Health?

Yes, the malnourishment and purging associated with Anorexia often cause other significant health problems.

People with Anorexia are often diagnosed with anemia, cardiovascular (heart and blood circulation) problems such as hypotension (low blood pressure) and irregular heart beat (arrhythmia), tooth decay from repeated vomiting, poor kidney functioning, and osteoporosis (a decrease in the size and strength of bone).

Perhaps most importantly, approximately 10 percent of all people diagnosed with Anorexia die because of starvation, suicide, or electrolyte imbalances due to malnutrition.

Are There Any Psychological Factors?

People diagnosed with Anorexia often tie their self-esteem into their ability to lose weight and stay thin. They view their weight loss as a sign of their self-worth. Weight gain is seen as a sign of weakness, poor self-discipline, and failure.

Many folks with Anorexia seem obsessed or preoccupied with thoughts of food. Some may count calories or weigh every bite of food that they intend to eat. Others may collect recipes or hide away large stashes of food.

People with Anorexia are often very concerned about controlling all aspects of their life. They may seem very rigid, inflexible or strict in their views of the world. Interestingly, many people develop Anorexia after experiencing a stressful event that is often outside their control (i.e., moving to a new home, changing schools, entering college, family problems, etc.).

These individuals are also more likely to experience significant levels of depression as compared to people without an eating disorder. They may often appear sad or irritable. They may have trouble sleeping or staying focused on tasks, and they may withdraw from social interactions or lose interest in actitivities that used to give them great pleasure (i.e., hobbies, sports, sex, etc.).

Finally, denial is a hallmark psychological characteristic of Anorexia. People with this disorder may deny that they have irregular eating patterns or are too thin. Rather, they appear to be sincerely convinced that they are quite overweight.

Even when confronted by family and physicians, they may deny that their attempts to lose weight have caused any significant health problems.

These individuals often refuse to accept, or simply don't understand, that there may be links between recent life events, their emotional condition, and their current eating patterns.

Such denial and lack of insight often frustrates friends and family members, causes conflict with others, and adds to the person's sense of social isolation.

Can Anorexia be Treated?

Fortunately, the answer is "yes." Physicians, mental health professionals, registered dietitians, and other health professionals, working in concert, have developed several successful treatments for Anorexia.

However, these treatments are often complicated by the aforementioned medical and psychological factors associated with Anorexia. Beyond the significant health problems that can be caused by this condition, a person with Anorexia often does not believe that they have a problem, and thus does not need any medical or psychological treatment.

The first step in getting help for a person with Anorexia is to have them seen by a doctor. A physician can assess their general health and provide more information about their current and expected weight.

Occasionally, a person with Anorexia must be hospitalized due to severe malnutrition or other health problems. Typically, they are kept in the hospital until they begin to gain weight and other health professionals can be consulted to establish outpatient treatment.

Long-term nutritional counseling may also be indicated. This counseling can best be accomplished by a registered dietitian who can assess the individual's current dietary practices and establish an eating plan that meets their individual needs.

Mental health professionals, such as psychologists, often provide psychotherapy designed to help these individuals understand their perceptions and unrealistic expectations for themselves, family members and significant others, or the world in general.

Individual or family therapy is often used to address the person's perceptions of food and body image as well as helping to resolve family issues that may be contributing to, or resulting from, the diagnosis of Anorexia.

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Author: Washington, DC.

Florida Dietetic Association (1997). Handbook of Medical Nutrition Therapy: Florida Dietetic Association Diet Manual 2nd Edition.