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Anorexia nervosa is a puzzling, frustrating, sometimes fatal disease that causes its victims to lose interest in or even to be repulsed by food. Treatment of anorexia is always complex and long-term, but it is possible to overcome the condition.

Anorexia nervosa, or more commonly, simply "anorexia", is a potentially fatal disease that causes an inability to maintain a normal weight. There can be an unusual fear of weight gain, relentless eating habits that prevent weight gain, and a distortion in the ways that weight and shape of the body are perceived.

Anorexia can strike anyone at any age. However, it is more common in women than in men, and more common in teenagers and young adults than in children and older adults. Worldwide, anorexia occurs in 0.3 to 1.0 percent of women and 0.1 to 0.3 percent of men. In the United States, between five and 13 percent of young women show some of the symptoms of the disease but not enough to be diagnosed with it. Anorexia is especially common in groups for whom thinness is rewarded, such as women in college sororities, wrestlers, skaters, runners, gymnasts, models, actors, and flight attendants.

What causes anorexia?

Teens and young people who develop anorexia often were previously overweight. They go on a diet and lose weight, and then receive praise for their weight-loss efforts. To get more compliments on their appearance, these young people continue their weight-loss behaviors to the point they endanger their health.

Susceptibility to these behavioral changes involves processes in the brain that are influenced by estrogen. People who are prone to anorexia tend to have difficulty with set shifting, the ability to "shift mental gears" in response to changing circumstances. They may have problems processing their emotions around social interactions. They may develop a low-energy personality because their bodies don't receive enough food to make energy. Deprivation of calories leads to physiological changes that cause the person to get stuck in their patterns of food avoidance even when psychotherapy is successful.

What are the symptoms of anorexia?

Anorexia is often accompanied by pervasive, persistent depression. Some people who struggle with anorexia lack the self-esteem that enables them to deal with their anxiety about "making it" in life. They may have problems with alcohol, opiates, marijuana, or other drugs, and they use praise from others or praise from themselves as a kind of drug to help them deal with this anxiety. Anorexia can be a slow suicide attempt to release them from their persistent depression.

As the condition continues, anxiety is replaced with apathy. The toll of malnutrition saps energy and makes emotion flat. Chronic food deprivation creates a variety of physical symptoms, including:

  • Cold hands and feet.
  • Constipation.
  • Dry skin and hair.
  • Fainting spells.
  • Headaches.
  • Irritability.
  • Lethargy.
  • Thinning hair.
  • Carotenemia, an orange tint to the skin.
  • Atrophy of the breasts.
  • Slow pulse.
  • Low blood pressure.
  • Acrocyanosis, purplish color in the hands and feet due to poor circulation.
  • Slow motion and retarded reflexes.

Anorexia can also produce psychotic reactions characteristic of Wernicke-Korsakoff syndrome when there is long-term deprivation of B vitamins.

How do doctors diagnose anorexia?

Doctors look for signs that the patient is afraid of gaining weight. The doctor also considers the body-mass index (BMI). A BMI that is lower than 97 percent of the population is common in anorexia. Clear signs of the disease include:

  • A "fat" body image that persists despite weight loss.
  • Weight less than 85 percent of what is expected for height.
  • Consumption of less than 1000 kilocalories per day or getting rid of calories by purging or excessive exercise.
Due to a change in the DSM-5 that deleted failure to have menstrual periods from the diagnostic criteria for anorexia, sometimes it can be difficult for doctors to distinguish between "constitutional thinness" and anorexia in young women. One relatively simple method of making the differential diagnosis is testing for a form of thyroid hormone called T3. Normal levels of T3 suggest that there is no eating disorder and no resistance to weight gain, that low weight is natural and not something to be treated. It is also possible to detect the difference between anorexia and "thinness" with tests for estradiol (in women) and a hormone called leptin, but these tests are more expensive and not as generally available.

What are some of the potential complications of anorexia?

In about 10 percent of cases, anorexia results in death. Even when the condition is brought under control, there can be lasting damage to the heart and kidneys, and the effects of B-vitamin deprivation on the brain cannot always be completely reversed.

What is the treatment for anorexia?

Anorexia cannot be treated without addressing shame, guilt, or lack of insight with regard to the disease. The damage to the body from under-nutrition and malnutrition, however, may make medical treatment of physical symptoms the priority. Patients may be put in the hospital for refeeding and then sent to rehab facilities for treatment of the underlying psychological disturbances of the disease. Recovery from anorexia usually involves pharmacological treatment for depression and ongoing monitoring to prevent relapse of the disease.

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th ed. Washington, DC: APA Press
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  • Flament MF, Bissada H, Spettigue W. Evidence-based pharmacotherapy of eating disorders. Int J Neuropsychopharmacol. 2011 Mar 18. 1-19.
  • Miller KK, Grinspoon SK, Ciampa J, Hier J, Herzog D, Klibanski A. Medical findings in outpatients with anorexia nervosa. Arch Intern Med. 2005 Mar 14. 165(5):561-6.
  • Photo courtesy of SteadyHealth

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