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| |    Recognizing and Treating Anorexia Nervosa by Robert Needlman, M.D., F.A.A.P. reviewed by Robert Needlman, M.D., F.A.A.P. Anorexia nervosa is about more than just dieting too much. A person with anorexia nervosa--most, but not all, patients are teenage girls and young women--believes that she is overweight, even when she is obviously way too thin. This delusion persists despite the fact that her parents, friends, and doctors may tell her she is underweight, and even though she is (or is becoming) weak and ill. This extreme fear of gaining weight dominates her thoughts. Being fat is the worst possible fate she can imagine; nothing else is nearly as important. In medical terms, "anorexia" means a loss of appetite. But many people with anorexia nervosa are actually hungry all the time! They wage a constant fight against the hunger they feel in order to attain the abnormal, waiflike body shape that they have come to see as normal. They may be obsessed with food, cooking elaborate meals that they do not eat. Some may exercise compulsively, two or three time a day, and if they do slip up and eat something fattening, they exercise even more to burn away the calories. Physical changes Along with the changes in behavior and thinking, there are physical changes in people who have anorexia nervosa. To be diagnosed with anorexia nervosa, a person has to have lost a significant amount of weight so that they are well below the normal lower limit for their age and height. With the loss of body fat, hormone levels fall and young women's menstrual periods cease (or do not start at all). Males with anorexia also have abnormal sex-hormone levels. As the state of undernourishment worsens, the bones lose calcium and weaken. There is damage to muscles throughout the body, including the heart and other organs. In the extreme case, about 1 out of 10 people with anorexia nervosa die prematurely as a result of their disease. Anorexia's relationship to other disorders Anorexia nervosa often accompanies other psychiatric disorders, such as clinical depression. People with the disorder may alienate their friends and family, who see the person's self-destructive behavior but cannot talk them out of it. Although anorexia starts with unrealistic attitudes toward thinness (which are common enough), by the time a person truly has the disorder, these attitudes are just part of the problem. In order for treatment to be effective, it has to include not only weight gain, but also changes in body image and thinking patterns, and often treatment of other psychiatric issues. What causes anorexia nervosa? Overall, somewhere between 0.5 percent and 3.7 percent of people develop anorexia nervosa at some time in their lives. Most are teenage girls or young women; about 1 in 20 to perhaps 1 in 7 is male. The exact causes are unknown. There seems to be an inherited component that may be related to the biological vulnerability underlying obsessive-compulsive disorder and perhaps addictive behavior. People who develop anorexia are often outwardly successful (earning good grades, for example), but often feel inwardly inadequate. They may have trouble expressing emotions, particularly anger. Their self-destructive dieting behavior becomes a way to do that. They may feel that they are not in control of their lives, and that weight loss is something that is in their control. Treatment methods Because anorexia is a complex disorder, with physical, psychological, and nutritional components, it's best treated by an experienced doctor, often with a psychologist or psychiatrist, family therapist, and nutritionist. Try to find a program that specializes in the comprehensive treatment of eating disorders. The first priority is weight gain. People who are severely underweight typically need to be hospitalized to ensure that they put on pounds safely. Hospitalization is expensive and difficult, but it's often necessary as there is a real risk of serious physical harm, and even death, from anorexia nervosa. Different types of psychotherapy can be helpful. These commonly focus on helping the person change how she thinks about her body and what it means to be attractive and successful. She needs to learn to take satisfaction in other activities (friends, art, or simply having fun) and to express her feelings in nondestructive ways. Medication can help treat depression or other psychiatric problems that go along with the eating disorder.
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