Anorexia Nervosa Basics
Anorexia is characterized by severe weight loss, a dangerously low body weight, extreme exercise and a distorted body image. Our guide outlines how to spot the signs and symptoms of anorexia, guidelines for diagnosing the disorder and current treatment options.
Anorexia: What Is It?
Anorexia nervosa is an eating disorder characterized by severe weight loss, a significantly low body weight, intense fear of getting fat, and a distorted body image that drives an otherwise high-functioning person—usually a young woman—to starve herself. Anorexics keep themselves underweight by eating sparsely and infrequently, as well as purging—voiding food by induced vomiting, laxative use, etc.—and exercising intensely, often without recognizing that their actions are unhealthy or that their perceptions of their bodies are not normal.
Anorexia usually manifests during adolescence and is diagnosed overwhelmingly among females, though one in 10 of those diagnosed are male, and the actual prevalence could be higher as symptoms of starvation in young men are less obvious than in young women. Adolescents and young adults with anorexia are often high-achievers and perfectionists—successful in school and popular with peers—making it difficult for parents and other adults to see how troubled they are. But anorexia is an extremely serious condition—a life-threatening psychiatric disorder that, untreated, leads to fatal medical problems and a high rate of suicide. The earlier it is treated, the better the odds of the patient recovering, and avoiding future relapse.
Anorexia: What to Look For
Behavioral signs that a child might be anorexic include rejection of a healthy amount of food, dramatic dieting, compulsive exercise, and a gross overvaluing of shape and weight as components of her identity. Visible signs that she is starving herself include extreme weight loss, abnormal thinness, brittle nails, hair loss, constipation, irregular menstruation, and swelling. Still, in growing children and adolescents what constitutes a normal weight is very difficult to ascertain; a failure to keep up with normal growth and weight gain that might be perceived as being a “late bloomer” could be a sign of anorexia. But experts agree that the defining characteristic of anorexia is body image distortion—what the child sees in the mirror as unacceptably fat is, to anyone else, disturbingly thin.
Anorexia: Risk Factors
Girls are more likely to have anorexia, as are children with a first-degree biological relative who has the disorder. Participating in activities that emphasize thinness, such as modeling and athletics, are a risk factor. Children with anxiety disorders or obsessional traits are also more likely to become anorexic.
The first step a professional will take towards a diagnosis of anorexia is an evaluation of the child’s weight relative to the average for her age. If she consistently maintains a body weight 15% below average, whether by weight loss or failure to gain weight, a clinician will dig deeper, and try to find out if she is extremely troubled by weight gain or the prospect of being fat, even though she’s so thin. He will look for evidence of an unrealistic body image or denial of the severity of her condition. Irregular periods can also be a factor in diagnosis. The diagnosis can be of restricting type (no purging) or binge eating/purging type (she uses self-induced vomiting or misuse of diuretics, laxatives, or enemas to keep her weight down).
Treatment for anorexia is psychotherapeutic and medical. No known medication can address the core symptoms of anorexia, though drugs are often prescribed to treat co-occurring symptoms.
Psychotherapeutic: While one-on-one cognitive behavioral therapy is often used for adults with anorexia, the most successful treatments for children and adolescents involve the whole family—intensive family therapy and education that enables parents and siblings to help a child with anorexia return to normal eating patterns. The first goal of any treatment is to restore your child to a healthy weight, and she should be immediately hospitalized for this purpose if she is in any medical danger. Milder cases respond well to family therapy; more severe cases require a hospital stay or a residential program. The disadvantage to residential programs is that patients tend to relapse when they are back at home, unless the family lifestyle has changed to make it incompatible with the dangerous behaviors. Treatment is more effective when the disorder is caught early, and the longer a child stays at a healthy weight, the less likely she is to relapse.
Pharmacological: Some drugs, particularly antidepressants, have been effective in treatment, but they are most often targeted at another condition the child might also have, such as depression or obsessive-compulsive disorder. Treating the co-occurring disorder can make the therapy for anorexia more successful.
Anorexia: Other Disorders
Depression, anxiety disorders, obsessive-compulsive disorder, and substance abuse have been associated with the occurrence of anorexia.
Anorexia: Other Concerns
The malnutrition associated with anorexia can create serious medical conditions, including anemia, kidney trouble, brittle bones, and hormone and electrolyte imbalances. At worst, it can be fatal: the havoc anorexia plays with the chemical balance in the body can cause the heart to shut down without notice, even in a young woman who does not appear to be dangerously thin. And the disorder can so impair social life, family connections, and personal development that suicide is a serious risk.