Disease Reference - Anorexia Nervosa Information

Anorexia Nervosa

Anorexia nervosa is a type of eating disorder which is primarily characterised by the sufferer's obsession with food; the intentional restriction of their intake of it plus a general psychological obsession caused by starvation. A person who is suffering from anorexia is known as an anorectic (although the spellings anorexic and anoretic also exist) .

What anorexia is
Anorexia alters an individual's body-image to the point that they may see themselves as being fat and bilious irrespective of their actual size: this distorted body image is a source of considerable anxiety, and losing weight is considered to be the solution. However, when a weight-loss goal is attained, the anoretic still feels overweight and in need of further weight-loss.

The attainment of a lower weight is typically viewed as a victory, and the gaining of weight as a defeat. 'Control' is a factor strongly associated with anorexia, and an anorectic typically feels highly out of control in their life. However the nature of the condition with respect to such psychological factors is highly complicated.

It is often the case that other psychological difficulties and mental illnesses exist alongside anorexia in the sufferer. Mild to severe manifestations of depression are common, partly because an inadequate calorie-intake is a well-known trigger for depression in susceptible individuals. Other afflictions may include self-harm and obsessive-compulsive disordered thinking (aside from such disordered thinking connected to their eating disorder). However, not all anoretics have any such problems besides their eating disorder.

Many anoretics reach a low level of bodyweight where hospitalization and forced-feeding are required on a long-term or recurring basis in an attempt to keep them from literally starving themselves to death. It is an unfortunate fact that prolonged starvation will result in death as the body's systems shut down, this in itself being the major danger-factor of anorexia aside from mental suffering and the risk of suicide.

Some anoretics may incorporate bulimic behaviors into their illness; binge-eating and 'purging' (themselves, of food) on a regular or infrequent basis at certain times during the course of their disease. Alternatively, some individuals might switch altogether from having anorexia to bulimia. While bulimia poses less of a mortal danger to life and limb, many who have suffered both say that bulimia involves more mental suffering.

Anorexia alters one's body image so that one does not see the truth about oneself even when one looks in the mirror - to the anorexic mindset, there is no such thing as being too thin. Anoretics acknowledge their condition to different degrees - at one extreme they do not see their 'disease' as dangerous and resent being labelled as psychologically ill, while at the other they understand and accept that they have a problem, yet the anorexia still takes control over their thinking to fluctuating degrees. In ways not too dissimilar from people who have had cult programming or post-traumatic stress disorder, an anoretic may be 'triggered' into manic disordered thinking by being exposed to certain words or conditions.

Some people eat unusually small amounts of food for reasons other than their own perceived obesity. Examples include those who fast for religous reasons, execute a hunger strike as a political statement, or are attempting to lengthen their lifespan through caloric restriction. Such individuals are not oridinarily considered anoretic, although some modern critics of religious asceticism have likened habitual fasting to anorexia.

Anorexia nervosa by medical definition
The following is considered the "text book" definition of anorexia nervosa to assist doctors in making a clinical diagnosis. It is in no way representative of what a sufferer feels or experiences in living with the illness. It is important to note that an individual can still suffer from anorexia even if one of the below signs is not present. In other words, it is dangerous to read the diagnostic criteria and think either oneself or others must not be anorexic because one or more of the symptoms listed are not present.

Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
Intense fear of gaining weight or becoming fat, even though underweight.
Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
In postmenarcheal females (women who have not yet gone through menopause), amenorrhea (the absence of at least three consecutive menstrual cycles).

Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating OR purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Dangers of anorexia nervosa
Anorexia has the highest death rate of any psychiatric illess. Starvation can cause major organs to shut down. A heart attack is one of the most common causes of death in those suffering with an Eating Disorder. People can die from eating disorders at any weight.
Osteoporosis is another danger of anorexia. Low calcium intake is only part of the problem. Even in those who take in adequate calcium through food or supplements, amenorrhea prevents the body from absorbing it fully.

see link: http://www.sfwed.com/dangers/dangers.php

Who suffers from anorexia
While anorexia may occur in individuals across the demographic divides, it definitely appears to be far more prone to developing among those in certain groups, such as:

females
those of age 10 through to 25
people who are active in dancing, modeling or gymnastics
people of European racial descent
students who are under heavy workloads
those who have suffered traumatic events in their lifetime such as child abuse and sexual abuse*
those positioned in the higher echelons of the socioeconomic scale
the highly intelligent and/or high-achievers
perfectionists

Anorexia is typically stereotyped as being a disease of teenage females. However, in real-life, almost any individual can be a sufferer, as even children as young as three have been known to develop the disease. The most common times of onset are at puberty, and during times of transition such as moving from school to university. Males are at a greater risk of not recovering from the disease due to a reluctance to report symptoms.

The disease is believed to be far more common in some societies than others, especially those of Europe, the Americas and Australasia.

What causes anorexia
The cause(s) of anorexia is a matter of debate in medical circles and society in general. General perspectives fit between the poles of it being physiological or psychological (with the potential for sociological and cultural influences being a cause to various degrees) in origin. Many now take the opinion that it is a mix of both; in that it is a psychological condition which is often (though not inherently) borne of certain conducive neurophysiologic conditions.

There is increasing speculation that the onset of anorexia has a genetic component, with a certain gene linked to abnormalities with the neurotransmitter chemical serotonin being shown to be more common amongst sufferers than the general population. Such genetic characteristics might potentially equate to an easier path towards overly high serotonin levels, thus instilling heightened levels of anxiety and the like. Biologically, when a person is in a state of starvation, their levels of serotonin decrease, and thence increase again upon the consumption of food because of the tryptophan amino acids contained therein (typtophan is used by the body to synthesise serotonin). This raises the spectre that the anoretic is conditioned into avoiding food to reduce their anxiety, and that there may be yet another layer of complexity with respects to the cause/effect relationship between physiological factors and the mental beliefs of the anoretic.

The mass media and advertorial marketing are also frequently viewed as being implicated in triggering eating disorders in teenage girls although it has recently come to light that there appear to be girls exhibiting anorexic behaviours in remote parts of Africa that have not been exposed to modern forms of advertising. These girls link their self-starvation to religious causes¹.

Many individuals who have obsessive-compulsive disorders also have an eating-disordered parent, presumably connected with shared genetic characteristics.

Victims of mercury, lead, beryllium and arsenic poisoning have been known to develop anorexia as a symptom thereof. Some psychological traits associated with anorexia are consistent with deficiencies in important vitamins and minerals, such as magnesium and the B vitamins. Zinc deficiency is common among anoretics, thereby resulting in heightened levels of copper which is associated with depression and nervousness. That these deficiencies (or untoward exposure to heavy metals) can produce powerful psychological effects, such as depression, anxiety, and loss of appetite, is not widely known. Conversely, overexposure is also harmful.

Signs that a person may have anorexia

they are too thin and / or appear to have lost weight
they are secretive about their eating and may try to not eat whilst being around others
their eating is ritualistic in nature: this can encompass taking abnormally small bites, cutting food up into abnormally small pieces, being sullen during mealtimes, staring at their food whilst eating, holding cutlery in odd ways or at strange angles at times, eating slowly - especially when putting food into the mouth
looking longingly or paying abnormal attention towards food but not eating it
cooking wonderful meals for others but avoiding eating the food they've made themselves
they say they're too fat when they are not
suffering from poor health and sunken eyes
they've grown lanugo (a thin hair that grows all over their body as a natural physiological reaction to severe starvation that serves to keep the body warm in the absence of fat)
they possess an extensive knowledge about the calorie contents of the different types of food, and the calorie-burning effects of each form of exercise they faint or otherwise pass out (an effect of starvation)
amenorrhea (the absence of menstruation)

A person can be anoretic without displaying all of the above signs.

Although the anoretic is less likely to choose fattening foods to eat, this is not always so. They may set their food-restriction objectives by the calorie rather than by food-type - for example one may set a goal of 500 calories in a day and the food chosen to attain that number may very well be a chocolate bar one day and apples the next.

Treating anorexia
Successful treatment of, and recovery from, anorexia is possible but it can take many years. The earlier intervention arrests the course of the disease, the more successful the treatment is likely to be. Anorexia nervosa has the highest death-rate of all mental illnesses, with around up to 20% of anoretics eventually dying, usually from heart/organ failure or low levels of potassium. Once an anoretic reaches a certain weight, death becomes a very real possibility. The BMI (or body mass index) where this starts becoming a danger is generally around 12 to 12.5.(As a point of reference, a normal BMI is between 20 and 23, most "centrefold" models have a BMI of 18, and most fashion models come in at 17. An anorexic weight is usually defined as being below 17.5. Approaches include hospitalisation, psychotherapy, specialised anorexia treatment-centres, and family counselling. The prescription of psychotropic drugs such as antidepressants is also practiced.

Appropriate treatment of any present vitamin and dietary-mineral deficiencies, particularly in the common case of zinc deficiency, may be highly beneficial to the sufferer's mental and physical wellbeing.

Anorexia is notoriously hard to treat, with sufferers often either emphatically denying that they are ill or paradoxically, accepting that they have anorexia, but seeing nothing wrong with their "lifestyle choice". This latter view is evidenced by the growing number of "pro-ana" websites and discussion groups where self-identified "anorexics" come together to reinforce their beliefs and behaviours, creating a positive feedback loop.

How to behave towards somebody who has anorexia
The best help an anoretic can receive is unconditional love and empathy. Anorexia is fundamentally less about food than an individual's psychological need to feel safe - in that they do not.

As is common among suffers of some eating disorders, an anoretic may be very secretive about their disorder. Being confronted by another about it for the first time may result in feelings of panic and distress, so an informed and considerate caution is recommended. However it is important to remember that anorexia is a dangerous disorder that signifies chronic suffering in an individual - it is important not to delay in seeking help for the person whom you believe has anorexia or bulimia. Researching the condition and consulting your local eating-disorder support-network are good beginnings.

In handling an anorexic dependant, is dangerous to 'just force' them to eat without support. Eating for most anorexics is not as easy as "just eat" as with non eating-disordered people. While being firm is important, keep in mind that eating things which are not considered 'safe' will most likely strike fear and panic inside the sufferer.