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Anorexia nervosa is a psychiatric disorder characterized by abnormal eating behavior, severe self-induced weight loss, and psychiatric comorbidities. People with anorexia have an extreme fear of gaining weight, which causes them to try to maintain a weight far less than normal. They will do almost anything to avoid gaining weight, including starving themselves or exercising too much. People with anorexia have a distorted body image -- they think they are fat (even when they are extremely thin) and won't maintain a proper weight.
Anorexia is an emotional disorder that focuses on food, but it is actually an attempt to deal with perfectionism and a desire to gain control by strictly regulating food and weight. People with anorexia often feel that their self esteem is tied to how thin they are.
Anorexia is increasingly common, especially among young women in industrialized countries where cultural expectations encourage women to be thin. Fueled by popular fixations with thin and lean bodies, anorexia is also affecting a growing number of men, particularly athletes and those in the military.
Anorexia most commonly affects teens, as many as 3 in 100. Although anorexia seldom appears before puberty, when it does, associated mental conditions, such as depression and obsessive-compulsive behavior are usually more severe. Anorexia is often preceded by a traumatic event and is usually accompanied by other emotional problems. Anorexia is a life threatening condition that can result in death from starvation, heart failure, electrolyte imbalance, or suicide. For some people, anorexia is a chronic disease, one that lasts a lifetime. But treatment can help people with anorexia develop a healthier lifestyle and avoid anorexia's complications.
Signs and Symptoms
The primary sign of anorexia nervosa is severe weight loss. People with anorexia may try to lose weight by severely limiting how much food they eat. They may also exercise excessively. Some people may engage in binging and purging, similar to bulimia. They may vomit after eating or take laxatives. At the same time, the person may insist that they are overweight.
Psychological and Behavioral Signs
What To Watch For
No one knows exactly what causes anorexia. Medical experts agree that several factors work together in a complex fashion to lead to the eating disorder. These may include:
People with anorexia may think they are in control of their disease and don't want any help. But if you or a loved one is experiencing signs of anorexia, it's important to seek help. If you are a parent who suspects your child has anorexia, take your child to see a doctor immediately. He/she will order several laboratory tests and perform a psychological evaluation. If your doctor suspects anorexia, he or she may use the SCOFF questionnaire, developed in Great Britain. A "yes" response to at least 2 of the following questions is a strong indicator of an eating disorder:
Lab tests may include:
If your doctor makes a diagnosis of anorexia, you will likely work with a multidisciplinary team including a doctor, a psychologist or psychiatrist, and a registered dietitian.
The most effective way to prevent anorexia is to develop healthy eating habits and a strong body image from an early age. Don't accept cultural values that place a premium on thin, perfect bodies. Make sure you and your children are educated about the life threatening nature of anorexia.
For people who have already developed anorexia, the primary goal is to avoid relapse.
The most successful treatment is a combination of psychotherapy, family therapy, and medication. It is important for the person with anorexia to be actively involved in their treatment. Many times the person with anorexia doesn't think they need any treatment. Even if they know they need treatment, anorexia is a long term challenge that may last a lifetime. People remain vulnerable to relapse when going through stressful periods of their lives.
A combination of treatments can give the person the medical, psychological, and practical support they need. Cognitive behavioral therapy, along with antidepressants, can be an effective treatment for eating disorders. Complementary and alternative therapies may help with nutritional deficiencies.
If the person's life is in danger, hospitalization may be needed, particularly under the following circumstances:
Even after some weight gain, many people with anorexia remain quite thin and the risk of relapse is very high. Several social influences may make recovery difficult:
Involving friends, family members, and others in the treatment may be helpful.
Treating anorexia nervosa involves major lifestyle changes:
There are no medications specifically approved to treat anorexia. However, antidepressants are often prescribed to treat depression that may accompany anorexia. Your doctor may also prescribe drugs to help with OCD or anxiety. Medications, however, may not work alone and should be used in conjunction with a multidisciplinary approach that includes nutritional interventions and psychotherapy.
Selective serotonin reuptake inhibitors -- These antidepressants are sometimes prescribed for people with anorexia. Fluoxetine (Prozac) has been studied in people with anorexia and depression, with mixed results. In some early studies, it appeared to increase weight and improve mood over several months. But in another, it helped relieve symptoms of depression, but did not affect the anorexia itself.
Recent studies indicate that the use of Prozac and other antidepressants may cause children and teenagers to have suicidal thoughts. Children who are taking these drugs must be monitored very carefully for signs of potential suicidal behavior.
People with anorexia may not be getting the essential nutrients their bodies need. Your health care provider may prescribe potassium or iron supplements, or other supplements to make up for any deficiency. He/she may also prescribe cyproheptadine, an antihistamine that may stimulate appetite. In one study, using high doses of cyproheptadine hydrochloride decreased the number of days it took people with anorexia to gain an appropriate amount of weight.
Nutrition and Dietary Supplements
People with bulimia are more likely to have vitamin and mineral deficiencies, which can affect their health. Vitamin deficiencies can contribute to cognitive difficulties such as poor judgment or memory loss. Getting enough vitamins and minerals in your diet or through supplements can correct the problems.
Always tell your doctor about the herbs and supplements you are using or considering using, as some supplements may interfere with conventional treatments.
Following these nutritional tips may help overall health:
Your doctor may suggest addressing nutritional deficiencies with the following supplements:
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
No scientific literature supports the use of homeopathy for anorexia. However, an experienced homeopath will consider your individual case and may recommend treatments to address both your underlying condition and any current symptoms.
Cognitive Behavioral Therapy
Cognitive behavioral therapy is one of the most effective therapies for anorexia. In cognitive behavioral therapy, the person learns to replace negative, unrealistic thoughts and beliefs with positive, realistic ones. The person is also encouraged to acknowledge their fears and to develop new, healthier ways of solving problems.
In addition to individual therapy for someone who has anorexia, family therapy that involves parents and siblings is also recommended. Parents and other family members often have intense feelings of guilt and anxiety that they need to address. Family therapy is aimed, in part, at helping the parents or partner (in the case of an adult) understand the seriousness of this illness and the ways in which family patterns may contribute to it.
Hypnosis may be helpful as part of an integrated treatment program for anorexia nervosa. Hypnosis may help the person strengthen both self confidence and the ability to cope. That may result in healthier eating, improved body image, and greater self esteem.
Studies suggest that biofeedback may be helpful in reducing stress in people with anorexia.
Anorexia poses several potential problems for women who are pregnant or wish to become pregnant:
Prognosis and Complications
Medical complications associated with anorexia include:
The outlook for people with anorexia is variable, with recovery often taking between 4 - 7 years. There is also a high chance of relapse even after recovery. Long term studies show that 50 - 70% of people recover from anorexia nervosa. However, 25% do not fully recover. Many, even after they are considered "cured," continue to show traits of anorexia, such as remaining very thin and striving for perfection. Anorexia is associated with high lifetime mortality from both natural and unnatural causes.
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Review Date: 12/11/2010
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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