Anorexia Nervosa often abbreviated to anorexia, is an eating disorder in which individuals have an intense fear of gaining weight. This type of eating disorder is more prevalent in young girls and women ((90% of cases found in females) but it is also found in boys and men. The actual prevalence of anorexia in girls and young women is thought to be about 1%, but due to the secretive nature of the disorder this figure may well be higher. Whilst anorexia nervosa actually means ‘loss of appetite due to nervous reasons’ in practice the disorder isn’t actually a lack of appetite but an individual not actually allowing themselves to satisfy their appetite.
It is characterized by a morbid obsession with weight and body shape with the sufferer developing chaotic and disordered eating patterns. This disorder is very different from the behaviours seen in those with food phobias or excessive faddy eating.
The causes of anorexia are unknown but are believed to be a combination of social, psychological and genetic processes. They can include
• Female sex
• Repeated dieting
• Low self-esteem
• Perfectionism
• Losses and major life events
• Early Puberty
• Temperament
• Family Dysfunction
• Teasing related to weight & dieting
Whilst some consider the society we live in which emphasizes the importance of being thin as being a trigger, anorexia is a complex disorder and is associated with feelings of control, self-worth and achievement.
Symptoms
There are many symptoms associated with anorexia and they include
• Progressive weight loss, which may actually start out as a normal weight reducing diet that becomes out of control. Whilst children and teenagers may still gain weight it is much less than expected for their age and height.
• Self-induced weight loss may involve severe restriction of foods, or restricting particular food groups such as those containing fat. Avoiding eating with others, or cutting food into tiny pieces so it appears they have eaten more.
• Self induced vomiting
• Excessive exercise
• Use of laxatives, appetite suppressants, diuretic tablets (to make you urinate more)
• Deny being underweight or any associated problems with food/weight.
• Mood swings, depression
• Socialising less, becoming more dependent and less assertive.
• Developing rituals related to eating and hiding food.
Health Problems related to Anorexia
• Women with anorexia can find that their periods stop
• Puberty can be delayed in young girls
• Stomach pains, swollen stomach and problems with constipation or diarrhoea.
• Downy hair growth on face and body
• Teeth problems due to erosion of tooth enamel from prolonged vomiting.
• Thin, dry hair that falls out
• Dry, rough or discoloured skin
• Feeling of being cold all the time
• Fainting spells, low blood pressure.
Obviously long-term health problems of anorexia are potentially very serious indeed, not only can the following conditions occur but if the illness remains untreated then individuals can actually die from related health problems.
• Osteoporosis
• Damage to the essential organs such as heart, brain, liver and kidneys.
• Infertility
Diagnosis:
A visit to the Doctor is the first port of call although this can be very difficult, as the sufferer tends to deny that they actually have a problem and often another family member may bring them to treatment. Or an individual may visit the doctor due to other symptoms that are actually related to their anorexia such as their periods stopping or stomach problems.
A diagnosis involves a thorough assessment of both psychological and physical factors, involving the individuals’ thoughts and beliefs related to foods, dieting and body image.
A person with anorexia typically weighs 15% less than their expected weight for their height and age. For an adult another way to help identify is by using the Body Mass Index, a healthy range is between 20-25, those suffering with anorexia have a BMI of less than 17.5.
Treatment:
It is outside the scope of this article to cover the full aspects of treatment so this is just to provide on overview of the sort of treatment to expect.
The National Institute for Health and Clinical Excellence (NICE) produced guidelines in 2004 that sets the standards for NHS treatment of eating disorders.
• Doctors should make an early diagnosis of an eating disorder so that those in need in help can assessed and receive appropriate treatment as soon as possible
• Assessment of individuals with eating disorders should be a thorough process and include physical, psychological and social needs and include an assessment to potential risk to self.
• Care will usually be provided on an outpatient basis and should involve a specialist mental health team; this may include psychiatrist, nurse, and dietitian. A number of treatments will be offered including psychological treatments such as cognitive behaviour therapy, to help the individual understand why anorexia developed in the first place and to learn to communicate emotions through a medium other than food.
• For those requiring more specialist inpatient treatment (i.e. those who have failed to respond to outpatient treatment or the risk to health is too significant) this should be a setting that is experienced in dealing with eating disorders.
• For children and adolescents, family members including other children should be involved in the treatment and care.
Treatment will vary dependent on the individual circumstances and no one person will respond in the same manner, but the overriding aim of treatment is to
• To reduce of harm or death caused by the illness
• To encourage healthy weight gain and healthy eating
• To treat any other associated physical conditions that have resulted from the anorexia
• To promote both physical and mental well being of the individual
Early intervention and treatment has been shown to greatly improve the chances of recovery from anorexia, although it is important to remember that this is an illness that may last for months or years and achieving what is considered to be a ‘normal’ weight can be a long process.
For children who develop anorexia before or during puberty their growth can be stunted as the physical changes of puberty are prevented from occurring at such a low body weight. Women with anorexia can find it more difficult to become pregnant and also more likely to suffer from premature or low birth weight babies.
