Anorexia nervosa is an eating disorder characterized by self-starvation,
of weight gain, and conspicuous distortion of body image.
The term anorexia nervosa comes from two Latin words that mean
"nervous inability to eat." Anorexics have the following
characteristics in common:
There are two subtypes of anorexia nervosa: a restricting type,
characterized by strict dieting and
without binge eating; and a binge-eating/purging type, marked by episodes
of compulsive eating with or without self-induced
and/or the use of
or enemas. A binge is defined as a time-limited (usually under two hours)
episode of compulsive eating in which the individual consumes a
significantly larger amount of food than most people would eat in similar
Anorexia nervosa was not officially classified as a psychiatric disorder
until the third edition of
Diagnostic and Statistical Manual of Mental Disorders (DSM)
in 1980. It is, however, a growing problem in the early 2000s among
adolescent females. Its incidence in the United States has doubled since
1970. The rise in the number of reported cases reflects a genuine increase
in the number of persons affected by the disorder and not simply earlier
or more accurate diagnosis. Estimates of the incidence of anorexia range
between 0.5 percent and 1 percent of Caucasian female adolescents. Over 90
percent of patients diagnosed with the disorder as of 2001 are female. The
peak age range for onset of the disorder is 14 to 18 years. In the 1970s
and 1980s, anorexia was regarded as a disorder of upper- and middle-class
women, but that generalization is as of 2004 also changing. Studies
indicate that anorexia is increasingly common among females of all races
and social classes in the United States.
Causes and symptoms
While the precise cause of the disease is not known, anorexia is a
disorder that results from the interaction of cultural and interpersonal
as well as biological factors.
The rising incidence of anorexia is thought to reflect the present
idealization of thinness as a badge of upper-class status as well as of
female beauty. In addition, the increase in cases of anorexia includes
"copycat" behavior, with some patients developing the
disorder from imitating other girls.
The onset of anorexia in
is attributed to a developmental crisis caused by girls' changing
bodies coupled with society's overemphasis on female appearance.
The increasing influence of the mass media in spreading and reinforcing
gender stereotypes has also been noted.
The risk of developing anorexia is higher among adolescents preparing for
careers that require attention to weight and/or appearance. These
high-risk groups include dancers, fashion models, professional athletes
(including gymnasts, skaters, long-distance runners, and jockeys), and
Girls whose biological mothers or sisters have or have had anorexia
nervosa appear to be at increased risk of developing the disorder.
A number of theories have been advanced to explain the psychological
aspects of the disorder. No single explanation covers all cases. Anorexia
nervosa has been given the following interpretations:
Although anorexia nervosa largely affects females, its incidence in the
male population is rising in the early 2000s. Less is known about the
causes of anorexia in males, but some risk factors are the same as for
females. These include certain occupational goals and increasing media
emphasis on external appearance in men. Homosexual males are under
pressure to conform to an ideal body weight that is about 20 pounds
lighter than the standard attractive weight for heterosexual males.
A healthcare professional should be contacted if a child or adolescent is
suspected of having anorexia nervosa or displays early signs of the
disorder, such as the following:
Diagnosis of anorexia nervosa is complicated by a number of factors. One
is that the disorder varies somewhat in severity from patient to patient.
A second factor is denial, which is regarded as an early sign of the
disorder. Many anorexics deny that they are ill and are usually brought to
treatment by a family member.
Anorexia nervosa is a serious public health problem not only because of
its rising incidence, but also because
Extreme weight loss in an anorexic adolescent.
(© Ed Quinn/Corbis.)
it has one of the highest mortality rates of any psychiatric disorder.
Moreover, the disorder may cause serious long-term health complications,
including congestive heart failure, sudden death, growth retardation,
, stomach rupture, swelling of the salivary glands, anemia and other
abnormalities of the blood, loss of kidney function, and osteoporosis.
Most anorexics are diagnosed by pediatricians or family practitioners.
Anorexics develop emaciated bodies, dry or yellowish skin, and abnormally
low blood pressure. There is usually a history of amenorrhea in female
patients, and sometimes of abdominal
, constipation, or lack of energy. The patient may feel chilly or have
developed lanugo, a growth of downy body hair. If the patient has been
self-inducing vomiting, she may have eroded tooth enamel or
Russell's sign (scars on the back of the hand). The second step in
diagnosis is measurement of the patient's weight loss.
specifies a weight loss leading to a body weight 15 percent below normal,
with some allowance for body build and weight history.
(Table by GGS Information Services.)
The doctor will need to rule out other physical conditions that can cause
weight loss or vomiting after eating, including metabolic disorders, brain
tumors (especially hypothalamus and pituitary gland lesions), diseases of
the digestive tract, and a condition called superior mesenteric artery
syndrome. Persons with this condition sometimes vomit after meals because
the blood supply to the intestine is blocked. The doctor will usually
order blood tests, an electrocardiogram, urinalysis, and bone densitometry
(bone density test) in order to exclude other diseases and to assess the
patient's nutritional status.
The doctor will also need to distinguish between anorexia and other
psychiatric disorders, including depression,
, social phobia,
, and body dysmorphic disorder. Two diagnostic tests that are often used
are the Eating Attitudes Test (EAT) and the Eating Disorder Inventory
Treatment of anorexia nervosa includes both short- and long-term measures
by dietitians and psychiatrists as well as medical specialists. Therapy
is often complicated by the patient's resistance or failure to
carry out a treatment plan.
is recommended for anorexics with any of the following characteristics:
Hospital treatment includes individual and group therapy as well as
refeeding and monitoring of the patient's physical condition.
Treatment usually requires two to four months in the hospital. In extreme
cases, hospitalized patients may be force-fed through a tube inserted in
the nose (nasogastric tube) or into a vein (hyperalimentation).
Anorexics who are not severely malnourished can be treated by outpatient
psychotherapy. The types of treatment recommended are supportive rather
than insight-oriented and include behavioral approaches as well as
individual or group therapy.
is often recommended when the patient's eating disorder is closely
tied to family dysfunction. Self-help groups are often useful in helping
anorexics find social support and encouragement. Psychotherapy with
anorexics is a slow and difficult process; about 50 percent of patients
continue to have serious psychiatric problems after their weight has
Anorexics have been treated with a variety of medications, including
, antianxiety drugs, selective serotonin reuptake inhibitors, and lithium
carbonate. The effectiveness of medications in treatment regimens is as of
2004 debated. However, at least one study of fluoxetine (Prozac) showed it
helped the patient maintain weight gained while in the hospital.
A key focus of treatment for anorexia nervosa is teaching the principles
of healthy eating and improving disordered eating behaviors. A dietician
or nutritionist plays an important role in forming a
plan for the patient; such plans are individualized and ensure that the
patient is consuming enough food to gain or maintain weight as needed and
stabilize medically. The anorexic's weight and food intake are
closely monitored to ensure that the plan is being followed.
Figures for long-term recovery vary from study to study, but reliable
estimates are that 40 to 60 percent of anorexics make a good physical and
social recovery, and 75 percent gain weight. The long-term mortality rate
for anorexia is estimated at around 10 percent, although some studies give
a lower figure of 3 to 4 percent. The most frequent causes of death
associated with anorexia are starvation, electrolyte imbalance, heart
failure, and suicide.
Short of major long-term changes in the larger society, the best strategy
for prevention of anorexia is the cultivation of healthy attitudes toward
food, weight control, and beauty (or body image) within families. Early
treatment such as counseling may help to prevent early signs of disordered
eating from progressing into more serious behaviors.
—The absence or abnormal stoppage of menstrual periods.
—A pattern of eating marked by episodes of rapid consumption of
large amounts of food; usually food that is high in calories.
Body dysmorphic disorder
—A psychiatric disorder marked by preoccupation with an imagined
—A method of refeeding anorexics by infusing liquid nutrients and
electrolytes directly into central veins through a catheter.
—A soft, downy body hair that covers a normal fetus beginning in
the fifth month and usually shed by the ninth month. Also refers to the
fine, soft hair that develops on the chest and arms of anorexic women.
Also called vellus hair.
—The use of vomiting, diuretics, or laxatives to clear the
stomach and intestines after a binge.
—A scraped or raw area on the patient's knuckles, caused
by self-induced vomiting.
Superior mesenteric artery syndrome
—A condition in which a person vomits after meals due to blockage
of the blood supply to the intestine.
Binge eating disorder
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American Anorexia/Bulimia Association.
418 East 76th St., New York, NY 10021. Telephone: 212/734–1114.
National Association of Anorexia Nervosa and Associated Disorders.
Web site: http://www.anad.org.
National Institute of Mental Health Eating Disorders Program.
Building 10, Room 3S231. 9000 Rockville Pike, Bethesda, MD 20892.