Anorexia nervosa is an eating disorder in which a person refuses to maintain a healthy weight for his or her age and height. It is a self-imposed starvation resulting from a distorted body image. The individual typically loses 25% or more of his or her original body weight.
People with anorexia nervosa have an overwhelming fear of obesity. They see themselves as fat, even when they are malnourished. They will deny hunger, even when they are starving. Body protein and fat stores become depleted.
The exact cause of anorexia nervosa is unknown. It is believed to be a result of psychological, biological, and social stress. It may be related to sexual development during adolescence. Some experts believe that anorexia nervosa is a response to social attitudes that equate beauty with being thin. Anorexia is extremely rare in areas of the world where food is scarce. There is also evidence that anorexia nervosa runs in families and can be inherited.
Anorexia nervosa occurs most often in females between the ages of 12 and 21. It is most common in middle- and upper-class females. However, it may also occur in males and adult women.
Individuals with anorexia often have the following characteristics:
The malnutrition caused by anorexia can affect many body systems. Some common symptoms of anorexia nervosa include:
If people repeatedly make themselves vomit to keep their weight down, they may develop:
An individual with anorexia may also show symptoms of depression or drug abuse.
Diagnosis of anorexia nervosa begins with a medical history and physical exam. The healthcare provider may order tests to check the person's health status, including:
It may not be possible to prevent the onset of anorexia. However, it is very important to recognize and treat it early. The longer the disease goes on, the more difficult it is to treat.
Five to 10% of the individuals with diagnosed anorexia die from the condition. It can cause dehydration, malnutrition, and salt imbalances. It can affect the brain and muscles. It may also affect the reproductive tract, bowels, stomach, and other body organs. It can cause serious heart problems, including:
People with anorexia may have trouble developing healthy relationships. The person also may be limited in the ability to succeed at school and work.
The goals of treatment are to correct malnutrition and the underlying psychological problem. Weight gain is important. A team approach is most effective. This includes:
Anorexia nervosa may be treated in the hospital or on an outpatient basis. The person's weight, cardiac status, and overall health are factors that influence the treatment options. Some people become so malnourished that they need to be fed through tubes to stay alive. While they are in the hospital, they will have strict rules about eating. In order to earn more privileges, they will have to eat a certain amount of food each day. They are expected to gain a certain amount of weight each week.
A combination of cognitive behavioral therapy and family therapy are often effective for people with anorexia.
Medicines are rarely used to treat anorexia. If the person has significant depression, antidepressants may be used. Sometimes, cyproheptadine is used because it can stimulate appetite. However, it isn't usually effective. People with anorexia do feel hungry. They just choose not to eat.
Antidepressants may cause drowsiness, dry mouth, and constipation.
Psychotherapy usually continues for at least one year after treatment starts. Some individuals may need 5 to 6 years of therapy. People who recover from anorexia need to be aware that this illness can recur.
The individual will have regular visits with the healthcare provider. Any new or worsening symptoms should be reported to the provider.
Author:Michael Johnson, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:06/30/01
Reviewer:Adam Brochert, MD
Date Reviewed:05/30/01