Anorexia Nervosa

Anorexia nervosa is a mental illness. You have a preoccupation with food and body image to the extreme: You don’t eat. Despite being underweight, you continue to try to lose weight. The syndrome is more common in women than in men, and most often begins between the ages of 13-30 years. The medical complications brought about by this psychiatric disorder can be severe. You may die.

A variety of psychological, genetic, biological, developmental, and societal factors may contribute to developing this syndrome. Anorexia nervosa may be encouraged because of our society's emphasis on thinness, especially in women.

• You may have some genetic risk toward developing it.

• Some evidence suggests differences in brain chemicals in those who develop anorexia.

• With anorexia nervosa, you have an intense fear of gaining weight or becoming fat despite the fact that you may be underweight.
  
  
• You may use one or more of the following methods to lose weight.

• Undereating
  
  
• Excessive exercise
  
  
• Vomiting
  
  
• Laxative use
  
  
• Diuretic use (increases amount of urination)

• Usually people do these things secretively. For instance, if eating with others, a person with anorexia may move food around on a plate or place some food in a napkin to hide it. If confronted by these unusual behaviors, the person may deny or refuse to discuss them.
  
  
• Some of the following signs may also be brought about by starvation or by weight reduction methods:
  
  
  • Constipation or diarrhea
    
    
  • Fatigue
    
    
  • Menstrual periods stop or puberty is delayed
    
    
  • Hand injuries from inducing vomiting
    
    
  • Decayed teeth from stomach acid
    
    
  • Yellowing of skin
    
    
  • Kidney stones
    
    
  • Depression
  
  
• Anorexia is more common among teen-aged women involved in gymnastics, ballet, or modeling in which being thin is thought to be a benefit.

Again, there is no home remedy. Any person who displays symptoms of anorexia nervosa (undereating, inducing vomiting, or abusing laxatives in an attempt to lose weight) needs medical and psychiatric attention. Some specialists are adept at treating these very challenging patients. Anorexia nervosa can cause severe medical complications or death if not treated.

Anorexia nervosa can result in life-threatening medical problems. The following signs and symptoms indicate need for emergency evaluation:

• Suicide is a major cause of death in people with anorexia nervosa. Any person with severe depression or suicidal thoughts or statements needs to be brought to the hospital’s Emergency Department immediately. Call 911 for an ambulance if you believe there is even a remote possibility of imminent suicide.

• Fainting

• Dizziness
  
  
• Confusion
  
  
• Shortness of breath
  
  
• Profuse vomiting or diarrhea
  
  
• Blood in vomit or diarrhea
  
  
• Chest pain
  
  
• Abdominal pain
  
  
• Weakness

• Often the doctor may choose to admit a person with anorexia to the hospital for a variety of medical or psychiatric reasons.

• The person may develop medical problems (cardiac, endocrine, electrolyte) from starvation, vomiting, diuretic, or laxative abuse.

• Outpatient treatment of anorexia nervosa is often unsuccessful. Someone with anorexia may need prolonged treatment (including cognitive, behavioral, drug, and counseling or some combination) in a structured hospital environment or special inpatient eating disorders program.

Medical assessment must include height and weight measurements, vital signs, blood and urine tests, an ECG, and a thorough history and physical exam.

• Criteria used to diagnose anorexia nervosa include the following:
  
  
  • Refusal to maintain body weight at or above a minimally normal weight for age and height (usually weight has dropped to less than 85% of an expected normal weight)
    
    
  • Intense fear of gaining weight or becoming fat even though underweight
    
    
  • Disturbance in the way your body weight or shape is experienced; undue influence of body weight or shape on your feeling of self-worth; denying the seriousness of your current low body weight
    
    
  • In menstruating women missing at least 3 consecutive menstrual cycles (creates the condition of amenorrhea)

• Diagnosing anorexia nervosa is difficult. A variety of acute and chronic medical and psychiatric conditions can have the same signs and symptoms. A physician must rule out the other illnesses.

|Self-Care at Home|

• Recognizing that a problem may exist is crucial.

• Rarely are people aware of this problem themselves because this disease is defined by a distorted view of their own body image or weight. A family member or friend must recognize the possibility of a medical or psychiatric problem.

• A person with anorexia nervosa often resists questioning and is extremely secretive, usually denying any problem and making excuses for weight loss or eating habits. If pressed on the subject, the person may become angry or withdrawn, further complicating attempts by others to help.

• If you think a friend or family member has a problem, get that person to a physician, even if she or he strongly resists cooperating.

• There is no home remedy.

|Medical Treatment|

Treatment often can be extremely challenging because someone with anorexia will not cooperate or resists participation in any treatment program. A coordinated team of specialists is needed to handle all the medical and psychological components of this illness.

• Initially, treatment must focus on stabilizing any life-threatening complications of starvation. In severe cases, the medical team will assist in regaining weight, possibly using nutrition replacement through an IV.

• The team must educate the person about the disease and its medical complications, as well as teach proper nutritional requirements.

• Psychiatric treatment uses cognitive, behavioral, and psychotherapeutic methods within a comprehensive treatment plan.

• Sometimes doctors will use medications, but such programs lack proof that they work.

• Family and support networks should be actively involved in treatment.

|Follow-up|

Treatment of anorexia nervosa often takes years, during which time close follow-up with a doctor is essential.

|Outlook|

• Death from the medical complications of anorexia or from suicide can be as high as 18%.

• About half of those affected will make a full recovery.

• Some people will develop chronic relapses.

• Coexisting psychiatric conditions may complicate the prognosis.

anorexia, starvation, eating disorder, anorexia nervosa

Author: Bradley J Kaufman, MD, Staff Physician, Department of Emergency Medicine, Albert Einstein College of Medicine.

Coauthor(s): Andrew Wollowitz, MD, Assistant Professor, Department of Emergency Medicine, Montefiore Medical Center, Albert Einstein College of Medicine.

Editors: Scott H Plantz, MD, FAAEM, Research Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Anthony Anker, MD, FAAEM, Attending Physician, Emergency Department, Mary Washington Hospital, Fredericksburg, VA.