Anorexia nervosa is a condition that involves maintenance of an unhealthy body weight, distorted perceptions about body structure, and an unrelenting desire to be thin.
People who have this illness have an extreme fear of gaining weight although they are already underweight by normal standards. And because anorexia has an underlying attitudinal problem, physicians may not find a physical explanation for the continued weight loss – that is, until it becomes so severe that the proper functioning of the body organs is compromised.
Causes
There is no single cause for anorexia. In fact, many factors are involved, and the root of the problem may differ from one patient to another. It is possible that heredity plays a role, plus the person's perception of body appearance. Some researchers have also attributed anorexia to conflicts within the family or among personal relationships.
Risk factors of anorexia
• Family history of eating disorders or addiction
• Childhood gastrointestinal illnesses and eating problems
• Negative self-image
• Childhood anxiety
• Twisted perception regarding thinness and/or the ideal figure
• Exposure to parents who are also obsessed about keeping thin
• Being a perfectionist
Prevalence
Women are more prone to this illness than men. It generally occurs in adolescence and is mainly reported in young Caucasian females whose families are goal-oriented. They are also often high achievers.
Symptoms
It takes friends and family members to make the victim aware that he or she has anorexia. They often limit their food intake, occasionally induce vomiting to eliminate the food that they have just eaten, and may also take laxatives and diuretics to lose weight in a very short time.
Behaviors of anorexia patients:
• Compulsive eating
• Limiting food intake
• Compulsive exercising
• Using laxatives, diuretics, and enemas excessively in order to lose weight
• Going to the bathroom right after eating
Symptoms of anorexia patients:
• Thinning and/or falling hair
• Increased irritability
• Reduced bone density
• Dry mouth
• Lack of alertness
• Depression
• Dental cavities caused by self-induced vomiting
• Worsening memory
• Hypotension
• Yellowish or blotchy skin
• Sensitivity to cold
• Missed menstrual periods
• Poor judgment
• Drastic weight loss
• Muscle atrophy
• Loss of body fat
Diagnosis and Treatment
Treatment of this condition can be especially challenging because patients often cannot accept that their weight loss is already out of the ordinary. Many cases are brought for medical attention only when anorexia is already in an advanced stage. Therefore, the most difficult part, is to make the patient realize that the problem is specifically the eating behavior, which they believe is the only way out of their problems.
It is not usual for the patient to present himself or herself to a physician or medical facility for relief; more often than none, it is because of friends’ or families’ growing concern that medical attention is sought.
Before a conclusive diagnosis of anorexia is made, physicians need to rule out other possible causes of drastic weight loss, such as brain tumors or chronic debilitating diseases, examples of which are: celiac disease, Addison’s disease, inflammatory bowel disease, or other disorders of the digestive, endocrine, nervous or metabolic systems. It is also important for the health professional to interview people who know the patient well.
Some of the tests that are usually done to determine the reason behind the weight loss or the extent of the damage are: urinalysis, thyroid function tests, ECG, LH response to GnRH, and CHEM-20.
Diagnostic Guidelines
The following guide is useful for coming up with a reliable diagnosis of anorexia:
1. The presence of an endocrine disorder, which involves the hypothalamic-pituitary-gonadal axis. This becomes noticeable in amenorrhea in women and loss of potency in men. Likewise, there could be raised cortisone and growth hormone levels as well as atypical insulin secretion and thyroid hormone metabolism.
2. The patient’s body weight is 15% or more below what is considered typical for the patient’s age, or Quetelet’s BMI is 17.5 or lower.
3. Delayed or arrested pubertal development, if the onset of the disease is during the prepubertal stage.
4. Drastic weight loss is self-induced because of avoiding consumption of what the patient considers ‘fattening’, or one or a combination of the following behaviors: obsessive exercising; purging after meals; self-induced vomiting, extreme use of diuretics and laxatives.
5. The fear of being fat persists so much that it consumes the patient; he or she also imposes an irrational body weight target caused by a distortion in body image.
Sometimes, hospitalization is deemed necessary, especially if:
• A lot of weight has been lost (30% or more of the ideal body weight for the patient’s age)
• There is continuous weight loss in spite of treatment
• Complications have already developed (such as extremely low potassium levels, heart rate problems, and psychological problems)
• The patient shows signs of depression or has suicidal thoughts
• Antidepressants are required
• Behavioral therapy or psychotherapy is required
• The patient needs to be under supportive care
Anorexia nervosa is potentially lethal and may even require severely affected patients to undergo IV feeding. Ten percent of the cases lead to death, but there is also a high percentage of full recovery from it. However, relapses are also fairly common.
The patient or family members may also want to seek out support groups to complement the traditional treatments, and this may go on for several months until the patient is able to sustain a healthy body weight.
Complications
Below are a few of the complications that may come to the fore when anorexia nervosa reaches a critical stage or when it is left untreated:
• Severe malnutrition
• Severe dehydration
• Bloating
• Appearance of lanugo
• Seizures caused by dehydration
• Arrhythmia
• Drop in leukocyte counts
• Osteoporosis
• Tooth decay
• Diseases involving the thyroid gland
Prevention
It can be difficult to prevent anorexia because the cause may be deeply rooted in the person’s psyche. Families must then ensure that the children are always given proper advice and support regarding self-image. Counseling is also advisable, especially for adolescents, who feel insecure about themselves and lack self-confidence due to negative self-image.