Description

Anorexia nervosa, commonly referred to simply as anorexia, is one type of eating disorder. More importantly, it is
also a psychological disorder. Anorexia is a condition that goes beyond out-of-control dieting. A person with
anorexia often initially begins dieting to lose weight. Over time, the weight loss becomes a sign of mastery and
control. The drive to become thinner is actually secondary to concerns about control and/or fears relating to one's
body. The individual continues the endless cycle of restrictive eating, often accompanied by other behaviors such as
excessive exercising or the overuse of diet pills, diuretics, laxatives, and/or enemas in order to reduce body weight,
often to a point close to starvation in order to feel a sense of control over his or her body. This cycle becomes an
obsession and, in this way, is similar to any type of addiction.

Causes

At this time, no definite cause of anorexia nervosa has been determined. However, research within the medical and
psychological fields continues to explore possible causes. Studies suggest that a genetic (inherited) component may
play a more significant role in determining a person's susceptibility to anorexia than was previously thought.
Researchers are currently attempting to identify the particular gene or genes that might affect a person's tendency to
develop this disorder, and preliminary studies suggest that a gene located at chromosome 1p seems to be involved in
determining a person' s susceptibility to anorexia nervosa. Other evidence had pinpointed a dysfunction in the part of
the brain, the hypothalamus (which regulates certain metabolic processes), as contributing to the development of
anorexia. Other studies have suggested that imbalances in neurotransmitter (brain chemicals involves in signaling
and regulatory processes) levels in the brain may occur in people suffering from anorexia. Feeding problems as an
infant, a general history of undereating, and maternal depressive symptoms tend to be risk factors for developing
anorexia. Other personal characteristics that can predispose an individual to the development of anorexia include a
high level of negative feelings and perfectionism. For many individuals with anorexia, the destructive cycle begins
with the pressure to be thin and attractive. A poor self-image compounds the problem. People who suffer from any
eating disorder are more likely to have been the victim of childhood abuse. While some professionals remain of the
opinion that family discord and high demands from parents can put a person at risk for developing this disorder, the
increasing evidence against the idea that families cause anorexia has mounted such that professional mental-health
organizations no longer ascribe to that theory. Possible factors that protect against the development of anorexia
include high maternal body mass index as well as personal high self-esteem.

Diagnosis

Anorexia nervosa can be a difficult disorder to diagnose, since individuals with anorexia often attempt to hide the
disorder. Denial and secrecy frequently accompany other symptoms. It is unusual for an individual with anorexia to
seek professional help because the individual typically does not accept that she or he has a problem (denial). In
many cases, the actual diagnosis is not made until medical complications have developed. The individual is often
brought to the attention of a professional by family members only after marked weight loss has occurred. When
anorexics finally come to the attention of the health-care professional, they often lack insight into their problem
despite being severely malnourished and may be unreliable in terms of providing accurate information. Therefore, it
is often necessary to obtain information from parents or other family members in order to evaluate the degree of
weight loss and extent of the disorder. Health professionals will sometimes administer questionnaires for anorexia as
part of screening for the disorder. In the binge-eating/purging type, the individual regularly engages in binge eating
or purging behavior which involves self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the
current episode of anorexia. In the restricting type, the individual severely restricts food intake but does not regularly
engage in the behaviors seen in the binge-eating type.

Symptoms
Anorexia can have dangerous psychological and behavioral effects on all aspects of an individual's life and can
affect other family members as well.

 The individual can become seriously underweight, which can lead to depression and social withdrawal.
 The individual can become irritable and easily upset and have difficulty interacting with others.
 Sleep can become disrupted and lead to fatigue during the day.
 Attention and concentration can decrease.
 Most individuals with anorexia become obsessed with food and thoughts of food. They think about it
constantly and become compulsive about eating rituals. They may collect recipes, cut their food into tiny
pieces, prepare elaborate calorie-laden meals for other people, or hoard food. Additionally, they may
exhibit other obsessions and/or compulsions related to food, weight, or body shape that meet the diagnostic
criteria for an obsessive compulsive disorder.
 Other psychiatric problems are also common in people with anorexia nervosa, including affective (mood)
disorders, anxiety disorders, and personality disorders.
 Generally, individuals with anorexia are compliant in every other aspect of their life except for their
relationship with food. Sometimes, they are overly compliant, to the extent that they lack adequate self-
perception. They are eager to please and strive for perfection. They usually do well in school and may often
overextend themselves in a variety of activities. The families of anorexics often appear to be "perfect."
Physical appearances are important to them. Performance in other areas is stressed as well, and they are
often high achievers.
 While control and perfection are critical issues for individuals with anorexia, aspects of their life other than
their eating habits are often found to be out of control as well. Many have, or have had at some point in
their lives, addictions to alcohol, drugs, or gambling. Compulsions involving sex, exercising, housework,
and shopping are not uncommon. In particular, people with anorexia often exercise compulsively to speed
the weight-loss process.

Treatment

Anorexia may be treated in an outpatient setting or hospitalization may be necessary. For an individual with severe
weight loss that has impaired organ function, hospital treatment must initially focus on correction of malnutrition,
and intravenous feeding or tube feeding that goes past the mouth may be required. A gain of between 1 to 3 pounds
per week is a safe and attainable goal when malnutrition must be corrected. Sometimes weight gain is achieved
using schedules for eating, decreased physical activity, and increased social activity, either on an inpatient or
outpatient basis. The overall treatment of anorexia, however, must focus on more than weight gain. There are a
variety of treatment approaches dependent upon the resources available to the individual. Because of increasing
insurance restrictions, many patients find that a short hospitalization followed by a day treatment program is an
effective alternative to longer inpatient programs. Most individuals, however, initially seek outpatient treatment
involving psychological as well as medical intervention. It is common to engage a multidisciplinary treatment team
consisting of a medical-care provider, a dietician or nutritionist, and a mental-health-care provider. Different kinds
of psychological therapy have been employed to treat people with anorexia. Individual therapy, cognitive behavior
therapy, group therapy, and family therapy have all been successful in the treatment of anorexia. In adolescents,
research shows that the Maudsley model of family therapy can be particularly effective in treating this disorder in
this population. In contrast to many past approaches to treatment, the Maudsley model approaches the family of the
individual with anorexia as part of the solution rather than part of the reason their loved one has the disorder. With
ongoing specific guidance from the professional mental-health team, this approach has the family actively help their
loved one eat in a more healthy manner. Any appropriate treatment approach addresses underlying issues of control,
perfectionism, and self-perception. Family dynamics are explored. Nutritional education provides a healthy
alternative to weight management for the patient. Group counseling or support groups often assist the individual in
the recovery process. The ultimate goal of treatment should be for the individual to accept herself/himself and lead a
physically and emotionally healthy life. While no medications have been identified that can definitively reduce the
compulsion to starve themselves, olanzapine (Zyprexa, Zydis) is a medication that is also used as a mood stabilizer
and to treat schizophrenia that may be useful in treating anorexia. This is thought to help increase weight and to
manage some of the emotional symptoms like anxiety and depression that can accompany anorexia. Some of the
selective serotonin reuptake inhibitor (SSRI) antidepressant drugs have been shown to be helpful in weight
maintenance after weight has been gained and in controlling the mood and anxiety symptoms that may be associated
with the condition.

History

The history of anorexia nervosa begins with early descriptions dating from the 16th century and 17th century and the
first recognition and description of anorexia nervosa as a disease in the late 19th century. In the late 19th century,
the public attention drawn to "fasting girls" provoked conflict between religion and science. Such cases as Sarah
Jacob (the "Welsh Fasting Girl") and Mollie Fancher (the "Brooklyn Enigma") stimulated controversy as experts
weighed the claims of complete abstinence from food. Believers referenced the duality of mind and body, while
skeptics insisted on the laws of science and material facts of life. Critics accused the fasting girls of hysteria,
superstition, and deceit. The progress of secularization and medicalization passed cultural authority from clergy to
physicians, transforming anorexia nervosa from revered to reviled.[200]