Multiple: Anorexia

Definition
Description
Demographics
Causes and Symptoms
Diagnosis
Treatment
Prognosis
Prevention
The Future
For more information

Definition

Anorexia is an eating disorder—a psychiatric condition marked by fear of gaining weight, a distorted mental picture of what one 's body actually looks like, and extreme dieting in order to lose weight. Many anorexics also exercise for long periods or take diuretics (drugs that increase urine output) in order to lose weight.

Description

The Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV), the reference that doctors use to diagnose mental illness, specifies that a person must have a body weight that is only 85 percent of normal for their sex, age, and height, combined with a fear of becoming fat and a preoccupation with the size and shape of the body in order to be diagnosed with anorexia. In addition, a girl must miss three or more menstrual periods in a row to fit the diagnostic criteria.

Other signs that are commonly seen in young people with anorexia include osteoporosis (brittle bones), slowed growth, hair loss, aches in the joints and muscles, feeling cold much of the time, low blood pressure, slowed heart rate, and dry skin.

Demographics

There are between eight and thirteen young people per 100,000 in the United States and Canada who meet the strict DSM-IV criteria for anorexia. On the other hand, many doctors think there are other adolescents and young adults who have a milder form of anorexia but are not counted because they do not meet all the DSM-IV criteria; thus the disorder may be more widespread than the official figures indicate.

Anorexia is most common in teenagers and young adults; 40 percent of diagnosed patients are between fifteen and nineteen years old. A few patients begin to show signs of the disorder between the ages of seven and twelve. At the upper end of the age spectrum, 10 percent of patients are women over the age of forty; it is estimated that between 1 and 3 million women in the so-called baby boomer generation are struggling with eating disorders. The

female/male ratio for anorexia is thought to be nine females to every male. Although gay men are at somewhat higher risk of anorexia, heterosexual men can also develop the disorder.

At one time it was thought that anorexia is primarily a disease of middle-class Caucasians; however, in recent years, more cases of the disorder are appearing in African American and Hispanic women.

Causes and Symptoms

Although there is general agreement that anorexia is caused by a combination of factors, doctors disagree about which are the most important. There is considerable evidence that genetic factors play an important role. Another factor that is being researched is the role of a brain chemical involved in both anorexia and depression.

Other factors that have been cited by researchers include personality traits, family issues, and cultural values. Many anorexics are high achievers with a tendency toward perfectionism, and controlling their weight appears to be part of a larger need to be in control of their lives. In terms of family issues, some psychiatrists think that anorexia may be a way for the young person to separate from their family and establish their own identity.

In addition, as many as 50 percent of girls hospitalized for anorexia were sexually abused as children, leading doctors to think that they may be afraid of growing into mature women and want to keep a childish figure as long as possible. Last, cultural emphasis on thinness as a mark of social status has been blamed for encouraging girls (and older women) to lose more weight than is healthful.

The symptoms of anorexia include psychological as well as physical symptoms. Anorexia affects most of the body's major organ systems:

• Heart and blood: abnormally slow heartbeat, low blood pressure, episodes of weakness and dizziness, low levels of calcium and magnesium in the blood, and anemia (red blood cell count that is too low)

• Muscles, bones, and skin: dry skin, loss of scalp hair, sore muscles, swelling of the joints caused by abnormal eating patterns, risk of developing osteoporosis, a bone disorder in which the bones break or fracture more easily than is normal as the result of the loss of minerals in bone caused by starvation
• Digestive system: constipation, stomach ulcers, bleeding in the digestive tract, and an increased risk of disorders of the liver and pancreas
• Temperature regulation: feeling cold, as the loss of body fat means that the body loses heat more rapidly
• Psychological symptoms: depression, distorted notions of the body, and an increased risk of suicide

Diagnosis

Anorexia is usually diagnosed during an office visit to the patient's primary care doctor, although she or he may be sent to a psychiatrist for an additional evaluation. Primary care doctors are now encouraged to give a screening test to an adolescent or young adult who seems unusually concerned about weight or asks the doctor a lot of questions about weight loss. These screeners are short sets of five questions about eating habits that the patient can quickly answer. Other questionnaires that the doctor may use include the Clinical Eating Disorder Rating Instrument (CEDRI) or the Eating Disorder Examination (EDE); these take a little longer for the patient to fill out.

Anorexia and Athletes

Athletes are a high-risk group for anorexia, particularly in sports in which weight is important in competition. Runners, wrestlers, gymnasts, figure skaters, racing jockeys, and dancers, male as well as female, have an increased risk of developing anorexia and its associated problems of brittle bones and digestive disorders in later life. Women in sports are at risk of what is called female athlete triad, a group of three symptoms and signs that appear when a woman diets too strictly for competition: amenorrhea (stopping of menstrual periods); an unusual number of stress fractures; and an eating disorder, most commonly anorexia.

Many people also do not realize that anorexia can be literally fatal to women in sports. Several well-regarded athletes and dancers, such as Christy Henrich (1972–1994) and Heidi Guenther (1975– 1997), died in their early 20s of organ failure resulting from anorexia; Henrich, a gymnast, weighed only 47 pounds (21.3 kilograms) when she died.

If the doctor thinks that the patient may have anorexia, he or she can look for some of the physical signs that accompany the disorder after weighing the patient. Besides extreme thinness, these signs typically include a yellowish discoloration of the skin, signs of dehydration, an abnormally low blood pressure reading, and a slow heartbeat. The doctor will order laboratory tests of the patient's blood and urine to see whether the blood chemistry and the red blood cell count are normal. The patient

will also be given an electrocardiogram (ECG) to check for abnormal heart rhythms and other potential heart problems.

Treatment

The treatment of anorexia is difficult and complicated, partly because many patients deny that they have a problem. It is common, in fact, for anorexics to argue with the doctor that they simply have a different lifestyle and should be left alone. Hospitalization may be necessary if the patient is having serious medical complications related to starvation or has threatened suicide. In the hospital she (or he) will be given fluids and nutrients intravenously at first in order to stop the weight loss and bring other physical problems under control. The patient will then be given psychotherapy (usually cognitive-behavioral therapy or CBT) and education about nutrition. Antidepressants may be given to treat anxiety or emotional depression, but they are not considered effective in treating the eating disorder by itself.

Anorexics who do not need to be hospitalized for serious physical conditions may be treated on an outpatient basis or in a day hospital. They are often referred to a dietitian for personalized advice about healthful eating patterns and sample menus. Group psychotherapy is considered less effective than either individual treatment or family therapy in treating anorexia because the patients in a treatment group are likely to compete to see who can stay the thinnest. Family therapy is particularly recommended for patients under eighteen and for families in which the mother has an eating disorder.

Prognosis

Anorexia is a potentially life-threatening illness with one of the highest death rates among psychiatric disorders; between 6 and 20 percent of patients die either from starvation or suicide. Because treatment is complicated and may take years, the prognosis varies. Most patients need monitoring over a period of months to years to help them maintain a healthy weight and not slip back into disordered eating habits. One very real problem since the coming of the Internet is the rise of a number of websites promoting anorexia, encouraging people with the disorder to consider it a valid lifestyle decision rather than an illness.

Prevention

There is not likely to be any new medical or psychological treatment for anorexia in the next few years. For now, prevention of anorexia depends

on early recognition of an unhealthy concern with weight, since girls as young as five or six are known to worry about their weight, especially if their mothers or older sisters are dieting. In some cases the child's pediatrician can help detect the problem or offer advice.

The Future

It can be difficult to change an entire society's obsession with thinness and a very limited notion of physical attractiveness. In addition, the availability of Web sites promoting anorexia increases the difficulty of teaching young people healthy eating habits even if they do not measure up to celebrity-inspired notions of glamour or beauty. A 2006 study at Stanford University found that 36 percent of the patients in the eating disorders unit of the university's hospital visited these Web sites, and of this percentage, 96 percent had learned new techniques for dieting or losing weight from the Web sites.

SEE ALSO Bulimia; Osteoporosis

WORDS TO KNOW

Amenorrhea: Stopping of normal menstrual periods.

Antidepressant: A type of drug given to treat eating disorders as well as mood disorders like anxiety and depression.

Cognitive-behavioral therapy (CBT): An approach to therapy that aims at changing distorted thinking patterns, beliefs, and behaviors in order to change the patient's feelings.

Diuretic: A type of drug that increases the body's production of urine. Some people with anorexia take diuretics to lose weight by reducing the amount of water in the body.

Female athlete triad: A group of three symptoms that often occur together in female athletes: amenorrhea, osteoporosis, and disordered eating.

Osteoporosis: A disease in which bones lose their density and are more likely to break or fracture under stress.

For more information

BOOKS

Lynette, Rachel. Anorexia. Detroit, MI: KidHaven Press, 2006.

O'Neill, Cherry Boone. Starving for Attention. Minneapolis, MN: LifeCare Books, 1992. Written by the daughter of singer Pat Boone, this is a first-person account of recovery from anorexia.

Watson, Stephanie. Anorexia. New York: Rosen Publishing Group, 2007.

PERIODICALS

Baker, Ken. “Heidi Guenther's Short, Tragic Life—and Death.” San Francisco Chronicle, April 4, 1999. Available online at http://www.sfgate.com/cgi-bin/article.cgi?f=/examiner/archive/1999/04/04/MAGAZINE2036.dtl (accessed April 11, 2008).

Collier, Lorna. “The Aging of Anorexia: Middle-Aged Women—and Older— Fight the Devastating Disease.” Chicago Tribune, October 24, 1999. Available online at http://www.lornacollier.com/anorexia.html (accessed April 12, 2008).

Kirby, Jane. “Dieting Jockeys Risk Eating Disorders.” Scotsman, March 10, 2008. Available online at http://www.news.scotsman.com/health/Dieting-jockeys-risk-eating-disorders.3859401.jp (accessed April 11, 2008).

Udovitch, Mim. “The Way We Live Now: 9-8-02: Phenomenon: The Secret Society of the Starving.” New York Times, September 8, 2002. Available online at http://query.nytimes.com/gst/fullpage.html?res=9E0DE3DF173EF93BA3575AC0A9649C8B63&sec=&spon=&pagewanted=all (accessed April 8, 2008). Includes a discussion of pro-anorexia websites as well as the disease itself.

WEB SITES

Nemours Foundation TeenHealth. Female Athlete Triad. http://www.kidshealth.org/teen/food_fitness/problems/triad.html (accessed April 11, 2008).

NOVA Online. Dying to Be Thin. http://www.pbs.org/wgbh/nova/thin/ (accessed April 10, 2008). This is a companion website to a television program first aired in 2000. The entire program can be viewed online in eight video segments. The site also includes a male anorexic's account of his experience and a presentation about anorexia among minority women.