Anorexia is an eating disorder, characterized by low weight, food restriction, fear of gaining weight and a strong desire to be thin. Many people with anorexia see themselves as overweight even though they are, in fact, underweight. They often deny that they have a problem with low weight. They weigh themselves frequently, eat small amounts and only eat certain foods. Some exercise excessively, force themselves to vomit or use laxatives to produce weight loss. Complications may include osteoporosis, infertility and heart damage among others.
The cause is currently unknown. There appear to be some genetic components with identical twins more often affected than non-identical twins. Cultural factors also appear to play a role with societies that value thinness having higher rates of disease. Additionally, it occurs more commonly among those involved in activities that value thinness such as high-level athletics, modelling and dancing. Anorexia often begins following a major life-change or stress-inducing event.
Signs and symptoms
Symptoms may include:
- A low body mass index for one’s age and height.
- Fear of even the slightest weight gain; taking all precautionary measures to avoid weight gain or becoming “overweight”.
- Rapid, continuous weight loss.
- Lanugo: soft, fine hair growing over the face and body.
- An obsession with counting calories and monitoring fat contents of food.
- Preoccupation with food, recipes, or cooking; may cook elaborate dinners for others, but not eat the food themselves or consume a very small portion.
- Food restrictions despite being underweight or at a healthy weight.
- Food rituals, such as cutting food into tiny pieces, refusing to eat around others and hiding or discarding of food.
- Excessive exercise including micro-exercising, for example making small persistent movements of fingers or toes.
- Perception of self as overweight, in contradiction to an underweight reality.
- Intolerance to cold and frequent complaints of being cold; body temperature may lower (hypothermia) in an effort to conserve energy due to malnutrition.
- Depression, anxiety disorders and insomnia.
- Solitude: may avoid friends and family and become more withdrawn and secretive.
- Dry hair and skin, as well as hair thinning.
- Chronic fatigue.
- Rapid mood swings.
- Having feet discoloration causing an orange appearance.
- Having severe muscle tension, aches and pains.
- Evidence/habits of self harming or self-loathing.
- Admiration of thinner people.
There is no conclusive evidence that any particular treatment for Anorexia Nervosa (AN) works better than others. However, there is enough evidence to suggest that early intervention and treatment are more effective.Treatment for Anorexia Nervosa tries to address three main areas:
- Restoring the person to a healthy weight;
- Treating the psychological disorders related to the illness;
- Reducing or eliminating behaviors or thoughts that originally led to the disordered eating.
Although restoring the person’s weight is the primary task at hand, optimal treatment also includes and monitors behavioral change in the individual as well. There is some evidence that hospitalization might adversely affect long term outcome.
Psychotherapy for individuals with AN is challenging as they may value being thin and may seek to maintain control and resist change. Some studies demonstrate that family based therapy in adolescents with AN is superior to individual therapy. Due to the nature of the condition, treatment of people with AN can be difficult because they are afraid of gaining weight. Initially developing a desire to change is important.
Diet is the most essential factor to work on in people with anorexia and must be tailored to each person’s needs. Food variety is important when establishing meal plans as well as foods that are higher in energy density. People must consume adequate calories, starting slowly and increasing at a measured pace.
Family-based treatment (FBT) has been shown to be more successful than individual therapy for adolescents with AN. Various forms of family-based treatment have been proven to work in which the parents and child are seen together by the same therapist, and separated family therapy (SFT) in which the parents and child attend therapy separately with different therapists.
Pharmaceuticals have limited benefit for anorexia itself. There is a lack of good information from which to make recommendations concerning the effectiveness of antidepressants in treating anorexia.
Admission to hospital
Anorexia Nervosa has a high mortality rate and patients admitted in a severely ill state to medical units are at particularly high risk. Diagnosis can be challenging, risk assessment may not be performed accurately. Moreover, consent and the need for compulsion may not be assessed appropriately, refeeding syndrome may be missed or poorly treated and the behavioral and family problems may be missed or poorly managed.
The rate of re-feeding can be difficult to establish, because the fear of re-feeding syndrome (RFS) can lead to underfeeding. It is recommended to start re-feeding slowly but to build up rapidly as long as RFS does not occur. Recommendations on energy requirements vary, from 5–10 kcal/day in the most medically compromised patients, who appear to have the highest risk of RFS, to 1900 kcal/day.