Anorexia Nervosa

Anorexia nervosa is an eating disorder characterized by self-imposed dietary behavior, odd ways of handling food, significant weight loss, and an intense fear of gaining weight and obesity. A drive for thinness and a preoccupation with perfection is characteristic. Accompanying these symptoms is a disturbance in body image. In anorexic individuals this is manifest in a persistent perception of being fat even when extremely under weight. In women there is amenorrhea. This is usually due to the low percentage of body fat and is a result of starvation. The incessant dieting often leads to abuse of diuretics and laxatives. Anorexia is one of the few psychiatric disorders that can lead to death. Most of the aberrant behavior exhibited in order to loose weight occurs in secret. Therefore, eating in public and with the family decreases, often further straining social relationships as a result, particularly over time and as the anorexia becomes more serious. Weight reduction is drastic as the intake of food is significantly decreased. There is a disproportionate decrease in high-carbohydrate and fatty foods while an individual strives for increased weight loss. The onset of anorexia nervosa occurs between the ages of 10 and 30. After the age of 13 the frequency of onset increases rapidly, where the ages of 17 and 18 marks the maximum frequency. About 85 percent of those with anorexia develop the disorder between the ages of 13 and 20 years.

Weight loss of at least 15 percent of the original body weight is required for a diagnosis of anorexia. Anorexic individuals refuse to maintain body weight over the minimal normal standards for their age and height. The diagnosis requires that there is no known physical illness or other causes that accounts for the weight loss.

The term anorexia is a misnomer in that it actually refers to a loss of appetite. Evidence suggests that patients have not lost their appetite, but deny having sensations of hunger, and constantly think about food. This dichotomy is often manifested in a passion for preparing elaborate meals or collecting recipes. It gives the person a sense of control over food and may actually contribute to a sense of superiority in the war against giving into it, or "being weak like everyone else who needs to eat."

Mot people who suffer with anorexia are uninterested in and usually resist treatment. They are often brought to a doctor's office by someone else, typically a family member or friends. The advice of hospitalization is usually rejected. The patient rarely accepts the advice of the doctor, arguing and criticizing the program or services. Individual's with anorexia are often very well informed, through personal research and extensive gathering of information on the subject, and feel like they know more than professionals about the disorder. This process of receiving care can bring up issues of control. At this time emphasizing the benefits of relieving the symptoms such as insomnia or depressive signs may be helpful in persuading the person to seek treatment willingly. It is important for family members remain supportive of the doctor and treatment plans. This involves family members carrying out recommendations and other treatment related plans as well as showing confidence in the doctor. Only when risk of death from complications of malnutrition is compulsory admission or commitment able to be obtained. After release from the hospital family therapy is usually recommended if feasible.

Diagnosis of Anorexia Nervosa

The diagnosis of Anorexia Nervosa is found in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), published by the American Psychiatric Association.

1. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth; leading to body weight less than 85% of that expected).
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
4. In post menarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration).

Specific Types

Restricting Type: During the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Binge-Eating/Purging Type: During the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Quick Warning Signs to Look For

• Excessive concern about weight and shape
• Obsession with food
• Significantly reduced food intake, extreme dieting
• Unusual eating habits
• Noticeable weight loss
• Excessive exercising
• Feeling fat in spite of weight loss and increasing thinness