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Anorexia nervosa is an eating disorder in which a person refuses to maintain a healthy weight for his or her age and height. It is a self-imposed starvation resulting from a distorted body image.

The individual with anorexia nervosa typically loses 25% or more of his or her original body weight. Anorexia has significant medical, psychological, and social components. Successful treatment must address all three.

What is going on in the body?

People with anorexia nervosa have an overwhelming fear of obesity. They see themselves as fat, even when they are malnourished. They will deny hunger, even when they are starving. Body protein and fat stores become depleted.

What are the signs and symptoms of the disease?

Individuals with anorexia often have the following characteristics:

• behavior that isolates them from others
• excessive dependency needs
• flat affect, a face, voice, and gestures that do not display normal emotions
• immaturity
• obsessive-compulsive behavior
• tendency toward an excess of exercise or other physical activity

The malnutrition caused by anorexia can affect many body systems. Some common symptoms of anorexia nervosa include:

• amenorrhea, the absence of menstruation
• arrhythmias (irregular heartbeats)
• constipation
• delayed puberty
• difficulty concentrating, apathy, or irritability
• fatigue
• slow pulse and low blood pressure that can cause fainting

• erosion of the tooth enamel, leading to cavities
• esophagitis, or inflammation of the esophagus which can cause heartburn

An individual with anorexia may also show symptoms of depression or drug abuse.

What are the causes and risks of the disease?

The exact cause of anorexia nervosa is unknown. It is believed to be a result of psychological, biological, and social stress. Some cases may be related to sexual development during adolescence. Some experts believe that anorexia nervosa is a response to social attitudes that equate beauty with being thin. Anorexia is extremely rare in areas of the world where food is scarce.

There is also evidence that anorexia nervosa runs in families and can be inherited. Anorexia nervosa occurs most often in females between the ages of 12 and 21. It is most common in middle- and upper-class females. However, it may also occur in males or adult women.

What can be done to prevent the disease?

It may not be possible to prevent the onset of anorexia. However, it is very important to recognize and treat it early. The longer the disease goes on, the more difficult it is to treat.

How is the disease diagnosed?

Diagnosis of anorexia nervosa begins with a medical history and physical exam. The healthcare professional may order tests to check the person's health status, including:

• abdominal X-ray to look for digestive tract problems
• blood tests, such as a complete blood count (CBC) and thyroid function tests
• chest X-ray to check for heart problems or lung infection
• an electrocardiogram (ECG) to check for heart problems
• urinalysis, to check for dehydration and infection

What are the long-term effects of the disease?

Five to 10% of the individuals with diagnosed anorexia die from the condition. It can cause dehydration, malnutrition, and salt imbalances. Damage to the brain, muscles, reproductive tract, bowels, stomach, and other body organs can occur because of the irregularity of food and fluid intake.

Serious heart problems can also result, including:

• arrhythmias
• congestive heart failure
• sudden death

In addition, an individual who induces vomiting repeatedly may damage the throat and esophagus.

People with anorexia may have trouble developing healthy relationships. The person also may be limited in the ability to succeed at school and work.

What are the treatments for the disease?

The goals of treatment are to correct malnutrition and the underlying psychological problem, as well as to remedy any medical problems (such as salt and water imbalance) that may have resulted from anorexic behaviors. Weight gain is important both for medical reasons and to show the individual objective evidence that he or she weighs in a healthy range, contrary to his or her subjective perception.

A team approach is most effective. This includes:

• aggressive medical management
• cognitive behavioral therapy
• individual, group, and family psychotherapy
• nutritional rehabilitation and counseling

Anorexia nervosa may be treated in the hospital or other inpatient facility, or on an outpatient basis. The person's weight, cardiac status, and overall health are factors that influence the treatment options. Some people become so malnourished that they need to be fed through tubes to stay alive.

While the individual is in the hospital, they will have strict rules about eating. In order to earn more privileges, they will have to eat a certain amount of food each day. They are expected to gain a certain amount of weight each week. A combination of cognitive behavioral therapy and family therapy are often effective for people with anorexia.

• Cognitive therapy helps individuals identify and question the reality of their beliefs about eating and their weight. The therapist would help these individuals understand that, by staying so thin, they are actually damaging their bodies.
• Behavioral therapy is designed to help change the behaviors that keep the illness going. For instance, the person may leave the dinner table after only a few minutes. A therapist may recommend sitting at the table for several hours. This may help overcome the person's fears about food.
• Family therapy helps family members learn about the illness. They learn what they can do to help their loved ones recover. Sometimes, family problems need to be addressed before recovery can begin.
• Spiritual counseling with a chaplain or pastoral professional can be helpful for many with anorexia.

Medicines are rarely used to treat anorexia. If the person has significant depression, antidepressants may be used. Sometimes, cyproheptadine is used because it can stimulate appetite. However, it is usually not effective. People with anorexia do feel hungry, they just choose not to eat.

What are the side effects of the treatments?

Antidepressants may cause drowsiness, dry mouth, and constipation.

What happens after treatment for the disease?

Psychotherapy usually continues for at least one year after treatment starts. Some individuals may need 5 to 6 years of therapy. People who recover from anorexia need to be aware that this illness can recur.

How is the disease monitored?

The individual needs to make regular visits with the healthcare professional to report progress as well as any new or worsening symptoms.