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Information on Anorexia

What Is Anorexia Nervosa?

Anorexia nervosa is a potentially life-threatening eating disorder. It is characterized by deliberate restriction of calories to the point of starvation. Anorexia usually begins at the start of puberty and is more common among women, affecting one to two percent of the female population and 0.1 percent to 0.2 percent of males.

Anorexia nervosa is specifically diagnosed by:

• restriction of calories to maintain a body weight that is less than 85 percent of the individual's normal healthy weight
• obsessive preoccupation with body weight and intense fear of gaining weight or becoming fat
• grossly distorted body image, resulting in unwarranted psychological impact on how one sees and values herself
• amenorrhea (absence of at least three consecutive menstrual cycles when they are otherwise expected to occur)

Types of Anorexia

There are two types of anorexia nervosa: the restricting type and the binge-eating/purging type. Someone who has the restricting type of anorexia does not engage in binge-eating or purging behavior. Purging behavior is defined as self-induced vomiting, excessive exercise, or the misuse of laxatives, diuretics or enemas. In both types of anorexia nervosa, the motivation is fear of weight gain.

Who develops anorexia nervosa?

Anorexia predominately affects adolescent girls and young adult women, as well as those for whom thinness and/or fitness is required, such as athletes, actors, dancers, models and media personalities.

Evidence indicates that one to two percent of females in the United States may develop anorexia nervosa in their lifetime. Because more than 90 percent of all those who are affected are adolescent and young women, the disorder has been characterized as primarily a young woman's illness. It should be noted that males and children as young as seven years old have been diagnosed with this illness as well as middle-aged and elderly women.

The hallmarks of anorexia nervosa are a preoccupation with body weight and calories, along with a pathological insistence that she looks fat in spite of objective evidence that she is sick and emaciated.

Causes of Anorexia

Anorexia is a poorly understood, multifaceted disease, for which the exact cause or causes are unknown. In an attempt to determine the origins of anorexia, scientists have studied the personalities, genetics, environments and biochemistry of people with this disorder.

Scientists have found that the neurotransmitters (brain chemical messengers) serotonin and norepinephrine are frequently decreased in patients with anorexia in much the same way as individuals with depression.

Common personality traits among those with anorexia include low self-esteem, obsessive tendencies and perfectionism. Those with anorexia tend to be very driven to succeed in academics and sports, but on the inside these seemingly perfect people are never satisfied with themselves or their performance. This hidden low self-esteem is pathologically tied to their appearance and body image.

Some characteristics or family traits associated with anorexia include:

• excessive concern within the family with outward appearances, including body shape and weight
• parental focus on perfection and performance, such as harsh criticism for mistakes and inappropriate ways of dealing with conflict
• family history of sexual abuse
• strained relationship between husband and wife
• arbitrary role boundaries where children are encouraged to act more responsible than their age should permit and to take on roles or responsibilities for which they are psychologically ill-prepared

Medical Complications

The physical complications associated with anorexia nervosa are potentially life-threatening.

Damage to vital organs as a result of dehydration and malnutrition can result in:

• low blood pressure
• electrolyte imbalance
• cardiac arrhythmias
• thyroid gland deficiencies, which can lead to cold intolerance and constipation
• appearance of fine, baby-like body hair (lanugo)
• bloating or edema
• decrease in white blood cells, which leads to increased susceptibility to infection
• osteoporosis
• tooth erosion and decay from malnutrition and self-induced vomiting
• seizures related to fluid shifts due to excessive diarrhea or vomiting

The courses and outcomes of anorexia vary. While some who receive treatment recover after a single episode, the majority of those with the disease experience a chronically deteriorating course of illness over many years. The mortality rate among young women and teens with anorexia is 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population. The most common causes of death are complications and suicide.

If you have, or think you might have, anorexia or another eating disorder, get help immediately. Calling the number on this site is a good place to start.

Sources

• American Psychiatric Association Work Group on Eating Disorders. Practice guideline for the treatment of patients with eating disorders (revision). (2000) American Journal of Psychiatry; 157(1 Suppl): 1-39.
• Sullivan, P.F. Mortality in anorexia nervosa. (1995) American Journal of Psychiatry; 152(7): 1073-4.
• Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. American Psychiatric Association, 1994.

By Drew Edwards, EdD, MS
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