Anorexia nervosa is a psychiatric disorder characterized by abnormal eating behavior, severe self-induced weight loss, and psychiatric comorbidities. People with anorexia have an extreme fear of gaining weight, which causes them to try to maintain a very low weight. They will do almost anything to avoid gaining weight, including starving themselves or exercising too much. People with anorexia have a distorted body image. They think they are fat, even if they are extremely thin.
Anorexia is an emotional disorder that focuses on food, but many researchers believe it is an attempt to deal with perfectionism and a desire to gain control by strictly regulating food and weight. People with anorexia often feel that their self worth is tied to how thin they are.
Anorexia is increasingly common, especially among young women in industrialized countries where cultural ideals encourage women to be thin. Fueled by popular fixations with lean bodies, anorexia is also affecting a growing number of men, particularly athletes and those in the military.
Anorexia most commonly affects teens, as many as 3 in 100. Although anorexia seldom appears before puberty, when it does, associated mental conditions, such as depression and obsessive-compulsive behavior are usually more severe. Anorexia is often preceded by a traumatic event and is usually accompanied by other emotional problems. Anorexia is a life-threatening condition that can result in death from starvation, heart failure, electrolyte imbalance, or suicide. For some people, anorexia is a chronic disease, one that lasts a lifetime. But treatment can help people with anorexia develop a healthier lifestyle and avoid complications.
The primary sign of anorexia nervosa is severe weight loss. People with anorexia may try to lose weight by severely limiting how much food they eat. They may also exercise excessively. Some people may engage in binging and purging, similar to bulimia. They may vomit after eating or take laxatives. At the same time, the person may insist that they are overweight.
Psychological and Behavioral Signs
What To Watch For
No one knows exactly what causes anorexia. Medical experts agree that several factors work together in a complex fashion to lead to the eating disorder. These may include:
Risk factors may include:
People with anorexia may think they are in control of their disease and do not need help. But if you or a loved one is experiencing signs of anorexia, it is important to seek help. If you are a parent who suspects your child has anorexia, take your child to see a doctor immediately. The doctor will order several laboratory tests and perform a psychological evaluation. If anorexia is suspected, your doctor may use the SCOFF questionnaire, developed in Great Britain. A "yes" response to at least 2 of the following questions is a strong indicator of an eating disorder:
Lab tests may include:
If your doctor diagnoses you with anorexia, you will likely work with a multidisciplinary team including a doctor, a psychologist or psychiatrist, and a registered dietitian.
The most effective way to prevent anorexia is to develop healthy eating habits and a strong body image from an early age. DO NOT accept cultural values that place a premium on thin, perfect bodies. Make sure you and your children are educated about the life-threatening nature of anorexia.
For people who have already developed anorexia, the primary goal is to avoid relapse.
The most successful treatment is a combination of psychotherapy, family therapy, and medicine. It is important for the person with anorexia to be actively involved in their treatment. Many times the person with anorexia does not think they need treatment. Even if they know they need treatment, anorexia is a long-term challenge that may last a lifetime. People remain vulnerable to relapse when going through stressful periods of their lives.
A combination of treatments can give the person the medical, psychological, and practical support they need. Cognitive behavioral therapy, along with antidepressants, can be an effective treatment for eating disorders. Complementary and alternative (CAM) therapies may help with nutritional deficiencies.
If the person's life is in danger, hospitalization may be needed, particularly under the following circumstances:
Even after some weight gain, many people with anorexia remain quite thin and the risk of relapse is very high. Several social influences may make recovery difficult:
Involving friends, family members, and others in the treatment may be helpful.
Treating anorexia nervosa involves major lifestyle changes:
There are no medicines specifically approved to treat anorexia. Antidepressants are often prescribed to treat depression that may accompany anorexia. Your doctor may also prescribe drugs to help with OCD or anxiety. However, medicines may not work alone and should be used in conjunction with a multidisciplinary approach that includes nutritional interventions and psychotherapy.
Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that are sometimes prescribed for people with anorexia. Fluoxetine (Prozac) has been studied in people with anorexia and depression with mixed results. In some early studies, it appeared to increase weight and improve mood over several months. But in another, it helped relieve symptoms of depression, but did not affect the anorexia itself.
Recent studies indicate that the use of Prozac and other antidepressants may cause children and teenagers to have suicidal thoughts. Children who are taking these drugs must be monitored very carefully for signs of suicidal behavior.
People with anorexia may not be getting the essential nutrients their bodies need. Your doctor may prescribe potassium or iron supplements, or other supplements to make up for any deficiency. They may also prescribe cyproheptadine, an antihistamine that may stimulate appetite. In one study, using high doses of cyproheptadine hydrochloride decreased the number of days it took people with anorexia to gain an appropriate amount of weight.
People with bulimia are more likely to have vitamin and mineral deficiencies, which can affect their health. Vitamin deficiencies can contribute to cognitive difficulties such as poor judgment or memory loss. Getting enough vitamins and minerals in your diet or through supplements can correct the problems.
Always tell your doctor about the herbs and supplements you are using or considering using, as some supplements may interfere with conventional treatments.
Following these nutritional tips may help overall health:
Your doctor may suggest addressing nutritional deficiencies with the following supplements:
Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.
No scientific literature supports the use of homeopathy for anorexia. However, an experienced homeopath will consider your individual case and may recommend treatments to address both your underlying condition and any current symptoms.
There is much anecdotal evidence supporting the use of acupuncture in treating the anxiety and irritability that often coincide with anorexia. Many inpatient eating disorder treatment facilities offer acupuncture as part of their treatment protocol.
Cognitive Behavioral Therapy
Cognitive behavioral therapy is one of the most effective therapies for anorexia. In cognitive behavioral therapy, the person learns to replace negative, unrealistic thoughts and beliefs with positive, realistic ones. The person also learns to acknowledge their fears and develop new, healthier ways of solving problems.
In addition to individual therapy for someone who has anorexia, doctors may recommend family therapy involving parents and siblings. Parents and other family members often have intense feelings of guilt and anxiety to address. Family therapy is aimed, in part, at helping the parents or partner (in the case of an adult) understand the seriousness of this illness and the ways in which family patterns may contribute to it.
Hypnosis may be helpful as part of an integrated treatment program for anorexia nervosa. Hypnosis may help the person strengthen both self confidence and the ability to cope. That may result in healthier eating, improved body image, and greater self esteem.
Studies suggest that biofeedback may help reduce stress in people with anorexia.
Studies suggest aerobic exercise, massage, body awareness therapy and yoga might reduce eating pathology in people with anorexia and bulimia nervosa. These forms of activity may also improve quality of life among people who have an eating disorder.
Anorexia poses several potential problems for women who are pregnant or wish to become pregnant:
Medical complications associated with anorexia include:
The outlook for people with anorexia is variable, with recovery often taking between 4 to 7 years. There is also a high chance of relapse even after recovery. Long-term studies show that 50 to 70% of people recover from anorexia nervosa. However, 25 never fully recover. Up to 20% die from complications of the disease. More people die from anorexia than from any other psychiatric disorder. Many, even after they are considered "cured," continue to show traits of anorexia, such as remaining very thin and striving for perfection. Anorexia is associated with high lifetime mortality from both natural and unnatural causes.
Barabasz M. Efficacy of hypnotherapy in the treatment of eating disorders. Int J Clin Exp Hypn. 2007 Jul;55(3):318-335. Review.
Birmingham CL, Sidhu FK. Complementary and alternative medical treatments for anorexia nervosa: case report and review of the literature. Eat Weight Disord. 2007 Sep;12(3):e51-e53. Review.
Clarke TK, Weiss AR, Berrettini WH. The genetics of anorexia nervosa. Clin Pharmacol Ther. 2012; 91(2):181-8.
Cook-Darzens S, Doyen C, Mouren MC. Family therapy in the treatment of adolescent anorexia nervosa: current research evidence and its therapeutic implications. Eat Weight Disord. 2008;13(4):157-170.
Escolar DM, Buyse G, Henricson E, et al. CINRG randomized controlled trial of creatine and glutamine in Duchenne muscular dystrophy. Ann Neurol. 2005;58(1):151-155.
Espindola CR, Blay SL. Anorexia nervosa treatment from the patient perspective: a metasynthesis of qualitative studies. Ann Clin Psychiatry. 2009;21(1):38-48.
Ferri: Ferri's Clinical Advisor, 2015, 1st ed. Anorexia Nervosa. St. Louis, MO: Elsevier Mosby. 2014.
Field T. Massage therapy effects. Am Psychol. 1998;53:1270-1281.
Franko DL, Keshaviah A, Eddy KT, et al. A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa. Am J Psychiatry. 2013; 170(8):917-25.
Goldman. Goldman's Cecil Medicine, 24th ed. Philadelphia, PA: Elsevier Saunders. 2011.
Holman RT, Adams CE, Nelson RA, et al. Patients with anorexia nervosa demonstrate deficiencies of selected essential fatty acids, compensatory changes in nonessential fatty acids and decreased fluidity of plasma lipids. J Nutr 1995;125:901-907.
Keski-Rahkonen A, Raevuori A, Bulik CM, Hoek HW, Rissanen A, Kaprio J. Factors associated with recovery from anorexia nervosa: a population-based study. Int J Eat Disord. 2014; 47(2):117-23.
Kishi T, Kafantaris V, Sunday S, Sheridan EM, Correll CU. Are antipsychotics effective for the treatment of anorexia nervosa? Results from a systemic review and meta-analysis. J Clin Psychiatry. 2012; 73(6):e757-e766.
Kleifield EI, Wagner S, Halmi KA. Cognitive-behavioral treatment of anorexia nervosa. Psychiatric Clin N Am. 1996;19:715-737.
LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp; 2000: 387-388.
Loeb KL, Walsh BT, Lock J, le Grange D, Jones J, Marcus S, Weaver J, Dobrow I. Open trial of family-based treatment for full and partial anorexia nervosa in adolescence: evidence of successful dissemination. J Am Acad Child Adolesc Psychiatry. 2007 Jul;46(7):792-800.
Lozano GA. Obesity with sexually selected anorexia nervosa. Med Hypotheses. 2008;71(6):933-940.
McNulty. Prevalence and contributing factors of eating disorder behaviors in active duty Navy men. Mil Med. 1997;162(11):753-758.
Moyano D, Sierra C, Brandi N, et al. Antioxidant status in anorexia nervosa. Int J Eating Disord. 1999;25:99-103.
Papadopoulos FC, Ekbom A, Brandt L, Ekselius L. Excess mortality, causes of death and prognostic factors in anorexia nervosa. Br J Psychiatry. 2009;194(1):10-17.
Pop-Jordanova N. Psychological characteristics and biofeedback mitigation in preadolescents with eating disorders. Ped Int. 2000;42:76-81.
Rakel: Textbook of Family Medicine, 8th ed. Philadelphia, PA: Elsevier Saunders. 2011.
Rock CL, Vasantharajan S. Vitamin status of eating disorder patients: Relationship to clinical indices and effect of treatment. Int J Eating Disord. 1995;18:257-262.
Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-247.
Shay NF, Manigan HF. Neurobiology of zinc-influenced eating behavior. J Nutr. 2000;130:1493S-1499S.
Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.
Vancampfort D, Vanderlinden J, De Hert M, et al. A systematic review of physical therapy interventions for patients with anorexia and bulemia nervosa. Disabil Rehabil. 2014; 36(8):628-34.
Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs. 2000;9(9):2103-2119.
Wheatland R. Alternative treatment considerations in anorexia nervosa. Med Hypotheses. 2002;59(6):710-715.
Williams PM, Goodie J, Motsinger CD. Treating eating disorders in primary care. Am Fam Physician. 2008 Jan 15;77(2):187-195.
Wiseman CV, Harris WA, Halmi KA. Eating disorders. Medical Clin N Am. 1998;82:145-159.
Wolfe BE, Metzger ED, Jimerson DC. Research update on serotonin function in bulimia nervosa and anorexia nervosa. Psychopharmacol Bull. 1997;33:345-354.
Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-596.
Young D. The use of hypnotherapy in the treatment of eating disorders. Contemporary Hypnosis. 1995;12:148-153.
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2022 A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.