Definition

Anorexia Nervosa is one of the major Eating Disorders classified in the DSM-IV. The central features of this disorder are a severe and prolonged inability to eat and considerable weight loss. Typically, individuals refuse to maintain the minimal normal body weight for their stature; they are extremely afraid of gaining weight and evidence a severe disturbance in the perception of the size and shape of their bodies. In addition, postmenarcheal females (i.e., females that have undergone menstruation) may experience amenorrhea (the absence of at least three consecutive menstrual cycles). The disorder may also delay menarche (the onset of first menstruation) in prepubertal females. It is also not uncommon for individuals to suffer from depressive symptoms and obsessive-compulsive behaviors.

In addition to these clinical features, Anorexia Nervosa has also been classified as having two subtypes: Restricting Type and Binge Eating/Purging Type. The former refers to weight loss that is accomplished through dieting, fasting, or execessive exercise, as opposed to binge eating or purging behaviors. The latter refers to weight loss that is accomplished through binge eating and/or purging behaviors.

Anorexia Nervosa is far more prevalent in industrial societies; there is an incidence of approximately 0.5% - 1.0% in the population for full-blown cases of the disorder. Further, it is rare for the disorder to occur before puberty. It is also estimated that more than 90% of presenting cases are female.

Symptoms

A number of symptoms have been associated with Anorexia Nervosa. Generally, they can include the following:

• refusal to maintain body weight over a minimum normal weight for age and height
• intense fear of gaining weight or becoming "fat"
• disturbance in the way one's body weight, size or shape is experienced
• in females, an absence of at least three consecutive menstrual cycles
• restricting food and fluids
• binge eating
• self-induced vomiting
• excessive exercising
• laxative, Ipecac, diuretic, diet pill or enema abuse
• loss of appetite
• a variety of physical changes: e.g., low body temperature, heart rate, or blood pressure; swelling; appearance of soft, fuzzy body hair; constipation; intolerance of cold temperatures; and a host of metabolic changes
• social withdrawal and an extreme preoccupation with food and eating

Cause(s)

A singular cause for the disorder has yet to be identified and may not be realistically forthcoming; research to date, for example, is showing that eating disorders lend themselves to a wide range of possible causal explanations. Scientists from a variety of disciplines are currently studying the possible impact of psychological, social, familial, cultural, biochemical, and genetic factors.

Personality factors research has been investigating a number of questions, such as how the disorder may develop as an adaptive response to stress and anxiety, and whether the possession of certain personality characteristics can leave individuals more predisposed to contracting the disorder.

Research into possible genetic explanations have arisen from repeated observations that eating disorders often run in families; such observations, however, have also drawn attention to possible environmental influences. Recent studies, for example, have found that family members' criticisms or undue preoccupation with weight and attractiveness may put young women at increased risk for such disorders.

Biochemical studies are considering the role of the neuroendocrine system and neurotransmitters in the development of eating disorders. The neuroendocrine system is involved in the regulation of sexual functioning, physical growth and development, appetite and digestion, sleep, heart and kidney function, emotions, thinking and memory. Neurotransmitters are chemicals that facilitate the transmission of signals between nerve cells (neurons). Both have been found disturbed in individuals with with eating disorders.

Course

Anorexia Nervosa usually begins in adolescence and rarely appears after the age of forty. It is also far more common in females than in males. Its course is variable; it may be unremitting until death, episodic, or, more often, consist of a single episode followed by a return to normal weight.

Treatment

Effective treatment of eating disorders involves a variety of treatments implemented by an expert team of health professionals, including physicians, nutritionists, therapists, and psychopharmacologists (specialists in drug therapy). Treatment plans may include a combination of individual, group and/or family therapy, cognitive-behavioral therapy, behavior therapy, psychodynamic therapy, nutritional counseling, hospitalization, and medication.

If an individual's health has deteriorated to critical levels, medical or psychiatric hospitalization may be required. Conditions that may warrant hospitalization include excessive and rapid weight loss, serious metabolic disturbances, clinical depression, a risk of suicide, severe binge eating and purging, and extreme disorientation. A major objective of institutional care is to control and carefully monitor the person's eating and eliminatory functions until his/her condition stabilizes. Personal control of these functions may be slowly and gradually returned as health improves. In most cases, long-term therapy and medical follow-up are essential for continued successful management of the disorder.

Dealing with Relapse

If signs of relapse occur, an individual should contact the health professional that they have arranged to be responsible for follow-up. If such a person has not been designated, a GP or the family physician should be contacted.

Signs of relapse can include an increase or decrease in weight that is five pounds (2.3 kg) or more out of the target range, an increase in addictive behaviors (e.g. food, exercise, drugs &/or alcohol), a decrease in appetite or ability to eat, a reoccurrence of binge eating, purging or vomiting, the use of pills or diuretics, as well as a marked increase or decrease in sleep.

Emergencies

In the case of an emergency, individuals should call their physician, therapist, or the emergency ward of their local hospital. Additional assistance may also be obtained by clicking on the Further Information and Support link below.

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