Diseases & Conditions
A serious, potentially lifethreatening EATING DISORDER characterized by selfstarvation, food preoccupation and rituals, compulsive exercising, and often in girls an absence of menstrual cycles. A child with anorexia nervosa is hungry but denies the hunger because of an irrational fear of becoming fat.
Anorexia affects one in every 100 to 200 adolescent girls and a much smaller number of boys. Approximately one percent of all adolescent American girls develop the problem, usually at puberty, which can be fatal if untreated. One in 10 cases ends in death from starvation, cardiac arrest, or suicide. The most common cause of death in a chronic anorexic is low potassium levels in the blood, which can cause an irregular heartbeat.
Anorexia is diagnosed when a girl is at least 15 percent below her normal body weight. Food and weight become obsessions, and for some, the compulsiveness shows up in strange eating rituals or the refusal to eat in front of others. Some girls with anorexia obsess about food, collecting recipes and preparing lavish gourmet feasts for family and friends while refusing any food themselves. They may adhere to strict exercise routines to keep off weight.
Certain personality characteristics seem to be associated with anorexia, including a fear of losing control, inﬂexible thinking, perfectionism, dissatisfaction with body image, and an overwhelming desire to be thin. Anorexia also has been linked to obsessive-compulsive tendencies, such as a preoccupation with food.
Anorexia nervosa is not a “fad” that the child will outgrow if left alone. Together with its associated syndrome, BULIMIA, these eating disorders are extremely widespread and dangerous problems. The chief symptoms are self-induced starvation and/or binge eating and purging. For many, this is a compulsive addiction, like alcoholism. Thousands of cases report ill health, psychological impairments, shame, guilt, withdrawal, and isolation.
Warning signs include:
• deliberate self-starvation with weight loss
• intense, persistent fear of gaining weight
• refusal to eat, except tiny portions
• continuous dieting
• excessive facial/body hair because of inadequate protein in the diet
• compulsive exercise
• abnormal weight loss
• sensitivity to cold
• absent or irregular menstruation
• hair loss
Because anorexia is basically self-starvation, the body is denied the essential nutrients it needs to function normally. As a result, it is forced to slow down all of its processes to conserve energy. This “slowing down” can have serious medical consequences, including an abnormally slow heart rate and low blood pressure. The risk for heart failure rises as heart rate and blood pressure levels sink lower and lower. Thyroid function slows, menstrual periods stop, and even breathing slows down. Nails and hair become brittle, the skin dries and yellows. Girls may become very thirsty and urinate often, as dehydration contributes to constipation and reduced body fat leads to lowered body temperature.
Children with anorexia also can develop osteoporosis, muscle loss and weakness, severe dehydration leading to kidney failure, fainting, fatigue, and overall weakness, hair loss, and growth of a downy layer of hair called lanugo all over the body, including the face. As the girl’s weight plummets, vital organs such as the brain and heart can be damaged.
Fortunately, the above symptoms can be reversed once normal weight is reestablished. The ﬁrst step in treating anorexia is to get the girl to put on weight; the greater the weight loss, the more likely she will need hospitalization.
Increasing awareness of the dangers of anorexia, backed by medical studies and extensive media coverage, has led many girls to seek help. Nevertheless, many girls with anorexia refuse to admit that there is a problem and reject treatment.
Friends, relatives, teachers, therapists, dietitians, peer support groups, and physicians all play an important role in helping a child with anorexia stick with a treatment program. Encouragement, caring, and persistence, as well as information about eating disorders and their dangers, may be needed to convince the child to get help, stick with treatment, or try again.
Outpatient programs have become common, including day programs requiring patients to stay eight hours a day, ﬁve days a week. Anorexic patients are given a carefully prescribed diet, starting with small meals and gradually increasing the caloric intake. A patient is given a goal weight range, and as she approaches her ideal weight, more independence in her eating habits is allowed. However, if she falls below the set range, greater supervision may be reinstated.
As she gains weight, she will usually begin individual and group therapy. Counseling typically involves education about body weight regulation and the effects of starvation, clariﬁcation of dietary misconceptions, and work on the issues of selfcontrol and self-esteem. Length of treatment varies among different programs and ranges from shortterm therapy of just 10 sessions to long-term psychotherapy lasting two or three years or more. Some researchers employ family therapy with a team approach. Others recommend two to three years of psychotherapy aimed at improving problems of low self-esteem, guilt, anxiety, depression, and helplessness. Family therapy (which may take about six months) focuses on changing the patterns of family interaction. Hypnosis is used by some therapists but may be resisted by many children with anorexia who fear the loss of self control. Some success is claimed by those teaching self-hypnosis and biofeedback techniques during three to six months of hospitalization.
Even after the eating disorder has been controlled, follow-up counseling for the child as well as her family may be recommended. While many girls can recover, relapse is common and may occur months or years after treatment has ended. Girls with anorexia tend to do better if they are younger when they become sick, or if they have more selfesteem or do not deny their condition as much.