Anorexics don't eat; but that doesn't mean they lack an appetite. Indeed, anorexics often display an obsessive interest in food. A typical anorexic will read about food, shop for, cook, and constantly think about food, in fact, will do everything with food except eat it.
According to the American Psychiatric Association, from one-half to one percent of women between ages 15 and 30 suffer from anorexia. The number of cases appears to have increased in recent decades, although it is not clear whether this is due to an actual increase or better reporting. More deaths are attributed to anorexia than any other psychiatric disorder.
Anorexics have usually been described as high-achieving, perfectionist, and compliant white adolescents from comfortable or affluent families. The stereotype has its limits, however. Increasingly, cases are being reported among African Americans and Hispanics. Those studying the spread of anorexia and other eating disorders have found that while age and gender are closely related to development of eating disorders, ethnic background and economic status are not.
- Warning Signs of Anorexia
- Hallmarks of Anorexia
- Ravages of Anorexia
- What Happens to Your Mind and Body
- Treatment for Anorexia: What to Expect
According to current diagnostic guidelines, you are anorexic if you:
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Anorexia typically begins to develop between ages 12 to 14, or later in adolescence, at about age 17. Some cases have appeared before puberty and some as late as the early 30s. The cause is unknown, although a variety of cultural and psychological factors are probably involved. Eating disorders seem to run in families, and a girl has a 10 to 20 times greater risk of developing anorexia if she has a sibling with the disease.
There also appears to be a link between overprotective parenting and anorexia. Many anorexics come from close-knit families that allow their members little room for individuality. Rebellion against this restrictive environment often takes the form of refusing to eat.
There are two types of anorexia. With the restricting type, you lose weight primarily through dieting, fasting, and excessive exercise. The binge-eating/purging type is more complicated because it can be confused with bulimia. This type of anorexic may binge-eat, then purge by vomiting and misusing laxatives, diuretics, or enemas, or even purge regularly after eating only small amounts of food.
What Happens to Your Mind and Body
Many anorexics describe the beginning of their disorder as a reaction to a comment such as "you really need to lose some weight." They begin to diet and enjoy the positive feedback that comes with weight loss and the sense of control that they feel over their bodies. But then they somehow lose perspective on what a healthy or attractive body image really is, and want only to continue losing weight. While they feel they are controlling their diet, the diet ends up controlling them.
"I controlled everything through my food," said Tracy Gold, a young TV actress whose battle against anorexia was well-publicized in gossip columns and fan magazines. She described this control as turning into a tremendous fear of food that became nearly impossible for her to overcome. "To me it was like an evil force inside of me," she said. "You want to live; you want to get better; but you literally don't know how."
Christy Henrich, the 22-year-old gymnast who died in July 1994 weighing 43 pounds, used similar words to describe what her life had become. "My life is a horrifying nightmare," she said when she went public with her illness a year before her death. "It feels like there's a beast inside of me, like a monster. It feels evil."
Psychologically, in addition to these feelings of fear and evil, anorexics often suffer from other psychological problems, such as obsessive-compulsive behavior, social isolation, anxiety, a revulsion toward fat and self-indulgence, and compulsive and excessive exercising. Often, a hidden depression lies at the core. Like people suffering from involuntary malnutrition, anorexics may also exhibit any of the following additional symptoms:
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Insomnia
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Lack of concentration
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Indecisiveness
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Preoccupation with food
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Mood swings
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Irritability
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Fatigue and lethargy
In the most extreme cases, mental functioning becomes severely impaired.
A number of medical conditions characterize anorexia, some stemming from what are believed to be underlying psychological issues. For example, teenage anorexics are often described as fearful of growing up and attempting to thwart their emerging sexuality. By fasting, these girls drastically reduce the amount of female hormones being produced, which not only keeps their breasts and hips from developing, but also blocks the process of menstruation.
Emaciation is a second, more obvious condition that develops, but more important is the body's protective response to the effects of starvation. Vital organ function begins to decline, as if shifting into a lower gear of operation. Breathing and heart rates decline. Heartbeat becomes irregular. Blood pressure drops. Thyroid function slows. Body temperature goes down. Most anorexics cannot tolerate cool temperatures and always feel cold, particularly in their hands and feet.
They may develop constipation due to water imbalance. Deprived of protein, their nails and hair may become brittle and their hair may fall out. Vitamin deficiencies will eventually cause their skin to become dry and scaly, often with a yellow or gray cast to it. As anorexia progresses, a type of fine body hair called lanugo will grow. This downy covering is probably an attempt by the body to compensate for the loss of muscle and fat tissue.
The breakdown that anorexia causes in hormone production also often results in osteoporosis, the loss of bone mass that leads to brittle bones. It is comparable to the condition that develops in postmenopausal women whose bodies have almost stopped producing estrogen. To halt bone loss, most doctors (more than three-quarters according to one report) prescribe hormone replacement therapy for teenage anorexics. There's no proof, however, that this does any good. On the contrary, recent studies have found that it has no effect on bone mass in adolescent girls.
Researchers are beginning to find other hormonal and chemical changes related to anorexia. Levels of serotonin, neuropeptides, and leptin, the chemical messengers that regulate appetite, are abnormal in people with anorexia, although it's not known whether this is a cause or an effect of the disorder. In addition, nutritional deprivation renders anorexics resistant to growth hormone and retards production of the insulin-like growth factor I, another hormone related to growth. Administration of these hormones may someday become a treatment for anorexia, but work in this area is still new and is not yet being applied to patients. Other researchers are investigating the role of enkephalins and endorphins, opiate-like chemicals produced in the brain.
The course of anorexia varies considerably, depending on when the condition is detected, what supports are in place, and how it is treated. Up to ten percent of those with anorexia nervosa eventually die of the disease. Most others go on to lead healthy and productive lives.
Treatment for Anorexia: What to Expect
There are two important points about treating anorexia. First, denial is one of the most consistent features of the disorder, and most anorexics resist treatment. It is usually up to a family member or close friend to recognize the problem and get the patient into treatment.
Second, continued treatment and monitoring is crucial because anorexia is often a chronic and recurring condition. This means that one successful course of treatment does not necessarily cure the disease and that even "cured" patients may suffer setbacks. In fact, some studies have found that as many as half of anorexics who have been hospitalized for treatment will relapse after what has been considered a successful course of treatment. So, for most patients, treatment will be a long-term process.
Most patients undergo a combination of psychological and medical treatment. In many cases, this means hospitalization to begin dealing with the physical effects of starvation. Hospitalization is usually advised if you weigh less than 70 percent of your recommended body weight, have rapidly progressing weight loss, and have symptoms such as irregular heartbeat, dizziness or fainting, and low potassium levels. Anorexia is probably the only psychiatric illness for which the most effective initial treatment is often a long stay in the hospital.
The first step is called "refeeding," which can be done on an in- or outpatient basis, depending on the severity of your condition and whether or not you're ready to cooperate. Some patients have to be force-fed through nasogastric or intravenous tubes; there are even cases in which courts have ordered such treatment in order to keep the victim alive.
While refeeding goes on, you'll begin to receive behavioral therapy, psychotherapy, and nutritional counseling. You'll be encouraged to develop your eating plans, which will start with small amounts of food that you can feel safe with, gradually increasing the number of calories you consume and broadening your selection of foods. Your doctor will keep a close watch to avoid potential physical problems that can develop with refeeding such as abdominal bloating, constipation, and swelling. If a slow and gradual approach is taken, these can usually be avoided or lessened.
Therapy is typically a lengthy process. A variety of different approaches are used, alone or in combination. These include cognitive behavioral therapy and individual or group psychotherapy. Cognitive therapy focuses on correcting a person's distorted notions about food, body image, and self-worth. Recently, as doctors began to realize the role the family plays in development of anorexia, family therapy has become increasingly common. Self-help groups such as Overeaters Anonymous are also a major source of supportive therapy. Nutritional counseling remains an absolutely crucial part of treatment.
A number of different medications have been used for anorexia. Some have helped, although no single medication stands out. Anti-anxiety drugs may work in some cases, while antidepressants are frequently prescribed for those with symptoms of depression.
The prognosis for anorexia varies, depending on the severity of the disease and your ability to cooperate with treatment. If you are able to acknowledge the severity of the problem, get help, and successfully rebuild your self-esteem, you have every right to be confident of recovery.