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
Anorexia nervosa does not develop overnight, and early treatment can head off severe illness and even save lives. Some warning signs are clear; others more subtle.
- Unnatural or obsessive preoccupation with food, dieting, and weight
- Distorted body image and intense fear of gaining weight
- Denial of hunger
- Avoidance of social situations with food
- Poor eating habits and decreasing daily intake of food
- Cessation of menstrual periods
- Lack of energy, weakness, fatigue, and depression
- Abdominal cramps and other aches and pains
- Excessive exercising
- Decreased coordination
- Inability to concentrate
- Indecisiveness
According to current diagnostic guidelines, you are anorexic if you:
- Refuse to maintain a minimally normal body weight. This is estimated at 85 percent of what is considered normal weight for your height.
- Have an intense fear of gaining weight or getting fat.
- Have a distorted perception of what your body actually looks like. If you are an anorexic, you will look in the mirror at what may be an emaciated image and honestly believe that you are overweight and need to lose weight.
- Stop having your menstrual periods. Depriving the body of nutrition interferes with the hormonal cycles that regulate menstruation, bringing it to a halt. (If you are male, this obviously does not apply, although hormonal abnormalities are also seen in male anorexics.)
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.
Ravages of Anorexia
Fatal in up to 10 percent of cases, anorexia can cause irreversible damage in those who survive. The severe malnutrition that accompanies the disorder can bring on osteoporosis, the brittle-bone disease underlying many of the fractures suffered by the elderly. Dry, scaly, yellowish skin and noticeable hair loss are other unpleasant signs of this insidious disorder that, ironically, begins with the pursuit of perfection. |
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.