• Anorexia

    (Anorexia Nervosa)

    Definition

    Anorexia is an eating disorder . It occurs when a person's obsession with diet and exercise leads to extreme weight loss. The disorder is considered if a person refuses to maintain a body weight at or above 85% of their ideal body weight. It can be fatal.

    Causes

    The cause of anorexia is not known. It appears that genetics and environment play a role.

    Risk Factors

    A risk factor increases your chance of getting a disease or condition. Risk factors for anorexia include:
    • Sex: female
    • Age: adolescence or early adulthood
    • Low self-esteem
    • Feelings of helplessness
    • Perfectionism
    • Fear of becoming overweight
    • Familial pressure to be thin
    • Families that are overprotective, rigid, not involved, or in conflict
    • Family history of eating disorders
    • Emotional stress
    • Mood disorders, such as depression or generalized anxiety disorder
    • Personality disorders
    • Influenced by social and fashion trends emphasizing or glamorizing thinness

    Symptoms

    Symptoms may include:
    • Excessive weight loss
    • Obsession with food, calories, and fat content
    • Dieting even when thin
    • Intense fear of gaining weight, even when underweight
    • Body dysmorphia—distorted self-image of being overweight despite evidence of the opposite
    • Basing self-evaluation heavily on body weight or shape
    • Loss of menstrual periods (secondary amenorrhea ) or delay in menarche (beginning of periods)
    • Excessive exercising
    • Feeling cold, especially hands and feet
    • Being secretive about food
    • Hair loss and/or growth of fine hair on the body
    • Fainting or severe light-headedness
    • Constipation
    • Depression and/or anxiety
    • Heart palpitations
    Anorexia often leads to a number of serious medical problems including:
    • Amenorrhea (loss of periods)
    • Osteoporosis
    • Cardiac problems—can be fatal
    Body Dysmorphia
    Anorexia
    Copyright © Nucleus Medical Media, Inc.

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. There will also be psychological tests. There may be lab tests. Findings may include:
    • Excessive loss of body fat
    • Loss of muscle mass
    • Low heart rate
    • Low blood pressure, particularly when standing
    • Decreased bone density
    • Signs of a slow metabolism

    Treatment

    The goal of treatment is to get you back to a healthy weight and keep you there. A healthy weight is above 85% of your ideal weight. To achieve this, your intake of calories is gradually increased. This can be accomplished through a number of interventions, including the following:

    Nutritional Consultation

    A dietician may be consulted to help you learn more about the components of a healthy diet. The dietician will also talk to you about reasonable weight goals and calorie goals.

    Cognitive-Behavioral Therapy (CBT)

    Cognitive-behavioral therapists help you develop a healthier and more realistic self-image. The therapist will help you find new ways to think about your body and your diet.

    Interpersonal Therapy

    Therapy can help you understand and cope with concerns about your relationships.

    Family Therapy

    Families often play a role in eating disorders. Many patients cannot recover unless their families are involved in the changes. All families need to understand the disorder and provide support.

    Antidepressants

    In some cases, anorexic patients benefit from a combination of psychotherapy and antidepressant medication. In particular, selective serotonin reuptake inhibitors (such as Zoloft or Prozac) are used. Used alone, antidepressant therapy is not an effective treatment for anorexia.

    Addressing Nutritional Status and Loss of Bone Density

    Medications and supplements may include:
    • Vitamins and minerals to maintain adequate nutrition
    • Hormone replacement to resume periods and prevent bone loss

    Hospitalization

    Hospitalization may be necessary if:
    • Weight is 25%-30% below ideal body weight
    • There are signs of serious physical or emotional deterioration
    If you are diagnosed with anorexia, follow your doctor's instructions .

    Prevention

    There are no guidelines for preventing anorexia. Early detection and treatment is the best option.

    RESOURCES

    National Association of Anorexia Nervosa and Associated Disorders http://www.anad.org

    National Eating Disorders Association http://www.nationaleatingdisorders.org

    CANADIAN RESOURCES

    Canadian Mental Health Association http://www.cmha.ca

    National Eating Disorder Information Center http://www.nedic.ca

    References

    Anorexia nervosa. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 3, 2012. Accessed November 5, 2012.

    Anorexia nervosa fact sheet. Office on Women's Health website. Available at: http://womenshealth.gov/publications/our-publications/fact-sheet/anorexia-nervosa.cfm . Updated June 15, 2009. Accessed November 5, 2012.

    Casper RC. How useful are pharmacological treatments in eating disorders? Psychopharmacol Bulletin . 2002;36:88-104.

    Ferri F, ed. Ferri’s Clinical Advisor 2010. Philadelphia, PA: Mosby Elsevier; 2009.

    Goldman L, Ausiello D, eds. Cecil Textbook of Internal Medicine. 23rd ed. Philadelphia, PA: Saunders; 2008.

    Lenders JW, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet . 2005;20-26,665-675.

    Rakel R. Textbook of Family Medicine. 7th ed. Philadelphia, PA: Saunders Elsevier; 2007.

    Rakel RE, Bope ET, Conn H. Conn's Current Therapy. Philadelphia, PA: Saunders Elsevier; 2009.

    Stern TA. Massachusetts General Hospital Comprehensive Clinical Psychiatry. Philadelphia, PA: Mosby Elsevier; 2008.

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