Attenuating Anorexia Nervosa
It all starts with a little remark. “I bet if you lose five pounds you will be much better.” So you do everything to make sure you do just that and then some. You work out like a maniac. You restrict what you eat to 500 calories a day. You may have anorexia nervosa.
Anorexia nervosa is a life-threatening eating disorder. It is characterized by an abnormally low body weight. Low body weight is described as weighing less than the minimum that is considered normal for the person’s age, sex, stage of growth and development, and physical health. Individuals with anorexia have a distorted body image believing that they are too fat. Extreme weight loss in people with this disorder can lead to dangerous health problems, even death.
It is estimated that 8 million Americans suffer from an eating disorder. One in 200 women suffers from anorexia. Twenty percent of people suffering from anorexia will prematurely die of complications related to their eating disorder, including suicide and heart problems. Only 1 in 10 people with eating disorders receive treatment. Anorexia is the third most common chronic illness among adolescents. Rates of minorities with eating disorders are similar to those of white women.
The physical signs and symptoms of anorexia may include extreme weight loss or not making developmental weight gains; thin appearance; abnormal blood counts; fatigue; insomnia; dizziness or fainting; bluish discoloration of the fingers; hair that thins, breaks, or falls out; soft, downy hair that covers the body; absence of menstruation; constipation and abdominal pain; dry or yellowish skin; intolerance of cold; irregular heart rhythms; dehydration; and eroded teeth and callouses on the knuckles from induced vomiting.
The behavioral aspects of anorexia are severely restricting food intake through diet and fasting, exercising extensively, bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products.
Emotional signs may include preoccupation with food, sometimes cooking elaborate meals for others but not taking part; frequently skipping meals or refusing to eat; denial of hunger or making excuses for not eating; eating only a few “safe” foods usually those that are low in calories and fat; adopting rigid meal or eating rituals, such as spitting out food after chewing; not wanting to eat in public; lying about how much food was eaten; fear of gaining weight that might include repeated weighing or measuring the body; frequently checking the mirror for flaws; social withdrawal; irritability; and covering up in layers of clothing.
The exact cause of anorexia is unknown but there may be certain factors that makes one prone to this disorder. For instance, genetics may play a role where certain people lean towards perfectionism, sensitivity and perseverance, traits associated with anorexia. Some people with anorexia have obsessive compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. Even more, modern Western culture emphasizes thinness. There may be a lot of pressure to be thin.
If your doctor suspects that you have anorexia nervosa, he or she will typically do several tests or exams to pinpoint a diagnosis and rule out medical causes for the weight loss and check for any related complications.
Your doctor will start by taking a physical exam. Lab tests will be involved like a complete blood count and more specialized blood tests. An urinalysis may be required as well. A psychological evaluation will be done. Other studies like X-rays to check your bone density, check for stress fractures, or broken bones or check for pneumonia or heart problems. Electrocardiograms may be done to look for heart irregularities.
Your physician will follow the diagnostic criteria specified for anorexia in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association.
Treatment of anorexia is a team effort including your doctor, mental health professionals and dietitians, all who are knowledgeable about anorexia. Ongoing therapy and nutrition advice are an important part of the healing process for patients.
If your health is in immediate danger you might need to be hospitalized for a while due to medical complications, psychiatric problems, severe malnutrition, and continued refusal to eat. There are clinics that specialize in treating patients with eating disorders. They might offer day programs or residential programs rather than full hospitalization. Specialized eating disorder programs may offer more intensive treatment over longer periods of time.
You may need frequent monitoring due to your condition such as vital signs, hydration level, and electrolytes. In some cases, people with anorexia may initially require feeding through a tube that is placed under the nose and goes into the stomach (nasogastric tube).
The primary goal for treating patients with anorexia is to get them back towards a normal weight. You can’t recover from anorexia without returning to a healthy weight and learning about proper nutrition. Your primary physician, dietitian, your psychologist or mental health professional and family will work together with you in this recovery process.
Different types of therapy may be effective for treating anorexia. Family-based therapy is ideal for teenage patients. Because a teenager with anorexia is unable to make good choices about eating and health while in the throes of a serious condition, this therapy mobilizes parents to help their child with re-feeding and weight restoration until the child can make good choices regarding health.
Then there is individual therapy, particularly cognitive behavioral therapy has been shown to help. The main goal is to normalize eating patterns and behaviors to support healthy weight gain. The second goal is to help change distorted beliefs and thoughts that maintain restrictive eating.
While there are no medications used to treat anorexia, your doctor may prescribe antidepressants or other psychiatric drugs for other mental health disorders you may have like depression or anxiety.
One of the biggest issues for patients with anorexia is not believing one needs treatment in the first place. Or believing that the person will gain weight. Or perceiving anorexia to be a lifestyle rather than an illness.
When you have anorexia, your judgment is questionable regarding your health so some important tips to follow are stick with a treatment plan, talk to your doctor about appropriate vitamin and mineral supplements, don’t isolate yourself from family and friends who want to see you get healthy, resist urges to weigh yourself (this may reinforce destructive thought patterns regarding your self-worth being tied to your weight).
The main thing is to ask for advice on coping strategies from your doctor. It is okay to question your physician regarding the best course of action towards recovery. Know that recovery is a journey not a destination and it may take some time before you reach an ideal weight or before you have changed your thoughts regarding disordered eating. You may have to take it one day at a time and rely on the support of family and friends.
