Anorexia Nervosa
What is anorexia nervosa?
Anorexia nervosa (AN) is an eating disorder characterized by refusal to maintain weight within a healthy range, fear of weight gain, severe body disturbance and absence of three menstrual cycles. In addition, those with Anorexia Nervosa deny the seriousness of their illness. Anorexia nervosa is sometimes referred to as anorexia.
What causes anorexia nervosa?
The cause of anorexia nervosa is not known. Anorexia usually begins as innocent dieting behavior, but gradually progresses to extreme weight loss. Social attitudes toward body appearance, developmental difficulties, family influences, genetics and neurochemical changes all contribute to the development of anorexia. Adolescents who develop anorexia are more likely to come from families with a history of eating disorders and other mental health problems, such as depression, anxiety or obsessive-compulsive disorder.
Who is affected by anorexia nervosa?
The occurrence of anorexia nervosa has increased over the past 20 years, mainly in older adults. It is most common in the adolescent years where it occurs in one out of every 100 teens. Five to 10 percent of teens diagnosed with anorexia are males. Anorexia is found in all industrialized countries, in all socioeconomic groups and in a variety of ethnic and racial groups.
What are the different types of anorexia?
There are two subgroups of behavior aimed at controlling weight:
- Restricting Type
- Severely limits the caloric intake of food, especially carbohydrates and fat containing foods.
- Binge-eating / Purging Type
- Induces vomiting and/or takes large amounts of laxatives, diet pills, or diuretics. May also binge eat regularly.
What are the symptoms of anorexia nervosa?
The following are the most common symptoms of anorexia. However, each child or adolescent may experience signs differently. Symptoms may include:
- rapid or extreme weight loss
- frequent weigh-ins
- expresses feeling fat, even when very thin
- preoccupation with food preparation
- uncomfortable eating at family or social gatherings
- unusual eating behaviors or rituals
- excessive exercise
The following are the most common physical symptoms associated with anorexia - often that result from starvation and malnourishment. However, each child may experience symptoms differently. Symptoms may include:
- absence of menstrual periods
- fatigue
- intolerance to cold temperatures
- dizziness or fainting spells
- abdominal pain
- constipation
- trouble sleeping
Persons with anorexia may also be socially withdrawn, irritable, moody and/or depressed. The symptoms of anorexia nervosa may resemble other medical problems or psychiatric conditions. Always consult your adolescent's physician for a diagnosis.
How is anorexia nervosa diagnosed?
Parents, teachers, coaches, or instructors may be able to identify the child or adolescent with anorexia, although many persons with the disorder initially deny any symptoms. However, an adolescent's physician, child psychiatrist or a qualified mental health professional usually diagnoses anorexia nervosa.
A detailed history of the child's behavior from parents and teachers, clinical observations of the child's behavior and sometimes, psychological testing contribute to the diagnosis. Parents who note symptoms of anorexia in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.
Anorexia, and the malnutrition that results, can injure nearly every organ system in the body, increasing the importance of early diagnosis and treatment. Anorexia can be fatal. Consult your child's physician for more information.
How is anorexia nervosa treated?
Specific treatment for anorexia nervosa will be determined by the adolescent's physician based on:
- age, overall health and medical history
- extent of symptoms
- tolerance for specific medications, procedures, or therapies
- expectations for the course of the condition
- ability of the family to participate in treatment
Anorexia is usually treated with a combination of individual therapy, family therapy, behavior modification and nutritional rehabilitation. Treatment should always be based on a comprehensive evaluation of the adolescent and family. The frequent occurrence of medical complications and the possibility of death during the course of acute and rehabilitative treatment requires both your child's physician and a nutritionist to be active members of the management team. Parents play a vital role in the treatment process.
Are there possible complications of anorexia nervosa?
Medical complications that may result from anorexia include, but are not limited to, the following:
Heart
While it is difficult to predict which patients might have life-threatening cardiac complications from their illness, most patients suffer some heart changes including:
- arrhythmias (irregular heartbeat)
- bradycardia (slow heartbeat)
- hypotension (low blood pressure)
- weakened heart muscle leading to decreased exercise endurance
Blood
Low white blood cell count (infection fighting cells) and low red blood cell count (oxygen carrying cells) occurs in up to 50 percent of anorexic patients. In addition, there may be abnormalities in other blood tests, such as the potassium (K+), Calcium (Ca), Phosphorous (Phos) and Magnesium (Mg).
Stomach and Intestines
Normal movement in the intestinal tract slows down leading to fullness, bloating, nausea and constipation.
Kidneys
The kidney loses its ability to concentrate urine, leading to frequent urination. Dehydration can occur easily as the injured kidney is unable to compensate for decreased drinking and eating behavior. Low carbohydrate, high protein diets can be especially dangerous to the kidney in these patients.
Hormones
Amenorrhea (loss of the menstrual cycle) is one of the hallmark symptoms of anorexia. It can even occur before severe weight loss (because of irregular nutrition) and can continue even after normal weight is restored. Reduced levels of estrogen, testosterone, and growth hormones may explain growth retardation and delayed pubertal changes seen in anorexic patients. Normal nutrition usually restores normal growth.
Bones
People with anorexia nervosa are at an increased risk for stress fractures and broken bones. When the onset of anorexia occurs before peak bone mass is formed (usually mid to late teens), a greater risk of osteoporosis (bone loss) exists.
How can anorexia nervosa be prevented?
Specific preventive measures to reduce the incidence of anorexia are not known at this time. Role modeling healthy eating habits and realistic attitudes toward weight may be helpful. Early evaluation and treatment can reduce the severity of symptoms, enhance the child's normal growth and development, and improve the quality of life experienced by children or adolescents with anorexia nervosa.
Contact us
For additional information on this or any Health Topic, please call the Family Resource Center, 513-636-7606, or your pediatrician.
Rev. 8/04, 6/05, 7/07
