By Dr. Loretta Lanphier, ND, CN, HHP, CH

Imagine seeing a friend or relative for the first time in several years, and being stunned at how gaunt and emaciated they appear. This would be shocking enough, but even more unsettling might be the fact that after spending time with them, you realize they are not even aware that they have a problem. This scenario is one that could easily fit the mold for a person struggling with anorexia, a psychological condition that can have critical physical consequences as well.

What is Anorexia?

Anorexia is an eating disorder that is characterized by an obsession with a thin body and an unrealistic fear of gaining weight. Individuals with anorexia have a distorted view of their own body, and will often engage in destructive behaviors such as self-imposed starvation, self-induced vomiting, and excessive exercise in order to maintain their perception of the “perfect” body. The official name of the illness is “anorexia nervosa,” which comes from the Latin, and literally means “nervous inability to eat.” Untreated, anorexia can lead to serious and potentially fatal complications. It has one of the highest mortality rates of all psychiatric disorders.

Eating disorders have been identified for centuries, but anorexia nervosa was not officially recognized as a psychiatric disorder until 1980. The illness came more into the public eye after the anorexia-related death of singer Karen Carpenter in 1983. It has since received a large amount of media attention, and the number of diagnosed cases has more than doubled since the 1970’s. Estimates vary widely as to the prevalence of the illness. Some say up to 1% of American girls and women have anorexia. Others state that perhaps 10% of adolescent girls in the U.S. are affected. It is difficult to say for sure because due to the nature of the illness, many cases go undiagnosed. Denial by patients that they even have a problem is a common trait of anorexia.

Approximately 90% of all anorexics are female, with the vast majority of those being girls between the ages of 14-18. Originally it was thought that less than 5% of cases were found in boys and men, but those numbers seem to be steadily increasing. Anorexia appears to equally affect females (and males to a lesser degree) from all socioeconomic classes and races. It is more common in cultures that put a high value on physical appearance, such as here in the United States. Some people have referred to it sarcastically as the “Barbie-Doll Syndrome.”

What Causes Anorexia?

This is a complex question for which there is no easy answer. However, several factors are thought to be involved:

  • One of the most likely culprits is the prevailing attitude in our society that beauty, status, and worth are equated with thinness and “ideal” physical appearance, especially for girls and young women. Teen girls are especially susceptible to these influences. They are at an age when they are seeking to find their identity and self-worth, while struggling to make sense of the world around them and the changes within themselves as they grow into adulthood. My heart goes out to these girls who are bombarded by the media with the message that physical attractiveness and sexuality are the vehicles to control and manipulate others to get what they want in this world. In addition to the negative role models in the media, there is also a “copycat” factor with many girls. If their peers begin to buy into the lie and practice anorexic behaviors, it is all too common for them to follow suit. More confusion can be created by the push in recent years to discourage obesity, which is a legitimate health problem. It becomes difficult for some folks to find that balance between avoiding excess weight and becoming unhealthily obsessed with staying thin.
  • Researchers suspect certain family dynamics can also play a role in predisposing a person for anorexia. Psychiatrists believe part of the psyche behind anorexia is related to the desire for control and independence. Families that push high-achievement and perfectionism may be unknowingly setting their daughters up for anorexia. An over emphasis on physical fitness, appearance, and dieting may also be contributing factors.
  • Other possible psychological factors include:
    • Difficulty or confusion with a mature female identity. Some girls may have abnormal desires to remain a child or have issues with appearing feminine. In some cases, this is a reaction to sexual abuse or assault.
    • Dysfunctional attitudes towards food and eating in the patient’s family of origin. Sometimes anorexia can be a backlash against gluttonous or obese family members. (“I’ll never be like them…”).
    • “Inappropriate feeding” is a term used to describe a phenomenon whereby infants are not fed consistently when they exhibit normal signs of hunger. Some researchers believe this can create difficulty interpreting hunger signals later in life, and may also be a factor in eating disorders such as anorexia.
  • People in certain occupations, or adolescents that are preparing for them, can be at a greater risk for anorexia. These lines of work usually put a lot of emphasis on body weight and appearance. Examples include entertainers, athletes, dancers, actresses, and fashion models. Actually, studies have shown that overweight people are at a disadvantage in securing employment of any kind. Individuals in our society are often pre-judged by their physical appearance.
  • It is possible that genetics and family history may influence one’s chances of being anorexic. If a woman has a mother or sister with anorexia or another eating disorder, her chances are slightly greater for developing anorexia herself. Studies involving twins have helped to form this hypothesis.
  • There is some indication that serotonin, a brain chemical involved with regulating moods, may contribute to anorexia. The connection, if it does exist, is not well understood, and more research needs to be done in this area.
  • Anorexia is becoming more common in teen boys and young men. Some of the same occupational and social pressures apply to males. Some sociological research has indicated that male anorexia has a higher incidence in the homosexual community, where appearance and body weight are more highly valued.

What Are the Symptoms of Anorexia?

There are two main types of anorexia nervosa. Patients often exhibit symptoms of both types, and may change between the two at times. The two categories are:

  • Restricting: This type of anorexic severely limits the amount of food they eat and exercises to the extreme in order to attempt to control their weight.
  • Binge-eating/purging: These anorexia patients “purge” themselves after “binging,” through self-induced vomiting and the abuse of laxatives and/or enemas. A binge means different things to different anorexics. Some will gorge themselves before purging, while others feel the need to purge after even small amounts of certain “forbidden” foods, such as candy or other sweets.

There are some red flags that you should be aware of if you are concerned about possible anorexia in yourself or a loved one:

  • Constant complaints about being “fat”
  • Excessively looking at yourself in the mirror
  • Skipping meals
  • Making excuses for not eating
  • Denial of hunger
  • Eating or food rituals, such as cutting into tiny bites, or spitting out mouthfuls after chewing
  • Excessive trips to the scale to weigh yourself
  • Wearing baggy clothes
  • Restricting your diet to only a few “safe” foods, such as popcorn, diet soda, or lettuce.
  • Cooking meals for others, but not eating them yourself
  • Visiting web sites that promote anorexia as a legitimate lifestyle choice, especially common with teens
  • Referring to anorexia as your “friend” (sometimes suggested in above web sites)
  • Several signs deserve special mention, as they can be tell-tale signs of a person struggling with anorexia:
    • Russell’s sign: Scars on the back of the hand that indicate repeated self-induced vomiting.
    • Lanugo: A soft, downy hair that grows mostly on the chest and arms of anorexic women. Lanugo is usually associated with newborn babies.
    • Eroded tooth enamel can indicate repeated vomiting as well
    • Amenorrhea: This is a condition that is characterized by failure to menstruate in anorexic women. They may miss two or three periods in a row.

Other common symptoms include:

  • Dangerously low body weight
  • Denial that they have a problem
  • Unusually low blood pressure
  • Brittle nails
  • Thinning hair that breaks off or falls out
  • Dry or yellowish skin
  • Low tolerance for cold temperatures
  • Fatigue
  • Dizziness and/or fainting spells
  • Constipation
  • Irregular heartbeat
  • Dehydration
  • Moodiness and/or irritability

What Are the Possible Complications of Anorexia?

Anorexia can lead to many life-threatening conditions. Some of these are chronic and progressive, but anorexia also has the potential to cause sudden death. Some of the more serious complications include:

  • Heart arrhythmias: Abnormal heart rhythms can strike an anorexic even if they are not severely underweight. This condition can be fatal in some cases. Other heart problems such as mitral valve prolapse or heart failure are also possible consequences of anorexia.
  • Electrolyte imbalances in the blood, such as low levels of sodium, potassium, and chloride, can also lead to sudden death. This, along with heart arrhythmia, are two of the most dangerous results of anorexia.
  • Malnourishment: This can be severe in some patients, and may cause irreversible damage to any of the body’s systems. Especially at risk are the heart, brain, and kidneys.
  • Anemia: Low red blood cell counts which can lead to fatigue and other complications
  • Osteoporosis: Anorexics can suffer significant bone loss, and greater susceptibility to bone fractures later in life
  • Low testosterone levels: Male anorexics are prone to develop this problem.
  • Lung conditions that may lead to shortness of breath and decreased oxygen levels in the blood.
  • Depression: Anorexics are at a greater risk of developing depression and other psychological maladies such as anxiety disorders, obsessive-compulsive disorders, personality disorders, and substance abuse problems.

Anorexia is treated as both a physical and psychological condition. Malnutrition is one of the most immediate issues that need to be dealt with. Severe cases often require hospitalization with intense nutritional therapy, such as intravenous feedings.

One of the problems with treating anorexia is that many patients don’t see that they have a problem and therefore will not submit to treatment. Others may know they are anorexic, and even embrace it as their chosen lifestyle.

Perhaps the best thing that can be done for an anorexic is to lovingly confront them with the gravity of their situation, and help them to overcome the denial that often accompanies this disease. The support of family, friends, and other anorexics in recovery can be invaluable.

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