Definition

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

Causes

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

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for anorexia nervosa include the following:

  • 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, under-involved, or in conflict
  • Family history of eating disorders
  • Emotional stress
  • Mood disorders such as depression or generalized anxiety disorder
  • Personality disorders
  • Susceptibility to 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 to the contrary
  • Basing self-evaluation heavily on body weight or shape
  • Loss of menstrual periods (secondary amenorrhea) or delay in menarche (onset 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:

Body Dysmorphia

Anorexia

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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 sluggish 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 to 1,500 to 3,500 per day. This can be accomplished through a number of interventions, including the following:

Cognitive-Behavioral Therapy (CBT)

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

This 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 sertraline [Zoloft] or fluoxetine [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 menstruation and prevent bone loss

Hospitalization

Hospitalization may be necessary if:

  • Weight is 25% to 30% below ideal body weight
  • There are signs of serious physical or emotional deterioration

Prevention

There are no guidelines for preventing anorexia nervosa. Early detection and treatment has been more successful than prevention.