What is Anorexia?

By The Fix staff 07/30/14
Image: 
anorexiapage.jpg
Shutterstock

Anorexia is a debilitating eating disorder that affects approximately 1% of the U.S. population and has one of the highest mortality rates of all mental health conditions. People who suffer from anorexia nervosa are seriously underweight and have little to no body fat, a condition usually brought on by self-imposed starvation. They exhibit low self-esteem directly related to their body image and express extreme anxiety about gaining weight. Some alleviate this anxiety by eating, then purging the food from their bodies, while others restrict foods altogether and refuse to eat. 

Of those who suffer from anorexia, 90% are women – mostly adolescent girls and young women. Female athletes are especially susceptible to anorexia, according to a Division 1 NCAA study that determined that more than one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa. 

What Behaviors/Factors Define Anorexia?

Psychological issues such as obsessive compulsive disorder and other anxiety-related conditions drive the disordered eating behaviors and hypercritical and distorted images of their bodies and their belief that they are overweight, when the opposite is actually true. Anorexics generally possess a body weight that is 15% or more below their expected weight based on current age and height. An average-framed female (25-59 years old) who’s 5-feet-3-inches tall should weigh between 115 and 124 pounds. Any weight below 100 pounds raises red flags for anorexia. 

The biggest difference between anorexics and individuals with other eating disorders is how they choose to lose what they perceive as “excess weight.” Some anorexics rely on restricting their food intake altogether or exercise excessively to “work off” the perceived extra weight. Others eat but then use purging as a way to avoid weight gain, either by vomiting or by forcing excessive bowel movements. Some anorexics alternate back and forth between the methods over a lifetime dealing with the disease.

Dawn Theodore, a recovered anorexic who currently serves as clinical director of the Monte Nido Eating Disorder of California, said she believes the pressures on American women to be thin and look good are major reasons for the disease’s disproportionate ratio of women to men. It’s especially prevalent, she said, in sports that focus on appearance and in the world of dance. Theodore struggled with anorexia for many years, from the time she was 15 years old into her mid-20s as a dancer in New York.

“Someone with anorexia can sit with you and tell you their thigh is fat, but when you sit next to them, they see you as a normal size,” she said. “It happens a lot.” 

How Does Anorexia Affect the Body?

Despite the method an anorexic uses to lose weight – purging or restricting – the self-inflicted starvation results in the loss of essential nutrients, causing their internal organs and systems to start shutting down to conserve what little energy they have left. Victims then start noticing symptoms such as dry skin, brittle hair falling out, general fatigue and muscle loss. The heart also starts to slow, leading to low blood pressure and sometimes loss of menstrual cycle. 

Athletes with anorexia have another set of symptoms that puts them at risk because they’re motivated by the misconception that if they weigh less, they will be faster. This disordered thinking is the exact opposite of the truth. When an anorexic loses weight, she also loses muscle, which makes her weaker and slower – not stronger and faster. This doesn’t mean that only athletes are anorexic – it just means athletes have to deal with additional complications and warning signs for which non-athletes aren’t at risk. 

Warning Signs 

People who struggle with eating disorders hide their diseases by avoiding friends and family, especially when it comes time to eat. They become experts at concealing their habits and behavior, which is why the Eating Disorders Coalition estimates that only 10 percent of those with an eating disorder actually receive treatment. 

Some of the visible signs include obsessing over weight and the number of calories they consume, having a negative preoccupation with their bodies, and participating in “fat talk” with others.

Here is a fuller list of physical and behavioral indicators to watch for:

•Refusing to accept the severity of their dangerously low weight.

•Preoccupation with weight, food, calories, fat grams and dieting.

•Frequent comments about feeling fat or overweight despite weight loss.

•Eating foods in a certain order, excessive chewing or rearranging food on a plate (also known as food rituals).

•Exercising excessively as a means to burn calories.

•Withdrawing socially from friends and family.

•Increasing the use of laxatives, diet aids or herbal products. 

Additional physical warning signs also include: 

•Inability to tolerate cold temperatures. 

•Increased dizziness.

•Irregular heart rhythms.

•Bluish discoloration of the fingers.

•Swelling of the arms or legs.

•Irritability.

Long-Term Effects

Many people who develop anorexia don’t survive the condition because of the damage the disease inflicts on the body. Those who do survive, however, often develop heart conditions such as low blood pressure and heart failure due to their slowed heart rate and shrinking heart muscle. Osteoporosis is another complication that arises because of a loss in bone density. Some anorexics also suffer from a general weakness, or fatigue, and are susceptible to kidney failure from starving their bodies of the essential vitamins and nutrients their bodies need to function. 

Coexisting Medical Conditions

Anorexia is an all-consuming disease that’s precipitated by anxiety conditions like depression or obsessive-compulsive disorder and often coexists with drug and alcohol abuse. Anxiety over hypercritical body image and fear of gaining weight or being overweight fuels an anorexic’s compulsions to either eat and purge or restrict food altogether. In the anorexic’s disordered mind, taking these actions – while they are extremely dangerous and unhealthy – alleviates the anxiety they feel in regard to their bodies and physical appearance.

Tests

The most prevalent questionnaire doctors use to determine whether someone suffers from anorexia – or any eating disorder - is the Yale-Brown-Cornell Eating Disorders Scale. This survey focuses on the psychological issues that trigger the disordered behaviors and has been successful at helping experts diagnose eating disorders for many years.

Since anorexia inflicts long-term damage to a patient’s heart, an electrocardiogram and chest X-ray are both important resources to determine whether the heart muscle has been compromised. A standard blood test will also help doctors assess patients by measuring blood cell levels and electrolytes, as well as the health of the liver, thyroid and kidneys. 

According to Jennifer Gaudiani, an assistant medical director of the Acute Center for Eating Disorders at Denver Health, a loss in bone density is one of the most critical side effects of the disease that many people overlook. She notes that since anorexics almost always deny the seriousness of their condition to friends and family members, getting them to agree to a bone density test can be the start of accepting the severity of their situation. 

“When someone’s underweight, bone density can drop remarkably fast. It’s the one complication medically that may never be fully reversible,” she says. “Athletes, especially, should have super bones. It should never be on the low side of normal for an athlete.”

Treatment

Although the full recovery rate for people with anorexia nervosa has been relatively low in the past, there are many techniques available to help patients heal.

Of this small percentage, studies show only half of the people afflicted with anorexia nervosa recover within a 10-year period. A few recover fully but often continue to maintain a low body weight and experience depression. Others continue to suffer from the disease, and the rest develop different eating disorders like bulimia or binge-eating. 

“Any psychiatric or psychological condition a patient had before they started to lose weight is about 10 times worse when it’s focused through the lens of starvation because people’s brains when they’re starved get really, really scared,” Gaudiani said. “They get very anxious, very resistant to change, very rigid, very crabby. It’s a tough time to be asking people to change their behaviors.”

Once someone has been diagnosed with anorexia, though, the first step toward treatment is revitalizing the body through nutrition, according to Gaudiani. And since anorexics are often dangerously underweight, restoring them to a healthy weight is always the top priority. 

Gaudiani believes there are many good residential and in-patient treatments around the country and cautions there are times when patients are too medically compromised to participate in a residential program because they’ve become dangerously underweight and have severe electrolyte imbalances from purging that must be addressed first. That’s when they’re referred to acute treatment. 

This treatment includes monitoring patients as they eat to ensure they aren’t abstaining or purging their food and limiting patients’ exercise until their weight returns to an acceptable level. The process, she said, can take up to two weeks to stabilize the patient to a healthy weight and state of mind before they can be referred for standard therapy. 

“We basically start relatively low oral calories in a carefully monitored and balanced set of quantities and slowly increase calories while watching patients’ heart rates, watching blood tests every day, checking their bone density,” Gaudiani said. “We try to give the feeling that we’re caring for the whole patient, even as we try to move them from life-threatening malnutrition to a state where they can go and do great work on the mental health side.”

After successfully navigating the initial phase of helping the physical body recover through nutrition and hydration replenishment, the next step is getting patients to accept long-term treatment.  

“I want them to think of it as the hardest, most sustained work they’ve ever done. A week or two later, they see what their body can do,” Gaudiani said. “After a week and a half of food and rest, they are walking around. They thought they could never get better from that, but it shows their body is ready to get strong again.” 

Once anorexics return to a healthy weight, doctors like Gaudiani use a variety of methods to treat the psychological disorder that motivates the patient’s anxiety. Some doctors use medications such as antidepressants or antipsychotics to treat the root causes, be it depression, obsessive-compulsive disorder or some other form of anxiety. Other doctors rely solely on individual or group psychotherapy. 

One specific form of therapy employed by doctors who treat adolescent anorexia patients involves a treatment that originated at the Maudsley Hospital in London. The treatment, which was conceived by staff psychiatrists and psychologists, is now commonly referred to as the Maudsley Approach or family-based treatment. 

With this approach, parents or responsible family members monitor an adolescent’s eating and control the amount and types of foods consumed. In conjunction with food monitoring, the patient also undergoes cognitive treatment to understand the behaviors fueling the eating disorder. When the supervising adult feels the adolescent can handle the responsibility of eating responsibly again, control of the food is turned back over to the child. 

This family-based treatment has enjoyed a good amount of success. Approximately two-thirds of adolescent anorexia nervosa patients maintained a full recovery five years after initial treatment, while 75%-90% maintained their full weight but exhibited occasional disordered behaviors over a five-year period. 

Please read our comment policy. - The Fix
Disqus comments
the-fix-logo.png

The Fix staff consists of the editor-in-chief and publisher, a senior editor, an associate editor, an editorial coordinator, and several contributing editors and writers. Articles in Professional Voices, Ask an Expert, and similar sections are written by doctors, psychologists, clinicians, professors and other experts from universities, hospitals, government agencies and elsewhere. For contact and other info, please visit our About Us page.

Disqus comments