You probably know many women who seem obsessed with dieting and weight; yet the majority of them do not have an eating disorder. A few individuals become very good at dieting, so good that they never want to stop...even when weight loss starts to sap their strength and threaten their health. They have anorexia nervosa, an eating disorder that affects 1 of 200 Americans, 90 percent of whom are women.
Anorexia can develop at any age, but usually in youth or adolescence. Characteristics, according to the American Psychiatric Association, include: a weight 15 percent or more below the healthy minimum; an intense fear of gaining weight or becoming fat; lack of a menstrual period for at least three consecutive cycles; distorted ideas about body shape, weight and self worth; and refusal to recognize that weight loss is a problem.
Individuals with anorexia do not necessarily lack an appetite. They just become better and better at denying food. When others are around, they may take small portions or hide food instead of eating it. Away from home, they often skip meals altogether. The disorder leads to malnutrition. Early detection can be a hope for a lasting cure. The longer it goes untreated, the harder it is to treat.
A person with anorexia often feels anxious, depressed and irritable. Physical effects include swollen joints, dry skin and hair, brittle nails, constipation, insomnia and loss of energy. The anorexic suffers loss of bone mass, sometimes permanently, and, if she’s young enough, her sexual development may be arrested. Without treatment, she will eventually die.
The typical patient is shy, conscientious and sensitive to rejection–a worry wart. Anorexics are prone to irrational guilt and feelings of inferiority. The most common trait perhaps is perfectionism.
The behavior of a woman with anorexia, according to various theories, may be an effort to assert control over her own life or a way to deal with conflicts or problems within her family. Some feminist theorists have proposed that refusal to eat may be an inarticulate social protest, a refusal to develop a woman’s body and the role that goes with it.
While there’s little question that television, films and advertising have created an unrealistic image of the female body, it’s too simple to blame the media for eating disorders. Anorexic behavior was reported in ancient Chinese and Persian texts and in African tribal lore. St. Catherine of Siena, who starved herself to death at age 32, was one of many Medieval mystics who denied themselves food in the quest for what they saw as perfection.
According to one theory, anorexia is an addiction to fasting or dieting. As with alcoholism and other addictions, denial is a hallmark, and one that makes treatment difficult. Any efforts by a parent to scold, criticize, nag or pressure the anorexic to eat are nearly always counter-productive. Anorexia is a disease that requires professional treatment–the sooner the better.
If a woman’s weight is 15 percent below normal or lower, the first order of business is restoring normal weight, and this usually has to be done in an institutional setting. Even a return to normal eating and weight, however, does not guarantee recovery unless there’s a change of thinking. A multidisciplinary approach is usually needed: nutritional education, supportive care, cognitive therapy to help the patient recognize and correct faulty beliefs and a system of rewards and motivation.
Recovery is usually a long-term project with numerous turns and many relapses. Some anorexics later become bulimic–with binge eating followed by purging–or alcoholic. Anxiety and depression are common.
The death rate associated with anorexia is unusually high for a mental illness, but that may be because many women don’t get the help they need early enough. In a recent study of records at the Mayo Clinic, 208 patients with symptoms of anorexia but no physical illness actually fared pretty well over an average follow-up period of 27 years. The 17 deaths–six from alcoholism, one suicide and one a direct consequence of anorexia–were 7 less than expected given the group’s age and sex.
Anorexia is a mental illness which must be detected early and treated by a professional. Food denial and excessive weight loss are warning signs parents and friends should watch for. While the disease may never go away completely, early detection and treatment lead to a much better long term outcome.
Michelle Herbert, PharmD, CDE
