Anorexia Nervosa Treatment

Anorexia nervosa is an extremely dangerous, life-threatening eating disorder in which a person intentionally deprives themselves of food and can literally starve to death in an attempt to be what they consider "thin." The disorder involves extreme weight loss--at least 15 percent below the individual's "ideal" weight--and a refusal to maintain body weight that is even minimally normal for their age and height. Even if they become extremely emaciated, an anorexic person's distorted body image convinces them they are "fat." The self-esteem of individuals with this disorder is directly dependent on their body shape and weight. Weight loss for them is viewed as an impressive achievement and an indication of extraordinary self-discipline.

Causes, Incidence, and Risk Factors

The exact cause of anorexia nervosa is not known, but social attitudes towards body appearance and family factors are believed to play a role in its development. The condition usually occurs in adolescence or young adulthood. It is more common in women, affecting 1-2% of the female population and only 0.1-0.2% of males.

Anorexia nervosa is seen mainly in Caucasian women who are high academic achievers and have a goal-oriented family or personality. Some experts have suggested that conflicts within a family may contribute to this eating disorder. It is thought that anorexia is a way for a child to draw attention away from marital problems, for example, and bring the family back together.

Other psychologists have suggested that anorexia may be an attempt by young women to gain control and separate from their mothers. The causes, however, are still not well understood.

Symptoms

  • weight loss of 15% or greater below the expected weight
  • inappropriate use of laxatives, enemas, or diuretics (water pills) in an effort to lose weight
  • self-imposed food intake restrictions, often hidden
  • absence of menstruation
  • skeletal muscle atrophy
  • loss of fatty tissue
  • low blood pressure
  • dental cavities may be present with self-induced vomiting
  • blotchy or yellow skin
  • depression may be present in addition to the eating disorder
  • most individuals with anorexia nervosa refuse to recognize that they have an eating disorder (denial)

Signs and Tests

Diagnosis is based upon ruling out other causes of endocrine, metabolic, digestive, and central nervous system abnormalities to explain the weight loss. This could include celiac disease, inflammatory bowel disease, Addison's disease, and many other possible conditions.
Tests that may be used to assess cause of or damage from weight loss include:

  • chem-20
  • urinalysis
  • thyroid function tests
  • other blood and urine tests
  • ECG

This disease may also alter the results of the LH response to GnRH test.

Anorexia Treatment

Treatment of anorexia calls for a specific program that involves three main phases: (1) restoring weight lost to severe dieting and purging; (2) treating psychological disturbances such as distortion of body image, low self-esteem, and interpersonal conflicts; and (3) achieving long-term remission and rehabilitation, or full recovery. Early diagnosis and treatment increases the treatment success rate. Use of psychotropic medication in people with anorexia should be considered only after weight gain has been established. Certain selective serotonin reuptake inhibitors (SSRIs) have been shown to be helpful for weight maintenance and for resolving mood and anxiety symptoms associated with anorexia.

The acute management of severe weight loss is usually provided in an inpatient hospital setting, where feeding plans address the person's medical and nutritional needs. In some cases, intravenous feeding is recommended. Once malnutrition has been corrected and weight gain has begun, psychotherapy (often cognitive-behavioral or interpersonal psychotherapy) can help people with anorexia overcome low self-esteem and address distorted thought and behavior patterns. Families are sometimes included in the therapeutic process.

The biggest challenge in treating anorexia nervosa is having the person recognize that their eating behavior is itself a problem, not a solution to other problems. However, most people who suffer from anorexia nervosa deny that they have an eating disorder. Therefore, most individuals enter treatment when their condition is fairly advanced.

The purpose of treatment is first to restore normal body weight and eating habits, and then attempt to resolve psychological issues. Hospitalization may be indicated in some cases (usually when body weight falls below 30% of expected weight).

Supportive care by health care providers, structured behavioral therapy, psychotherapy, and anti-depressant drug therapy are some of the methods that are used for treatment. Severe and life-threatening malnutrition may require intravenous feeding.

Prognosis

Anorexia nervosa is a serious and potentially deadly medical condition. By some estimates, it leads to death in 10% of cases. Experienced treatment programs have a two-thirds success rate in restoring normal weight, but relapse is common.

Women who develop this eating disorder at an early age have a better chance of complete recovery. Most people with anorexia will continue to prefer a lower body weight and be preoccupied with food and calories to some extent, however. Weight management may be difficult, and long-term treatment may be necessary to help maintain a healthy body weight.

Complications

The presence of any of these suggests a severe disease, and hospitalization may be required:

  • severe dehydration, possibly leading to cardiovascular shock
  • electrolyte imbalance (such as potassium insufficiency)
  • cardiac arrhythmias related to the loss of cardiac muscle and electrolyte imbalance
  • severe malnutrition
  • thyroid gland deficiencies which can lead to cold intolerance and constipation
  • appearance of fine baby-like body hair (lanugo)
  • bloating or edema
  • decrease in white blood cells which leads to increased susceptibility to infection
  • osteoporosis
  • tooth erosion and decay with self-induced vomiting
  • seizures related to fluid shifts due to excessive diarrhea or vomiting

Prevention

In some cases, prevention may not be possible. Encouraging healthy, realistic attitudes toward weight and diet may be helpful. Sometimes, counseling can help.