Anorexia Nervosa

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Anorexia is an eating disorder in which a person has an irrational fear of getting fat and therefore diets excessively to stay thin. They have an intense fear of weight gain, so they starve themselves, avoid high-calorie foods and exercise constantly (Vollstadt6). Many people with anorexia can also exhibit the practice of bulimia, which is ingesting large quantities of food and then voiding it through self-induced vomiting to remain thin (AnorexiaNP). This disorder mainly affects adolescent girls although it can affect both boys and girls of any age group. The girls are single minded in their determination to lose weight, and they believe they are fat even though they are very thin. The weight loss is slowly progressive and often starts with a perfectly normal weight reducing diet (IntroducingNP). After this has continued for several months the weight loss becomes extreme and noticeable (AnorexiaNP).


The cause of anorexia isn’t known, but people with anorexia may believe they would be happier or more successful if they were thin, or they want everything in their lives to be perfect (AnorexiaNP). A combination of psychological, environmental and physiological factors are associated with the development of this disorder. Researchers have found that part of the brain called the hypothalamus begins to work improperly after the onset of anorexia. This part of the brain controls activities such as the maintenance of water balance, regulation of body temperature, and secretion of endocrine glands and sugar and fat metabolism. Further studies are being performed to determine if anorexic patients have a biological predisposition to develop the illness (EatingNP). A person’s family, relationships, and stresses at home or school can cause anorexia. Many cases often involve girls who are high achievers academically but suffer from low self-esteem (IntroducingNP). Studies have shown that the amount of control that parents exert over what their child eats, as well as when to eat and how much, can affect the child’s development of normal, healthy eating habits. Some supervision of their eating habits is necessary but instances such as consistently requiring a child to clean his or her plate at the dinner table can affect later eating behaviors (Strada1).


Furthermore, there are numerous warning signs or symptoms of anorexia. These include deliberate self-starvation with weight loss, fear of gaining weight, refusal to eat, denial of hunger, constant exercising, greater amounts of hair on the body or face, sensitivity to the cold, loss of scalp hair, and irregular periods (AnorexiaNP). Often times many anorexics can be easily recognized since their bodies look seriously ill, as they are (Worsnop1100). In women their menstruation can come to a stop known as amenorrhea and the absence of ovulation. Menstruation will usually not resume until endocrine balance is restored. A female’s ovulation is suppressed because production of certain necessary hormones for the process decreases. (EatingNP) Anorexia brings regression to a pre-pubertal stage of development, signaling the victims inability to cope with the stresses and demands of adolescence. This manifests itself in suspension of menstruation, breast development, and sexual interest(Worsnop1104). Psychiatrist Russel Marx states, “She’s regaining control over her life. She feels relieved because weight loss reverses maturity. Menstruation stops. She becomes like a child again-physically, at least (Worsnop10).” Research indicates that disordered eating, when combined with strenuous exercise, leads to physical damage that is most often only partially reversible (Worsnop110). In addition to over-exercise, anorexics may also show signs of general restlessness, which can be the body’s reaction to food deprivation. This restlessness can lead to insomnia for some (Strade45). Other symptoms include preoccupation with food, calories, fat contents and nutrition, fainting spells, lying about food, weakness, exhaustion, constipation, shortness of breathe and brittle, dry skin. Often anorexics are in a bad mood and may have a hard time concentrating because they are always thinking about food (AnorexiaNP). Most anorexics are also likely to eat strictly low-fat or low-calorie foods and believe that any other types of foods are bad or wrong (Strada45). They often reduce their food consumption to less than 600 calories a day, resulting in a rapid weight loss of 5% or more of their body weight. Self-induced vomiting and the use of laxatives or diuretics may accompany the fasting also to produce greater weight reduction (Worsnop10). Since the main goal of anorexics is to lose weight, they view food as something to avoid whenever possible (Strada1). They stop thinking of food as a source of nutrition and energy, and as a consequence avoid eating even when hungry. When offered a meal or food they may repeatedly respond that they are not hungry, and if they do eat a meal or snack they do not enjoy their indulgence and feel guilty afterwards (Strada1). However if they do eat they may show signs of having eating rituals, such as cutting up food a certain way or taking a long time to chew each bite (Strada44). Some anorexics take a vicarious pleasure from food. They enjoy cooking a big dinner for their friends and they will barely eat, nibbling on food and pushing it around on their plate so it looks as if they have been eating. When they don’t eat, it’s an achievement, a sign of success, rather than an act of deprivation (Strada14). One patient stated, “I was hungry, but I didn’t think I was depriving myself. I was pretty proud of the tight rein I had on my eating.” If the patient doesn’t lose weight as desired or if they ate more food than usual at a meal or during the day then exercise seems like a way to prevent weight gain (Strada15). One doctor states how anorexics view themselves; “Anorexics often become judgmental of others and behave as if they feel alienated, tending to isolate themselves from family and friends. They are usually disciplined in their behavior � not just in how they eat or exercise but also in how they deal with other aspects of daily life, such as school, work, and other activities. They will also indicate signs of a poor body image. Often times the anorexic may complain of being overweight-even when it is not true-or make statements suggesting that they do not perceive themselves realistically. Also they may act overly self-conscious about physical appearance in general.” (Strada45)


This disorder also consist of side effects, both short and long term. Irregular heartbeat, dehydration, kidney stones or kidney failure, muscle atrophy, and osteoporosis are all effects (Strada4). Being an anorexic puts a major strain on the heart, which effects the body’s normal potassium and sodium levels and creates an electrolyte imbalance. Electrolytes are essential for the body’s muscles and nerves to function properly. This electrolyte imbalance can also result in an irregular heartbeat, known as cardiac arrhythmia and possible heart failure (Strada44). Another side effect of this disorder is osteoporosis. Which is characterized by a decrease in bone density. The bones become dry and fragile and more prone to fracture. This disorder can be treated with hormone replacement therapy, calcium, and vitamin D, but the bones never fully heal (Strada4). A slowed metabolism is also included in the effects of anorexia. This lowers a person’s blood pressure causing organs to possibly shrink and dehydration can cause damage to the kidneys (Strada44). Severe cases of anorexia include all these effects and can result in death. Nearly 15% of all anorexics die as a result of their starvation (Strada44).





Anorexia was finally identified as a distinct clinical entity in the 1870’s by Ernest C. Lasegue, a French physician and professor of medicine and Sir William Gull an English physician. Both physicians agreed that anorexia was a psychological disease not an organic one. Later researchers have tried to demonstrate that anorexia stemmed from disruption of the endocrine system, but by the 140’s the Gull-Lasegue theory of the disorder’s psychological origins was generally accepted (Worsnop1106). Today, researchers at the National Institute of Mental Health are studying the biological aspects and changes in brain chemistry, which control appetite (IntroducingNP). Although psychological or environmental factors may hasten the onset of the illness, studies indicate that it may be prolonged by starvation-induced changes in body process. More topics currently under investigation include sexual maturation, endocrine evaluation, hypothalamic and pituitary aspects of anorexia and potassium aspects of anorexia with potassium levels in a person with anorexia (EatingNP). Some researchers have found that additional factors have been proposed as contributors to eating difficulties such as twins. Researchers suggest that genes may transmit chronic eating problems to either or both of the twins. They also suggest that tensions generated in dysfunctional families can spark an eating disorder, such as mother daughter relationships which may be key (Worsnop1108). Furthermore, some experts believe anorexia may go hand in hand with depression. Dr. J Raymond DePaulo Jr. and Keith Russel Ablow, both psychiatrists whom specialize in mood disorders state, “depression can cause some people to become anorexic, but on the other hand, anorexia can produce it’s own fatigue, inability to concentrate and moodiness. It may be difficult to determine whether these symptoms are coming from an underlying depression or from the eating disorder and subsequent state of starvation (Worsnop1108).”


The American Anorexia Bulimia Association (AABA) reports that over five million Americans suffer from eating disorders (Vollstadt50). In the United States and elsewhere, about 0% of eating disorder sufferers are female (Worsnop107). Boys and men make up a mere 10% of those affected with anorexia or bulimia, but there is an overall 500,000-800,000 men are affected (Vollstadt50). Researchers believe that is statistics included binge eating for eating disorders, the percentage of males would be greater than 10% (Strada50). A 10 survey of about 00 patients was taken and showed females outnumber males by more than 10 � 1. About 5% of patients were poor or lower class and % were Hispanic or Asian, while blacks accounted for less than 1% of the patients surveyed (Worsnop1100). The National Association of Anorexia Nervosa and Associated Disorders (ANAD) states that approximately 8 million Americans suffer from eating disorders, chiefly anorexia and bulimia. Among them, -6% of serious cases will die (Worsnop10). Many critics say this eating disorder problem would ease if society became more tolerant of a broad range of shapes, as society tends to view overweight people as unattractive and lacking inner discipline (Worsnop10). Women in “display professions” such as fashion modeling, actresses, and dancers are thought to be at particular risk of developing an eating disorder because thinness is virtually a job requirement. Women athletes who participate in swimming, gymnastics, and distance running are also vulnerable to an eating disorder since a lean frame is developed giving an athlete competitive advantage (Worsnop110). A 10 survey by the National Collegiate Athletic Association (NCAA) was given. Of the 41 responding situations, 1 said they had one type of disorder (anorexia or bulimia). Women athletes accounted for 810 of the 87 reported cases, and at least one eating disorder case was reported in 15 out of 17 women sports and 11 out of 0 men’s sports covered in this study (Worsnop110).


Any teens with eating disorders have many things in common whether they are boys or girls. Boys also suffer from low self-esteem and depression. They can also be perfectionists and obsessive, some even feeling unworthy and don’t like themselves (Strada55). Like girls, boys can believe that losing weight will help them to be accepted and will make them happy. Changing their bodies can give them a feeling of power and control. Males suffer from chemical imbalances just as women do. Men with anorexia have a lower level of male hormone testosterone, which causes depression and obsessive behavior (Strada56). Male actors, dancers and models are more at risk for eating disorders because a slim appearance is important to these young men just as it is in young woman (Strada54). However, teen boys don’t always face as much pressure to be thin as girls do, they face a pressure to be physically fit and muscular to try and get the ideal V-shaped body look (Strada51). As a result, many boys begin to exercise and diet to meet some goal of athletic achievement (Strada5). A study of body image attitudes of high school football players who have the large, muscular physique build and cross country runners who are thinner and leaner was taken. Results showed that football players had a more positive body image, and wanted to put on more weight, whereas cross country runners were less satisfied and wanted to increase the size of their upper bodies (Strada5). Many boys who see themselves as thinner than average such as cross country runners are more likely to have a negative view of their bodies (Strada51). Dieting and exercising are both ways these athletes can change their weight and body builds, but both are at risk factors for developing eating disorders if carried to extremes (Worsnop1110). A study at Cornell University and Ithaca College found that 4% of lightweight football players had dysfunctional eating patterns. Of those, 74% had engaged in binge eating and 17% had made themselves vomit (Strada5). Many treatment centers have reported an increase in the number of men seeking help for all eating disorders. But they aren’t sure if that means more men are developing disorders or more men are seeking help (Worsnop10).


Preventing eating disorders is possible if you realize that every person’s body is unique, and you ignore cultural ideas about the “perfect” body. This is the key to developing a healthy body image and preventing eating disorders. It is also essential to understand nutritional balance, which is the understanding that the food provides nutrients necessary for a strong and healthy body, and to also realize that food isn’t the right channel to cope with emotions. Having a healthy attitude towards eating also includes snacking and eating meals because it tastes good, not only to satisfy hunger (Strada67). Maintaining a healthy attitude towards food and physical appearance at home can also help prevent an eating disorder later in life (Strada7). Managing healthy diets ensures that they don’t become physically or psychologically harmful which is crucial in prevention of eating disorders (Vollstadt7). Many therapists discourage dieting altogether because it can evolve into an eating disorder very easily, but if a person has to diet, you must ensure healthy dieting by learning about good nutrition and make it an effort to practice this on a daily basis. If you are dieting, it is also important to step back regularly and make sure your eating habits are both physically and mentally healthy. When your eating habits become a way to express feelings or seek comfort, that can be a danger sign in which doctors advise that you talk with family, friends, or get professional help if you can’t break the pattern on your own. Drastically reducing your caloric intake is the worst way to achieve weight loss. When your body’s caloric intake drops significantly, your metabolism actually slows because your body needs to conserve energy, therefore weight loss may not happen as rapidly. If your goals are unrealistic such as getting to a particular weight or clothing size, this leads to dissatisfaction and impatience therefore turning into a more aggressive unhealthy dieting method and possible development of an eating disorder. Obtaining realistic goals is an important piece to healthy dieting (Strada70). About 5% of all dieters regain their lost pounds within a few years and many times they gain more than they lost, therefore teens need to remember dieting doesn’t always work (Vollstadt7). Having a carefully planned diet that involves choosing foods wisely for their nutritional value and by eating moderate portions which suite your needs can prevent dieting from turning into an eating disorder (Strada6). Nutritionists recommend a balanced diet from each of the five major food groups meats, dairy, fruits, vegetables, and grains. This type of balanced diet will ensure that the body gets all of its essential nutrients. Even if a person is vegetarian they should still find other ways to consume a good amount of protein. Most often if a person wants to lose weight or maintain a weight, a nutritionist can give you advice on how to achieve your goal through dieting in a healthy and moderate way (Strada70). It is best to think of a long-term goal and not set rules for how long it will take to get there. Eating disorder therapists recommend that you don’t frequently weight yourself at home, because of their belief that this creates an unhealthy fixation on weight reduction. Therefore, being weighed regularly by a medical professional but not too frequently can prevent unnecessary frustration which can lead to an eating disorder (Strada7). Often times people set out to lose weight not for health reasons, but for an attempt to make them feel better about themselves. People should find other ways to boost their self-esteem and they can do this by exploring personal interests or activities that make them feel positive about themselves. One doctor said, “a well-rounded sense of self and solid self-esteem are perhaps the best antidotes to dieting and disordered eating.”(Strada71). Experts say developing healthy outlets for coping with emotions or stress can avoid reliance on food as a way to express your emotions. This can be done by going for a brisk walk or making time for activities that provide you with happiness and satisfaction (Strada7). Exercising when done in moderation can be fun and healthy, which leads a person to lose weight by increasing their metabolism and burning calories (Vollstadt80). Communicating openly with your friends and family can help express feelings and could be misdirected through disordered eating. A recovering anorexic said, “I learned that I had a hard time expressing myself. I’d keep everything bottled up, and bingeing and purging became the way I expressed my frustrations rather than voicing them. I became aware that I needed to say what was bothering me. Express it.”(Strada7). Another way to prevent an eating disorder is to look at yourself realistically and understand that super models and actors are underweight. Eating disorder organizations are now offering educational programs which increase awareness of society’s obsession with being thin, and teaches you to value yourself (Vollstadt78). Many magazines are now putting out new editions, which are for girls of all shapes and sizes, and many are realizing that thin isn’t the only way to be. A 14 People magazine selected a size 14 model as one of its 50 most beautiful people. Now many fashion designers are putting together collections for larger sizes. These steps are now enhancing public awareness of eating disorders and challenge cultural attitudes and values, which contribute to eating disorders (Vollstadt8).


Treatment for anorexia is usually a threefold, consisting of nutritional therapy, individual psychotherapy, and family counseling (EatingNP). Recovery is associated with the continuation of maturation after a period of emotional regression; therefore it involves several stages. Regaining of normal weight is an essential component in the process of recovery but not the only element of it. However, regaining the weight with a normal eating pattern is the first priority, which may require admission to a hospital for its achievement (IntroducingNP). The weight gain is achieved by gradually adding calories to the patient’s daily intake. For patients who have only a mild case of this disorder, they may regain a normal weight successfully at home. Over a period of a few months everything may have returned back to normal (IntroducingNP). When the eating disorder becomes life threatening, hospitalization may be required and provides a structured environment making it difficult for the person to continue his/her self-destructive behavior (Strada64). During hospitalization, a team of pediatricians, psychiatrists, social workers, and nurses administer the treatment. Physicians and hospital staff make an effort to ensure that the patient doesn’t feel overwhelmed and powerless. Since the weight gain is encouraged, the patient often feels in control of her situation, and she wants to gain weight. Oftentimes, privileges are granted in return for their weight gain. This can include desirable activities such as leaving the hospital for an afternoon’s outing. The anorexic is then hospitalized until they are nutritionally stable (EatingNP). Individual psychotherapy is also necessary in the treatment to help the patient understand the disease process and it’s effects. Focus on the patients’ family, friends, and reasons she may have fallen into self-starvation are all accomplished in therapy. Once the patient learns more about her condition, she becomes more willing to help herself recover. Drugs such as antidepressants are a part of therapy in cases of severe depression. In these cases behavior improvement occurs more rapidly, therefore the patient responds more quickly to the treatment. The third aspect of treatment is family therapy. This examines how the patient and her parents relate to one another. Family tension is often developed, because of the patients’ refusal to eat causing frustration to the parents (EatingNP). However, a family’s presence in therapy can be a vital source of support helping the patient feel less isolated. When family members participate they can sometimes provide insight into any family dynamics underlying the eating disorder. This includes parents, siblings, the patients spouse or any other combination. Since many eating disorders partially stem from certain family relationships, family therapy can help the person suffering to address the issues with those who share the same experiences ( Strada5). With all this treatment, it is very important to remember that immediate success does not guarantee a permanent cure. Sometimes even after successful hospital treatment and return to normal weight, the patient can suffer relapses. Therefore, follow-up therapy for -5 years is recommended so the patient can be completely cured (EatingNP). Despite serious dangers to their health, it is difficult for those with eating disorders to recognize that their behavior is harmful and requires treatment. If an anorexic or person with an eating disorder does not seek help on his or her own, intervention by someone else is the first step toward treatment. Many patients lack the ability to confront the disorder and assess how it is affecting them physically and psychologically. Of all eating disorders, studies show that anorexics are least aware of their attitude towards food being unhealthy causing treatment to be hard. The American Anorexia Bulimia Association advises, “when you address the problem initially, you need to prepare yourself for all possible reactions. The person you are confronting may become upset, defensive, and/or angry. There is also a chance that he/she will be relieved that someone has offered help. Either way, you need to stress the fact that you are bringing the issue up because you care about the person, and that you are genuinely concerned about his/her well being.” For some people it can be stressful enough just admitting their problem to themselves, friends or family, and seeking professional help could be a step they are unwilling to take. However, it is very unlikely that an eating disorder will just run it’s course and taper off with time so it is important to get treatment for the patient (Strada54). There are several fields of treatment for a person with anorexia. Hospitalization is used to prevent death, suicide, and medical crisis. Medication is used to relieve the patient’s depression and anxiety. Antidepressants have been more often used to treat bulimics and binge eaters, but some have shown a positive effect for treatment of anorexic patients and their ability to begin eating healthier (Strada6). Individual counseling is provided to develop healthy ways of taking control. Group counseling, you learn how to manage relationships effectively, also allows patients to explore the causes of their eating disorders and the emotions associated with them, while receiving support from members of the group. Some people seeking help with eating disorders find it helpful to go through therapy with others who are similarly afflicted in group therapy (Strada60). Nutritional counseling is available to debunk food myths and design healthy meals for the patient. This type of counseling educates the patient on what the body needs to remain strong and function normally. The nutritionist then maps out a diet that provides the nutritional balance needed for the patient to stay healthy. This is generally recommended in addition to individual or group therapy. And finally, support groups, which break down isolation and alienation. They also provide a nurturing environment for patients, and focus on building a support network and sharing personal stories or advice with those in recovery. However, support groups are not usually an alternative to therapy, they are an additional source available to a patient (Strada61). For any kind of therapy or counseling, the key to success is to select a therapist with whom a comfortable, trusting relationship can be built.


Several approaches to therapy are provided; two common types are psychodynamic and cognitive-behavioral therapy. Psychodynamic therapy is an approach, which revolves around the assumption that past experiences, or conflicts could be affecting the person’s current behavior. For an anorexic you gain insight on issues developed over their life and attempt to resolve them. The cognitive behavioral approach focuses more on details of present behavior. It analyzes how the patient adapts his/her behavior in response to personal relationships, family roles, work or school environments and emotions. This type of counseling explores factors that trigger the eating disorder and how the person reacts to them (Strada57). Those patients who may seem fully recovered are still vulnerable to relapses. The Center for Eating Disorders stated, “60% of people with eating disorders can recover through treatment regimes, yet it is estimated that another 0% of those with eating disorders make only partial recoveries (Strada65).”











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