Anorexia nervosa is often confused with bulimia nervosa, although the two disorders are different in their characterisations. In anorexia, patients will intentionally restrict their diet, whereas in bulimia patients will binge eat and then purge the food from their body through vomiting. Neither disorder is mutually exclusive from the other, and some sufferers may have both anorexia and bulimia.
It is estimated that around 1% of school girls meet the criteria for anorexia, although this is likely an underestimation due to a lack of reported cases where sufferers believe their behavior is normal based on social and peer observations.
Anorexia is characterised by a maintained body weight of at least 15% under the average acceptable weight for the patient. This is achieved through intense fasting and diet restriction, and often leads to associated conditions such as malnutrition, as well as mental health problems such as depression and anxiety. Despite the prevalent idea that anorexic weight loss is induced by vomiting, this is not always true, and sufferers may display alternate behaviours instead of or alongside vomiting. These can include excessive exercise, or overuse of laxatives and diuretics. The disorder is often prompted and exacerbated by an overwhelming fear of gaining weight, as well as a preoccupation with the shape or size of the body. This causes sufferers to pursue an excessively low "ideal" weight. In some cases the disorder can cause hormonal changes, which can lead to a reduction in the size of the breasts, loss of hair and the stopping of the menstrual period cycle all together.
Causes
Currently the causes of anorexia nervosa are largely unknown, but it is primarily thought to be a mental health condition, with physical symptoms being the consequence of the behavioural problems of the sufferer. Social and peer observations and pressure may have a large role to play in the development of anorexia, and it has been demonstrated the the number of people suffering from the disorder is higher in countries where there is a cultural preoccupation with being thin, as well as in certain professions where the same is true, such as modelling and ballet. Often anorexia is triggered by bullying, relationship problems, abuse, as well as other life stresses, and certain personality traits have been shown to carry a higher risk of developing the disorder, such as a tendency to depression and anxiety, or a poor ability to manage stress.
There is also reason to believe that biological factors have a role to play in the development of anorexia, although no major research has established what these may be.
Signs and Symptoms
The signs and symptoms of anorexia nervosa are:
- Weight loss of at least 15% below the normal ideal body weight for a person of the same sex, age and height
- Delayed development in puberty, or the ceasing of menstruation
- Self-induced weight loss, which can be induced in a number of ways, such as fasting, lowered food intake, excessive exercise, or vomiting
- Fear of gaining weight, generally overwhelming and accompanied by a obsessive preoccupation with the size or shape of the body
- Secondary symptoms can include mental health problems, such as depression and anxiety, as well as the development of social phobias, fatigue, shivers, constipation and stomach ache.
If anorexia goes untreated the sufferer may become chronically ill, suffering from liver, kidney, and heart failure, as well as osteoporosis. The disorder can also lead to brain damage and, in some cases, death.
Treatment
Due to the complex nature of anorexia nervosa, there is no uniform treatment for the disorder. Treatment will vary from case to case, and often involves a lengthy process of psychiatric care and support. In some cases medication may also be employed.
Treatment for anorexia primarily focuses on encouraging healthy habits through a marked system of progress. This includes promoting weight gain and healthy eating habits. This is accompanied by psychological treatment designed to address the underlying thoughts, feelings and beliefs associated with food, and to solve mental health problems the sufferer may have.
Psychological treatment for anorexia includes cognitive analytic therapy, cognitive behavioural therapy, interpersonal psychotherapy, focal psycho-dynamic therapy. Psychologists may also pursue family intervention therapy focused specifically on the eating disorder.
Medication may be employed to help treat depression, anxiety, as well as compulsive behaviours.
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