Anorexia Nervosa

I

Introduction

Anorexia Nervosa, mental illness in which a person has an intense fear of gaining weight and a distorted perception of their weight and body shape. People with this illness believe themselves to be fat even when their weight is so low that their health is in danger. A person with anorexia nervosa severely restricts food intake and usually becomes extremely thin.

Although cases of self-starvation have been known since antiquity, anorexia nervosa has become much more common in modern Western societies as thinness has increasingly become a primary measure of attractiveness. The disorder is thought to be most common among whites, people of higher socioeconomic classes, and people involved in activities where thinness is especially prized, such as dancing, theater, and distance running. More than 90 percent of cases are diagnosed in females, but some experts believe that many cases of anorexia nervosa in males go unreported. The disorder typically begins in the mid- to late teenage years.

Researchers estimate that about 0.5 to 1 percent of young women in the United States suffer from anorexia nervosa as it is clinically defined by the American Psychiatric Association. However, many more individuals, perhaps 5 to 10 percent of all young women in the United States, have a distorted body image and a preoccupation with becoming thin, though they do not fit all the criteria for a clinical diagnosis of anorexia nervosa.

II

Behaviors and Psychological Symptoms

People with anorexia nervosa—who are sometimes known as anorectics or anorexics—have a preoccupation with food, weight, dieting, and body image. They are dissatisfied with their bodies, perceive themselves to be fat regardless of their actual weight, and are obsessed with becoming thin. Many are so focused on outward appearance that they have little awareness of internal sensations such as hunger and fullness. Anorexics usually undertake strict diets, severely restricting food intake and avoiding certain foods they deem taboo. They may also undergo intense, strenuous exercise regimens and weigh themselves frequently. Despite eating very little, many people with anorexia nervosa become overly involved with food by preparing elaborate meals for others or taking over food shopping or preparation for the family. At meals, they may cut their food into tiny pieces, eat very slowly, and dispose of food secretly. About 50 percent of people with anorexia nervosa also develop bulimia nervosa. This is a type of eating disorder in which individuals engage in episodes of binge eating, or consuming large amounts of food in a short period, and then purging the food from their bodies by self-induced vomiting or abuse of laxatives.

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People who develop anorexia nervosa often share certain personality attributes, such as perfectionism, introversion, low self-esteem, difficulty expressing emotions, and a need for control. As the disorder develops, they may experience depression, irritability, sleep problems, lack of sexual interest, and they may withdraw from friends and family.

In 50% to 75% of cases, anorexia nervosa is accompanied by other mental illnesses, particularly depression and anxiety disorder. At least 25 percent of people with anorexia nervosa also have obsessive-compulsive disorder (OCD). A person with OCD experiences recurrent, often irrational thoughts or fears and feels compelled to perform certain behaviors over and over. Some evidence suggests that the psychological symptoms of anorexia nervosa, such as obsessive behavior, preoccupation with food, and depression, may actually be an effect of food deprivation. In many cases, however, the depression or another mental illness develops before the diagnosis of anorexia nervosa, and some scientists believe these other mental illnesses may make people more vulnerable to developing anorexia nervosa.

People with anorexia nervosa usually deny that they have a problem. They do not see low weight as a health risk or symptom of a psychological problem. They believe that dieting and losing weight is logical because they perceive themselves to be fat. Many feel pride in their ability to adhere to their strict diet. To the outside world, anorexics frequently appear normal. They are often successful in school and other activities, and may be perceived as respectful, obedient, helpful, and compliant—in short, they are seen as model young people.

III

Medical Symptoms and Consequences

Anorexia nervosa has a wide variety of medical complications that affect every system of the body and can be life threatening. Often, people who are later diagnosed with anorexia nervosa initially seek treatment for the medical symptoms caused by semistarvation. Undernourishment usually causes females with anorexia nervosa to stop menstruating (see Menstruation)—in fact, this symptom is so typical that it is one of the criteria used to diagnose the disease.

People with anorexia nervosa often suffer from fatigue and muscle weakness, have trouble staying warm, and have dry, yellowish skin, brittle hair, and sometimes hair loss. Changes in the function of the kidneys and gastrointestinal system are common. People with the disorder frequently develop osteoporosis, a loss of bone mass that makes bones fragile and prone to fracture. This bone loss may be at least partially irreversible, and delayed or arrested bone development can also lead to stunted growth. Many changes in the function of the heart can occur, such as slow heartbeat, low blood pressure, and heart palpitations. These changes can cause a person to become prone to dizziness and fainting, and abnormal heart rhythms sometimes result in sudden death. Scientists estimate that between 5 and 20 percent of people with anorexia nervosa die of medical complications related to the illness.

IV

Causes

Anorexia nervosa results from an interaction of several different factors. Most researchers agree that one of the most important causes of anorexia nervosa is Western society’s emphasis on thinness and body shape as a primary measure of attractiveness. In fact, many believe that most people who develop anorexia are female because there is more pressure for women to be thin. Media images of very thin models and actors lead many people to believe that they will only be considered attractive and successful if they are also very thin. These images may cause many people to develop unrealistic expectations for their own bodies. People may also feel pressure from family members or peers to be thin.

These social pressures interact with a variety of other factors to cause some people to develop anorexia nervosa. Some people who develop the disorder have experienced physical, sexual, or emotional abuse or the loss of someone close to them, such as a parent. Other existing psychological problems, such as anxiety, depression, and compulsive behavior, can also contribute to the development of the illness. In some cases, the characteristics of a person’s family may encourage personality traits associated with anorexia nervosa, such as perfectionism, emotional reserve, desire to conform and avoid conflict, and need for control. The onset of the disorder in the mid- to late teenage years leads some researchers to believe that the disorder sometimes reflects a patient’s fear of emerging sexuality.

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