Although the public’s attention is being drawn to the growing obesity epidemic sweeping through many countries, very little focus has been paid to Anorexia nervosa, another food related disorder. People who suffer from anorexia are fixated on their appearance, especially in regards to their weight and body shape. Although they might be very thin, they perceive themselves as being fatter and as such starve and/or exercise excessively in order to reduce their weight. Others tend to induce weight loss by vomiting after eating meals. As both pictures below depict, the distortion in the way people with anorexia see themselves can be quite dramatic with some research reporting as much as 20% difference between what they assume they weigh and how much they actually do.
Although very much tied to food, psychiatrists and nutritionists believe that anorexia is an indirect expression of a deep consuming desire for control, a means of coping with emotional problems and an attempt at achieving perfection. Not being able to control external factors causes some individuals to shift their focus internally, seeing their bodies as a new project to perfect. They convince themselves over time to see flaws and body fat that do not actually exist and dedicate their energy to ridding themselves of these imperfections.
Causes
Like other eating disorders, anorexia is believed to have some biological (genetic), psychological and socio-cultural roots with some overlap (figure 2). The evidence in support of a biological linkage comes from studies of families with one or more individuals who suffer from the disorder. These studies have shown that it is more likely for a person to develop anorexia if they have a blood related mother or sister with the same disorder. The risk is even higher in identical twins, pointing to a very strong genetic association.
As briefly pointed out earlier, there is also an equally important psychological contribution to the disorder such as the need for control and perfection. People who have low-self esteem are more likely to have emotional problems that manifest as anorexia while those with obsessive-compulsive personality traits might strive for a perfect body with no fatty tissues. The problem is that because of the need for perfection, they never achieve their ideal weight despite how thin they get. The socio-cultural aspects of anorexia have received much more publicity compared to the other two because of recent public complaints of media portrayal of beautiful women as being only those who are extremely thin. Both Hollywood and the modeling industry have also received negative publicity after it was discovered that several models have had to be hospitalized for anorexia related complications. But young girls and even adults continue to be subjected to media and peer pressure to be thin regardless of the cost to their health or other relationships. I refer to women here because 95% of those who suffer from the disorder are female and approximately 1-10% of all women during their lifetime will battle with anorexia.
Symptoms and criteria for diagnosis
The American Psychiatric Association (APA) has a manual that provides detailed guidelines to medical practitioners for the diagnosis of almost all mental health related illnesses. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition describes four main criteria for diagnosing anorexia nervosa:
- The refusal to maintain body weight at or above a minimally normal weight for age and height (minimal body weight is equivalent to less than 85% of a person’s expected normal weight, Fig. 3)
- An intense fear of gaining weight or becoming fat, even though the person is underweight.
- Self-perception that is grossly distorted and weight loss that is not acknowledged.
- Missing at least three consecutive menstrual periods, or periods that occur only after a hormone to taken.
Other symptoms that usually are seen with anorexia include extreme weight loss, constant fatigue, dizziness or fainting, brittle nails and hair, no menstrual periods, constipation, cold intolerance, low blood pressure and weak bones that are prone to fractures from minor falls. The individual might also pay more attention to their image in mirrors, comment constantly on bodily flaws, refuse to eat, have a preoccupation with counting calories and reading food labels, constantly measure their weight, exercise excessively and have difficulties concentrating with drop in school grades or general work performance.
Complications of anorexia
Of all the mental health disorders, anorexia has one of the highest death rates. What makes it an even greater concern is that death can occur with no prior warning signals even when a person is not very underweight. Death usually is as a result of imbalance of the electrolytes needed to run the body smoothly and changes in the heart valves (mitral valve prolapse) that control blood flow. This leads to abnormal heart rhythms and finally heart failure. Other complications include anemia, bone loss and fractures, pneumonia and emphysema (lung diseases) and kidney dysfunction. With prolonged malnourishment, other organs in the body also start to shut down including the brain. Clearly this is a disorder that warrants immediate attention given both its associated morbidity and mortality.
Treatment
First, it is important to realize that anorexia nervosa is not a disease to be ashamed of. Like alcoholism, drug abuse and other behavior-linked disorders, it is a disease that can affect anyone at any point of their lives given the right combination of circumstances. Also like other addictions, most people deny having a problem and refuse help. Sadly, anorexia causes as much grief to loved ones as other addictions do.
Once you have come to terms with this fact, take an honest look at how you see yourself and the thoughts you have about your body. Then take a look at the APA’s criteria for diagnosis that have been outlined earlier in this article. It’s a hard thing to admit, but if you feel that you meet most or all of the criteria, consider talking to a friend, a parent or family friend that you trust. They will be a great support system to help you work through some of the root causes of the problem, get you through the treatment phase of the disorder and keep you accountable. Also seriously consider talking to your health care provider who can either help you directly or refer you to a mental health specialist if needed. Remember, anorexia is a behavior-linked disorder and like other addictions, it is pretty hard to quit on your own. Asking for help, although difficult, is sometimes the best thing one can do.
Now, treatment depends on the extent to which an individual is underweight or malnourished and if they have any current complications requiring immediate medical attention. Some individuals will need only nutritional therapy while others might need to be hospitalized for a period of time to slowly and carefully bring their weight back to normal. Your doctor might want to monitor your vitals signs, blood electrolytes and hydration frequently in order to avoid any sudden complications or even death. Many doctors like to incorporate individual, family and group therapy with their overall treatment given that psychological and socio-cultural factors are two out of the three main causes of anorexia. This allows for a unified, all-rounded approach to helping one overcome this eating disorder.
Although we are bound by a similar humanity, we do come in our own unique shape, color and size. Each of us is intricately, lovingly and wonderfully woven together by our Creator for a specific purpose. It is not how we look on the outside that makes us who we are, but rather it is that fun-loving, adventure seeking person that lives on the inside that defines us and who is remembered when we finally exit this earth. It is good that we take time to ponder and remember these things, especially in a world that wills us to be only superficial beings.
Sources:
Mayo Clinic Mental Health Section: Anorexia Nervosa
http://www.mayoclinic.com/health/anorexia/DS00606/DSECTION=symptoms
MedicineNet: Anorexia Nervosa
http://www.medicinenet.com/anorexia_nervosa/page2.htm