What is anorexia nervosa?

Anorexia nervosa is an eating disorder that predominantly affects young females (about 0.5% to 3.7% of this age group), but also men. It is defined as being 15% or more below the ideal weight for height. It most commonly occurs during adolescence and includes physical and emotional symptoms such as:

• an intense fear of becoming fat or putting on weight - even if already underweight
• distorted views of weight or shape image
• denying the seriousness of extremely low body weight
• resistance to maintaining a normal body weight
• severe sensitivity to cold
• growth of down-like body hair
• infrequent or no menstrual periods in females who have reached puberty
• irritability, inability to concentrate/think clearly
• obstinate behaviour, unhappiness, depression.

People with anorexia often start with dieting, which develops into an obsession to control food intake. They develop obsessive eating habits such as avoiding eating, eating only small amounts of certain foods, or extremely careful weighing and measuring of their food, despite suffering hunger pangs.

Other habits to maintain low body weight may also include frequent, intense exercise and purging mechanisms such as forced vomiting, and abuse of laxatives, enemas and diuretics. Girls with anorexia nervosa often experience delayed onset of their periods.

The outcome of patients with anorexia nervosa varies from recovery after a single episode, fluctuating weight gain and loss, or chronic illness that causes health deterioration over many years. The most common fatal complications of anorexia nervosa are imbalances in electrolytes (the body's essential fluids and salts), which can lead to cardiac arrest, and suicide. Kidney, bladder, bowel and brain function can also deteriorate.

Treatment for anorexia

Those with anorexia need to realise they have a serious problem. Because of the complexities of eating disorders, treatment should be started as early as possible for best outcomes, and should involve comprehensive specialist care.

Family/friends should try to encourage the person to take personal responsibility in seeking help, and to learn to accept their strengths/weakneses and successes/failures as being part of life.

Three treatment goals for anorexia nervosa have been outlined:

• restoring bodyweight
• psychological treatment for issues such as body image disturbances and low self-esteem
• long term remission or full recovery from the condition.

If weight loss has been rapid or severe, initial treatment involves hospitalisation to stabilise weight loss and fluid and electrolyte imbalances. Adequate nourishment can also help restore better thinking processes, helping the person be better able to take part in subsequent therapy programmes.

Selective serotonin re-uptake inhibitors (SSRIs) - a modern class of antidepressants - have been used to maintain weight gain, treat mood and anxiety symptoms associated with anorexia and prevent relapse. SSRIs are generally used only after the patient has recovered their weight loss.

It is important to remember:

• Early recognition can help prevent more serious eating disorders developing.
• While dietary monitoring and advice are important, effective treatment must address any underlying psychological issues.
• The same approach will not work for all people with an eating disorder.
• Do not give up if the first treatment approach does not work.

Original material provided by Eating Disorders Association (NZ) Inc. and Pharmacy Today. Edited by everybody.