Anorexia Nervosa Can Be Deadly - What can be done.

Anorexia nervosa is psychological disorder in which a person refuses to eat and consequently loses more weight than is healthy for him or her.
The condition occurs in between 5% and 10% of the population, mostly in adolescent girls and young women, but one in ten sufferers are males.

The key feature of Anorexia Nervosa is self imposed starvation because of a distorted body image.
Those effected have an irrational but nevertheless intense fear of getting fat even when the condition has progressed so far that they are obviously emaciated.
Although anorexia  means without appetite, anorexics are paradoxically often extremely hungry and rarely lose their appetite.

Causes and Incidence of Anorexia

No direct causes have been isolated but genetic factors, social pressures equating slimness as a sign of beauty and psychological factors have been implicated.Associated conditions such as obsessive compulsive disorders, depression and anxiety are often present as well.

Anorexia is quite often seen in people with cancer, particularly in patients who have advanced cancer and in fact Anorexia is the most common cause of malnutrition in cancer patients. 

Signs and Symptoms

An almost morbid preoccupation about being fat and a recent weight loss of 25% or more without physical causes, anger, ritualistic behaviour, amenorrhea, loss of libido, constant tiredness, sleep disturbances, constipation and an intolerance of cold temperatures are indicative of Anorexia.
Loss of fatty tissues and breast tissue, blotchy and sallow skin, scalp problems and skeletal muscle atrophy are other indicators.

On examination, the pulse rate may be low and Bradycardia may also be present, salivary glands and bowels may be distended.
These physical symptoms are strangely enough often accompanied by excessive vigor and exercise.
Another rather paradoxical finding is an obsession with preparing and serving elaborate meals for others.

Diagnosis of Anorexia

Anorexia is usually first diagnosed by the family physician but formal diagnosis is based on the following standards;

*Refusal to maintain bodyweight at a normal level for age and height, often falling to 15% or as much as 25% below the norm.

*An intense fear of gaining weight or becoming fat despite the obvious underweight problem.

*A distorted perception of their body shape.

*The absence of at least 3 consecutive menstrual cycles.

Further tests can rule out endocrine, metabolic and CNS abnormalities as well as cancer and other diseases implicated in physical wasting.

Treatment of Anorexia

After assessment by a team which includes physicians, dietitians and psychiatrists, the aim is to promote weight gain, control bulimia if present and discover and address any underlying spychological problems.

Hospitalisation may be required, supplementation with vitamins and minerals will likely be necessary and group or family psychotherapy is essential.
Mood altering medicines such as tricyclic antidepressants and serotonin reuptake inhibitors are sometimes prescribed but the evidence for this kind of treatment is weak. Appetite stimulants may also be used.
The use of accupunture patches to help activate the body's immune system and physical welfare has some possible beneficial effects.
 
For treatment to be successful, the underlying problems of low self esteem, anxiety and depression must be addressed first.

A good regime may include;

* Hospitalisation

* Psychiatric counselling

* The negotiation of a target weight and an adequate food intake

* Supervision during meal times

* Emotional support

* Group therapy

* The use of a food journal

* Advice to the family

While a fairly good number of anorexics can be successfully treated, especially in early cases, mortality is still from 5% to 15% with about a third of deaths due to suicide.