>> Anorexia Nervosa
For people with anorexia, it really is true that one
can never be too thin. Despite being dangerously underweight,
anorexics see a fat person when they look in the mirror.
What they don’t see is the tremendous physical
and emotional damage that self-starvation inflicts,
so they continue to diet, fast, purge, and over-exercise.
While people with anorexia often deny having a problem,
the truth is that anorexia is a serious and potentially
deadly eating disorder. Fortunately, recovery is possible.
With proper treatment and support, you or someone
you care about can break anorexia’s self-destructive
pattern and regain your health and happiness.
WHAT IS AN ANOREXIA NERVOSA?
Anorexia nervosa is characterized by an irrational
dread of becoming fat coupled with a relentless pursuit
of thinness. People with anorexia go to extremes to
reach and maintain a dangerously low body weight.
But no matter how much weight is lost, no matter how
emaciated they become, it’s never enough. The
more the scale dips, the more obsessed they become
with food, dieting, and weight loss.
The key features of anorexia nervosa are:
- Refusal to sustain a minimally normal
- Intense fear of gaining weight, despite
- Distorted view of one’s body or
weight, or denial of the dangers of one’s
There are two types of anorexia. In the restricting
weight loss is achieved by restricting
calories. Restricting anorexics follow drastic diets,
go on fasts, and exercise to excess. In the purging
people get rid of calories they’ve
consumed by vomiting or using laxatives and diuretics.
Anorexia is most common in adolescent girls and young
women, with a typical age of onset between the ages
of 13 and 20. But people of all ages—including
men and children—can suffer from anorexia.
THE DIFFERENCE BETWEEN DIETING
Eating disorders, including anorexia, often begin
with normal dieting. A person may start dieting and
exercising to get in shape, but as the pounds come
off, a desire to lose even more weight is triggered.
This cycle continues until the person almost completely
Many factors influence this destructive progression
from healthy dieting to full-blown anorexia. For many
anorexics, self-starvation is a way to feel in control.
People with anorexia may feel powerless in their everyday
lives, but they can control what they eat. Restricting
food is a way to cope with painful feelings such as
anger, shame, and self-loathing. Saying “no”
to food, getting the best of hunger, and controlling
the number on the scale make them feel strong and
successful—at least for a short while.
Unfortunately, this boost to self-esteem is short-lived.
Anorexics believe that their lives will be better—that
they’ll finally feel good about themselves—if
they lose more weight. But no amount of dieting or
weight loss can repair the negative self-image at
the heart of anorexia. In the end, anorexia only leads
to greater emotional pain, isolation, and physical
SIGNS AND SYMPTOMS OF ANOREXIA
|Is it a Diet or Anorexia?
|Weight loss is viewed as a way to improve
health and appearance
||Weight loss is viewed as a way to achieve
|Self-esteem is based on more than just weight
and body image
||Self-esteem is based entirely on how much
you weigh and how thin you are
|Is an attempt to control weight
||Is an attempt to control your life and emotions
|The goal is to lose weight in a healthy way
||Becoming thin is all that matters; health
is not a concern
People with anorexia often hide their condition, so
the warning signs are not always easy to spot. Furthermore,
anorexics will typically try to explain away their
disordered eating behaviors when confronted. But as
anorexia progresses, the signs and symptoms become
increasingly obvious and difficult to deny.
Eating and food behavior signs and symptoms
Appearance and body image signs and symptoms
- Dieting despite being thin
– Follows a severely restricted diet.
Eats only certain low-calorie foods. Bans
“bad” foods such as carbohydrates
- Obsession with calories, fat
grams, and nutrition – Reads
food labels, measures and weighs portions,
keeps a food diary, reads diet books.
- Pretending to eat or lying about
eating – Hides, plays with,
or throws away food to avoid eating. Makes
excuses to get out of meals (“I had
a huge lunch” or “My stomach
isn’t feeling good.”).
- Preoccupation with food –
Eats very little, but constantly thinks
about food. May cook for others, collect
recipes, read food magazines, or make meal
- Strange or secretive food rituals
– Often refuses to eat around
others or in public places. May eat in rigid,
ritualistic ways (e.g. cutting food “just
so”, chewing food and spitting it
out, using a specific plate).
Purging signs and symptoms
- Dramatic weight loss –
Rapid, drastic weight loss with no medical
- Feeling fat, despite being underweight
– May complain about being
overweight in general or just “too
fat” in certain places such as the
stomach, hips, or thighs.
- Fixation on body image
– Obsessed with weight, body shape,
or clothing size. Frequent weigh-ins and
concern over tiny fluctuations in weight.
- Harshly critical of appearance
– Spends a lot of time in
front of the mirror checking for flaws.
There’s always something to criticize.
They’re never thin enough.
- Denies being too thin
– Refuses to believe that his or her
low body weight is a problem, but may try
to conceal it (drinking a lot of water before
being weighed, wearing baggy or oversized
CAUSES AND RISK FACTORS
- Using diet pills, laxatives, or
diuretics – Abuses water
pills, herbal appetite suppressants, prescription
stimulants, ipecac syrup, and other drugs
for weight loss.
- Throwing up after eating
– Frequently disappears after meals
or goes to the bathroom. May run the water
to disguise sounds of vomiting or reappear
smelling like mouthwash or mints.
- Compulsive exercising
– Follows a punishing exercise regimen
aimed at burning calories. Will exercise
through injuries, illness, and bad weather.
Works out extra hard after bingeing or eating
What sets someone on a course toward self-starvation?
It’s easy to blame a culture that equates slenderness
with beauty and success and portrays stick-thin women
as the physical ideal, but eating disorders have been
around for centuries.
Although our culture’s idealization of thinness
plays a powerful role in the development of anorexia,
there are other contributing factors, including genetics,
individual personality traits, and family environment.
Major risk factors for anorexia nervosa
causes of anorexia
- Body dissatisfaction
- Low self-esteem
- Childhood sexual abuse
- Family history of eating disorders
Research suggests that a genetic predisposition to
anorexia may run in families. If a girl has a sibling
with anorexia, she is 10 to 20 times more likely than
the general population to develop anorexia herself.
Brain chemistry also appears to play a significant
role. People with anorexia tend to have high levels
of cortisol, the brain hormone most related to stress,
and decreased levels of serotonin and norepinephrine,
which are associated with feelings of well-being.
Psychological causes of anorexia
People with anorexia are often perfectionists and
overachievers. They’re the “good”
daughters and sons who do what they’re told,
excel in everything they do, and focus on pleasing
others. But while anorexics may appear to have it
all together on the surface, inside they feel helpless,
inadequate, and worthless. They view themselves through
a harshly critical lens. If they’re not perfect,
they’re a total failure.
Family and social pressures
In addition to the cultural pressure to be thin, there
are other family and social pressures that can contribute
to anorexia. This includes participation in an activity
that demands slenderness, such as ballet, gymnastics,
or modeling. It also includes having parents who are
overly controlling, put a lot of emphasis on looks,
diet themselves, or criticize their children’s
bodies and appearance. Stressful life events—such
as the onset of puberty, a breakup, or going away
to school—can also trigger anorexia.
Effects of anorexia
The severe calorie restriction of anorexia has dire
physical effects. When the body doesn’t get
the fuel it needs to function normally, it goes into
starvation mode. It slows down to conserve energy
and turns in on itself for essential nutrients. In
essence, the body begins to consume itself. As the
self-starvation continues and more body fat is lost,
the medical complications pile up.
The first physical signs and effects of anorexia are:
- Loss of menstrual periods
- Lack of energy and weakness
- Feeling cold all the time
- Dry, yellowish skin
- Constipation and abdominal
- Restlessness and insomnia
- Dizziness, fainting, and headaches
- Growth of fine hair all over the body
If anorexia continues unchecked, the health problems
only get worse. Over time, anorexia causes hair loss,
infertility, stunted growth, osteoporosis, heart problems,
kidney failure, and death. Other effects of anorexia
include tooth decay and gum damage from malnutrition
and vomiting, and damage to the esophagus and larynx
from acid reflux. Anorexia can also lead to depression,
severe mood swings, and thoughts of suicide.
ANOREXIA TREATMENT AND RECOVERY
While the physical and emotional consequences of anorexia
can be devastating, the good news is that it’s
a treatable condition. With the right treatment team,
people with anorexia can and do get better. They can
regain their health, learn to eat normally again,
and develop healthier attitudes about food and their
Since anorexia involves both mind and body, both attitudes
and behaviors, a team approach is often best. Those
who may be involved in anorexia treatment include
medical doctors, mental health professionals, and
dieticians. The participation and support of family
members also makes a big difference in anorexia treatment
Medical treatment for anorexia
The first priority in anorexia treatment is to address
and stabilize any serious health issues. Hospitalization
may be necessary to prevent starvation, suicide, or
a medical crisis. Dangerously thin anorexics may also
need to be hospitalized until they reach a less critical
weight. Outpatient treatment is an option when the
patient is not in immediate medical danger.
Getting back to a normal weight is no easy task, especially
for those being treated against their will. Fear of
weight gain is extraordinarily frightening to people
with anorexia, and forced weight gain even more so.
But research shows that the closer body weight is
to normal at the end of treatment, the greater the
chance of recovery, so weight restoration should be
a top treatment goal.
Nutritional therapy for anorexia
A second component of anorexia therapy is nutritional
counseling. In nutritional counseling, a dietician
teaches the patient about healthy eating, proper nutrition,
and balanced meals. The dietician also helps the person
develop and follow meal plans that include enough
calories to reach or maintain a normal, healthy weight.
Counseling and therapy for anorexia
Therapy plays a crucial role in anorexia treatment.
Its goals are to identify the negative thoughts and
feelings about weight and the self that are behind
the anorexic behaviors, and to replace them with healthier
and less distorted attitudes. Another important goal
is to teach the anorexic how to deal with difficult
emotions, relationship problems, and stress in a productive,
rather than a self-destructive, way.
HELPING A PERSON WITH ANOREXIA
|Types of Therapy for Anorexia
||Explores the critical and unhealthy thoughts
underlying anorexia. The focus is on increasing
self-awareness, challenging distorted beliefs,
and improving self-esteem and sense of control.
Cognitive therapy also involves education about
||Promotes healthy eating behaviors through
the use of rewards, reinforcements, self-monitoring,
and goal setting. Teaches the patient to recognize
anorexia triggers and deal with them using relaxation
techniques and coping strategies.
||Examines the family dynamics that may contribute
to anorexia or interfere with recovery. Often
includes some therapy sessions without the anorexic
patient—a particularly important element
when the person with anorexia denies having
an eating disorder.
||Allows people with anorexia to talk with each
other in a supervised setting. Helps to reduce
the isolation many anorexics may feel. Group
members can support each other through recovery
and share their experiences and advice.
Encouraging an anorexic friend or family member to
get treatment is the most caring and supportive thing
you can do. But because of the defensiveness and denial
involved in anorexia, you’ll need to tread lightly.
Waving around articles about the dire effects of anorexia
or declaring “You’ll die if you don’t
eat!” probably won’t work. A better approach
is to gently express your concerns and let the person
know that you’re available to listen. If your
loved one is willing to talk, listen without judgment,
no matter how out of touch the person sounds.
You can also seek advice from a health professional,
even if your friend or family member won’t.
And you can bring others—from peers to parents—into
the circle of support. You can also help by being
a good role model for healthy eating, exercising,
and body image. Don’t make negative comments
about your own body or anyone else’s. And whatever
you do: don’t turn into the food police. A person
with anorexia needs support, not an authority figure
standing over the table with a calorie counter.
WHAT YOU CAN DO FOR SOMEONE
You can’t force a person with an eating disorder
to change and you can’t do the work of recovery
for them. But you can help by offering your compassion,
encouragement, and support throughout the treatment
Someone with an Eating Disorder
Melinda Smith, M.A., Ellen Jaffe-Gill, M.A, Robert
Segal, M.A., and Jeanne Segal, Ph.D., contributed
to this article. Last modified on 2/27/08.
Reprinted with permission from http://www.helpguide.org/.
C 2008 Helpguide.org. All rights reserved
You can find the original article at
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