Anorexia Nervosa

Main Features of Anorexia Nervosa

• Refusal to maintain body weight at or above a minimally normal weight for age and height
• Weight loss leading to maintenance of body weight less than 85% of that expected
• Intense fear of gaining weight or becoming fat, even though underweight
• Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
• Amenorrhea in women (loss of menstrual periods)

Behaviours Associated with Anorexia Nervosa

• Dietary restriction; eating less calories, only "safe" foods, no fat
• Hoarding, concealing, picking at, crumbling or throwing away food.
• Engaging in compulsive or ritualistic behaviour such as cutting food into small pieces, or rearranging food
• Behaviors associated with anxiety if a person has to handle certain foods (measuring, weighing food)
• Preoccupation with food, reading recipes, preparing food only for others
• Wearing baggy or layered clothing to conceal weight loss, or to keep warm
• Compulsive activity, stands instead of sitting, stairs instead of the escalator, and exercise
• Social withdrawal, secretiveness

Physical Consequences of Weight Loss

• Difficulty concentrating, thinking clearly
• Sensitivity to cold
• Lowered blood pressure which may result in fainting, dizziness, passing out
• General weakness
• Shrinking of muscles and other organs such as the brain
• Thinning of hair or hair loss
• Pale skin tone (anaemic), develop downy hair (lanuga) on face and arms
• Dehydration that may result in constipation and dry cracked skin
• Osteoporosis
• Heart failure, death

Anorexia nervosa is more prevalent among females ( 90 % are women) and usually begins in early or late adolescence. A recent study by Woodside et al. (2001) of a community sample in Ontario found the prevalence rate of full syndrome eating disorders (anorexia and bulimia combined) in men was 0.3%, compared with 2.1% for women. Results of full or partial eating disorders for men was 2 %, compared with 4.8% for women. The female-male ratio of full or partial syndrome anorexia nervosa was 2:1. Common characteristics of persons with anorexia are: a tendency toward perfectionism, high achiever and difficulty adapting to change.

Anorexia nervosa usually starts with dieting and continues into a cycle of losing weight and not eating. Individuals with anorexia nervosa may exhibit a combination of food restriction and purging (laxatives, diuretics, self-induced vomiting) to maintain a low weight. Restrictive behaviors include under eating, avoidance of high calorie food and engaging in strenuous exercise. These behaviors undermine an individual's physical health, self-esteem and feelings of competency. Fifteen percent of people who develop anorexia die either directly from or consequences of the eating disorder such as heart failure.

Treatment for anorexia nervosa should be individualized and may include: hospital inpatient programs, outpatient day programs, medication to treat an associated mood disorder, individual or group psychotherapy. Therapists use different approaches and some of the more common ways to treat anorexia nervosa include behaviour therapy, cognitive-behaviour therapy, family therapy, psychodynamic or expressive art therapies. Sheena's Place functions as a community resource for individuals to access support at any point in their recovery.

References

American Psychiatric Association, (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

American Psychiatric Association Work Group on Eating Disorders (2000). Practice guidelines for the treatment of patients with eating disorders. American Journal of Psychiatry, 157(1), 1-39.

Mehler, P.S, & Anderson, A.E. (Eds.). (1999). Eating disorders: A guide to medical care and complications. Baltimore: John Hopkins University Press.

Woodside D.B., Garfinkel P.E., Lin E., Goering P., Kaplan A.S., Goldbloom D.S. et al. (2001). Comparisons of men with full or partial eating disorders, men without eating disorders, and women with eating disorders in the community. American Journal of Psychiatry, 158 (4), 570-574.

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