Anorexia nervosa (AN) is a severe eating disorder characterized by a distorted body image that leads to restricted eating, over exercise and other behaviors that prevents a person from gaining weight or maintaining a healthy weight.
The cause of anorexia nervosa is not known. Anorexia nervosa usually can begin as innocent dieting or increased exercising for health or fitness, but then progresses to extreme and unhealthy weight loss. Genetic factors may play a role in increasing the risk for anorexia nervosa. Other mental health problems, such as anxiety disorders or affective disorders, are commonly found in teens with anorexia nervosa.
The majority of those affected are females (90 to 95 percent), although those statistics are changing as males are now more frequently identified. Anorexia nervosa can be found in all socioeconomic groups and ethnic and racial groups.
There are two subgroups of anorexic behavior aimed at reducing caloric intake, including the following:
Restrictor type. An individual severely limits the intake of food, especially carbohydrates and fat containing foods.
Bulimia (also called binge-eating or purging type). An individual eats in binges and then induces vomiting and/or takes large amounts of laxatives or other cathartics (medications, through their chemical effects, that serve to increase the clearing of intestinal contents).
The following are the most common symptoms of anorexia. However, each child may experience signs differently.
Symptoms may include:
Significantly low body weight due to restriction of food intake relative to requirements
Intense fear of gaining weight or persistent behaviors like severe dieting and exercise that prevent weight gain when underweight
Inability to accurately assess weight, size, or shape and seeing oneself as fat, even though underweight
The following are the most common physical symptoms associated with anorexia nervosa--often that result from starvation and malnutrition. However, each child may experience symptoms differently. Symptoms may include:
Dry skin that when pinched and released, stays pinched
Intolerance to cold temperatures
Development of lanugo (fine, downy body hair)
Yellowing of the skin
Loss of menstrual periods in girls
People with anorexia may also be socially withdrawn, irritable, moody, and/or depressed. The symptoms of anorexia nervosa may resemble other medical problems or psychiatric conditions. Always consult your child's doctor for a diagnosis.
Parents, teachers, coaches, or instructors may be able to identify the child or adolescent who may be developing anorexia nervosa, although many people with the disorder initially keep their illness very private and hidden. However, a pediatrician, child psychiatrist or a qualified mental health professional with expertise in eating disorders is needed to diagnose anorexia nervosa in children and adolescents. A detailed history of the child's behavior from parents and teachers, clinical observations of the child's behavior, and, sometimes, psychological testing contribute to the diagnosis. Parents who note symptoms of anorexia nervosa in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.
Anorexia nervosa, and the malnutrition that results, can adversely affect nearly every organ system in the body, increasing the importance of early diagnosis and treatment. Anorexia can be fatal. Consult your child's doctor for more information.
Specific treatment for anorexia nervosa will be determined by your child's doctor based on:
Your child's age, overall health, and medical history
Extent of your child's symptoms
Your child's tolerance for specific medications or therapies
Expectations for the course of the condition
For adolescents, family based treatment is the best evidenced-based approach for anorexia nervosa. This treatment facilitate parental management of the restrictive dieting and over exercise in their child until the child is recovered enough to manage more age appropriate eating. Individual therapy is also an effective treatment, but it not as effective as family based treatment and appears to take longer for patients to restore weight. Other forms of family therapy also appear to be useful, though there are fewer studies available that demonstrate effectiveness. Treatment should always be based on a comprehensive evaluation of the adolescent and family. There are no medications known to be helpful for anorexia nervosa, but medication (usually antidepressants) may be helpful if the adolescent with anorexia is also depressed or anxious. The frequent occurrence of medical complications and the possibility of death during the course of acute and rehabilitative treatment requires your child's doctor to be an active member of the management team. Parents play a vital supportive role in any treatment process. Hospitalization may be required for medical complications related to weight loss and malnutrition.
Medical complications that may result from anorexia include, but are not limited to, the following:
Cardiovascular (heart). While it is difficult to predict which patients with anorexia nervosa might have life-threatening heart problems that result from their illness, the majority of hospitalized patients with anorexia nervosa have been found to have low heart rates. Heart muscle damage that can occur as a result of malnutrition or repeated vomiting may be life threatening. Common cardiac complications that may occur include the following:
Arrhythmias (a fast, slow, or irregular heartbeat)
Hypotension (low blood pressure)
Electrolytes (salts and minerals in the blood). Electrolyte abnormalities are common, especially in those who purge, abuse laxatives or diuretics, or drink excessive amounts of fluid. Electrolyte abnormalities may also develop during refeeding. Electrolyte abnormalities can cause abnormal heart rhythms, brain swelling, or other complications that can be life threatening.
Hematological (blood). An estimated one-third of anorexic patients have mild anemia (low red blood cell count). Leukopenia (low white blood cell count) occurs in up to 50 percent of anorexic patients.
Gastrointestinal (stomach and intestines). Normal movement in intestinal tract often slows down with very restricted eating and severe weight loss. Improved eating and associated weight gain often help to restore normal intestinal motility or movement.
Renal (kidney). Some people with anorexia may restrict fluid intake or drink excessive amounts of fluid. Limited fluid intake can cause dehydration and highly concentrated urine. Excessive fluid intake can cause dilute urine, and also may lead to electrolyte abnormalities (see above). Polyuria (increased production of urine) may also develop in patients with anorexia when the kidneys' ability to concentrate urine decreases. Renal changes usually return to normal with the restoration of normal weight.
Endocrine (hormones). In females, amenorrhea (cessation of the menstrual cycle for at least three consecutive months when otherwise expected) is one of the hallmark symptoms of anorexia. Amenorrhea may precede severe weight loss and continue after normal weight is restored. Reduced levels of growth hormones are sometimes found on anorexic patients and may explain growth retardation sometimes seen in anorexic patients. Normal nutrition usually restores normal growth and menstrual cycles.
Skeletal (bones). People with anorexia nervosa are at an increased risk for skeletal fractures (broken bones). When the onset of anorexic symptoms occurs before peak bone formation has been attained (usually mid to late teens), a greater likelihood of decreased bone mineral density and increased fracture risk exists.
Preventive measures to reduce the incidence of anorexia nervosa are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the child's normal growth and development, and improve the quality of life experienced by children or adolescents with anorexia nervosa. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.