Anorexia Nervosa - Facts, symptoms and treatment of the eating disorder Anorexia

Characteristics of Anorexia Nervosa

 

The causes of anorexia are a matter of debate in medical circles and society in general. General perspectives fit between the poles of its being physiological or psychological (with the potential for sociological and cultural influences being a cause to various degrees) in origin. Some now take the opinion that it is a mix of both, in that it is a psychological condition which is often (though not inherently) borne of certain conducive neurophysiologic conditions.

Clinical definition

The four DSM IV criteria

The following is the definition of anorexia nervosa from the Diagnostic and Statistical Manual of Mental Disorders, used to assist medical and psychological doctors in making a clinical diagnosis. This definition may not be representative of what an individual sufferer feels or experiences in living with the illness. Additionally, it is important to note that an individual may still suffer from a health- or life-threatening eating disorder (e.g., subclinical anorexia nervosa or ED-NOS: eating disorder, not otherwise specified) even if one of the below signs is not present. In particular, a substantial number of patients diagnosed with ED-NOS meet all criteria for diagnosis of anorexia nervosa except the requirement of three consecutive missed menstrual cycles.

The two DSM IV Subtypes

Physiological

The primary physiological characteristics of anorexia nervosa are:

Note that these are not diagnostic criteria but are instead characteristics associated with many or most individuals with anorexia nervosa. In addition to the intentional starvation almost always associated with anorexia nervosa, some subjects will also take part in a high level of physical activity.
Anorexia nervosa has a negative impact on the immune system and the central nervous system (CNS). It is also thought to be linked to serotonin and dopamine abnormalities.
Many anorectics are diagnosed with obsessive-compulsive behavior at some point in their lives. Some have an eating-disordered parent, demonstrating a possible genetic link with the disorder. Drs. Jose Yaryura-Tobias and Fugen Neziroglu have demonstrated by their pioneering work in getting FDA approval for American use of the drug Anafranil that obsessive-compulsive aspects of the disease can be alleviated by that drug, generically known as clomipramine. Total cessation of all anorexic disease was reported in one patient in as short as one hour after administration of Anafranil in clinical trials in Manhasset, NY in February 1979. After a one year course of treatment with Anafranil, this patient has lived a normal life except for occasional visual hallucinations caused by underlying paranoid schizophrenia.
In a long-term set of studies done by Wentz Nilsson, Gillberg, Gillberg, and Råstam on fifty-one adolescents with anorexia nervosa, eighteen percent of subjects were consistently diagnosed with some type of autism-like disorder at onset and at five- and ten-year follow-ups. Researchers Christopher Gillberg and Carina Gillberg have noted that a "small but important minority" of young women with anorexia nervosa may be suffering from undetected and underlying autistic disorders.
Anorexic subjects will often go through a cycle of recovery and relapse, unless weight is restored long-term.

Neurochemistry abnormalities

There is increasing speculation that the onset of anorexia has a genetic component. It has been shown that a certain gene linked to abnormalities with the neurotransmitter chemical serotonin is more common amongst sufferers of anorexia than in the general population. Such genetic characteristics might potentially equate to an easier path towards overly high serotonin levels, thus instilling heightened levels of anxiety and the like. Biologically, when a person is in a state of starvation, their levels of serotonin decrease, and thence increase again upon the consumption of food because of the tryptophan amino acids contained therein (tryptophan is used by the body to synthesise serotonin). This raises the spectre that the anorexic is conditioned into avoiding food to reduce his or her anxiety, and that there may be yet another layer of complexity with respect to the cause/effect relationship between physiological factors and the mental beliefs of the anorexic.

Blood chemistry abnormalities: dietary minerals and heavy metals

Victims of mercury, lead, beryllium and arsenic poisoning have been known to develop anorexia as a symptom thereof. Some psychological traits associated with anorexia are consistent with deficiencies in important vitamins and minerals, such as magnesium and the B vitamins. Zinc deficiency is common among anorexics, thereby resulting in heightened levels of copper which is associated with depression and nervousness. That these deficiencies (or untoward exposure to heavy metals) can produce powerful psychological effects, such as depression, anxiety, and loss of appetite, is not widely known. Conversely, overexposure is also harmful. Anorexia is also associated with general anemia.

Animal model

There exists an animal model of anorexia nervosa that closely mimics the physiological effects of the disease. In the animal model, subjects are intentionally subject to starvation and given unlimited access to exercise. Under these conditions, without intervention, subjects will eventually run and starve themselves to death. Compared to cases of food restriction without exercise access, the subject will not starve themselves to death.
In the animal model of anorexia nervosa, it has been shown that repeated cycling of recover and relapse will lead to physiological adjustments from the subject. Subjects under these conditions will eventually become "resistant" to the animal model, and will not starve themselves to death. Subjects under these conditions show a metabolic adjustment.
Physiological effects in the animal model include:

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Psychological, Sociological, and Cultural

Psychological

Anorexia nervosa alters an individual's body image to the point where the person perceives himself or herself as fat irrespective of his or her actual size. This distorted body image is a source of considerable anxiety, and losing weight is considered to be the solution. However, anorexia alters one's body image to such a degree that many anorexics do not see the truth about themselves even when they look in the mirror. Therefore, even when an original weight-loss goal is attained, the anorexic still feels overweight and in need of further weight loss. To the anorexic mindset, there is no such thing as being too thin.
The attainment of a lower weight is typically viewed as a victory, and the gaining of weight as a defeat. "Control" is a factor strongly associated with anorexia nervosa, and an anorexic typically feels highly out of control in his or her life. However, the nature of the condition with respect to such psychological factors is highly complicated.
It is often the case that other psychological difficulties and mental illnesses exist alongside anorexia nervosa in the sufferer. Mild to severe manifestations of depression are common, partly because inadequate food energy-intake is a well-known trigger for depression in susceptible individuals. Other afflictions may include self-harm and obsessive-compulsive disordered thinking (aside from such disordered thinking connected to ther person's eating disorder). However, not all anorexics have any such problems alongside their eating disorder.
Many anorexics reach a low level of body weight at which hospitalization and force-feeding are required on a long-term or recurring basis in an attempt to keep them from literally starving themselves to death. Prolonged starvation will result in death as the body's systems shut down. This in itself being the major danger factor of anorexia aside from intense mental suffering and the risk of suicide.
Some anorexics may, at certain times during the course of their illness, incorporate bulimic behaviours into their illness: binge-eating and purging themselves of food on a regular or infrequent basis. Alternatively, some individuals might move from having anorexia nervosa to having bulimia. Many who have suffered both say that bulimia involves more mental suffering. Anorectics who also practice bulimic behavior are more likely to die as a result of their disease.
Anorexics acknowledge their condition to different degrees — at one extreme, they do not see their "disease" as dangerous and resent being labelled as psychologically ill; at the other, they understand and accept that they have a problem, yet the anorexia still takes control over their thinking to fluctuating degrees. In ways not too dissimilar from people who have had cult programming or post-traumatic stress disorder, an anorexic may be "triggered" into manic disordered thinking by being exposed to certain words or conditions.
Some people do eat unusually small amounts of food, for reasons other than their own perceived obesity. Examples include those who fast for religious reasons, execute a hunger strike as a political statement, or are attempting to lengthen their lifespan through caloric restriction. Such individuals are not ordinarily considered anorexic, although some modern critics of religious asceticism have likened habitual fasting to anorexia nervosa.

Sociological and Cultural

Anorexia nervosa can be traced back to or connected with 19th-century American society. In her article "The Appetite as Voice," Cornell University professor Joan Jacobs Brumberg stresses the importance of the history of anorexia nervosa. "A history of anorexia nervosa must consider the ways in which different societies create their own symptom repertoires and how the changing cultural context gives meaning to a symptom such as non-eating" (Brumberg, p.159). During the Victorian era, medical examiners were more interested in physical characteristics, or what the patient's body had to say, rather than his or her description of the illness. Young women were also viewed as non-reliable sources of information. Related to the section below on contemporary culture, doctors of the 19th century viewed the connection between culture and the disease very differently. "In effect, nineteenth-century medicine did not relate anorexia nervosa to the cultural milieu that surrounded the Victorian girl. The ideas of Victorian women and girls about appetite, food, and eating, as well as the cultural categories of fat and thin, were not mentioned as contributing to the disease. Only in the twentieth century has medicine come to understand that society plays a role in shaping the form of psychological disorders and that behavior and physical symptoms are related to cultural systems."
The mass media and advertorial marketing, such as beauty advertising, are also frequently viewed as being implicated in triggering eating disorders in teenage girls. And although anorexia nervosa is usually associated with western cultures, exposure to western media seems to have caused the disease to appear in some third-world nations. In addition, it has recently come to light that there appear to be girls exhibiting anorexic behaviours in remote parts of Africa that have not been exposed to modern forms of advertising. These girls link their self-starvation to religious causes.
In recent years, the Internet has enabled anorexics and bulimics to contact and communicate with each other outside of a treatment environment, with much lower risks of rejection by mainstream society. If an anorexic is already socially withdrawn, such a network of friends can be very helpful in bringing him or her back. On the other hand, the Internet is also a powerful tool with which people can isolate themselves. A variety of websites exist, some run by sufferers, some former sufferers, and some by professionals; attitudes on these sites range from a no-holds-barred, tough-love "put it in your mouth" approach to simple acceptance and even to promotion of anorexia nervosa as an "alternate lifestyle" .

 

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