Life in a fun-house mirror: anorexia nervosa

Anorexia nervosa (AN) is a serious and complex medical and psychiatric illness.1 It is not a personal choice with a simple solution. The disorder is a multifaceted problem that involves biological, genetic, social, cultural, familial, relational, and psychological factors.2 Patients suffering from AN may be oblivious to their unhealthy behaviors. Their body image mimics what we might see in a fun-house mirror. Despite evidence to the contrary, they still see an overweight individual staring back at them.3

While AN affects mostly girls and young women, it also affects older individuals, both female and male, and crosses racial, ethnic, and economic backgrounds.2 Anorexia does not always start as a clear cut disorder. It can start gradually with a new diet and exercise routine and develop into an unhealthy desire to lose weight that causes the individual to completely stop eating.3 That being said, anorexia is NOT dieting. A diet is a healthy desire to lose weight to improve health and appearance, while AN is a serious medical and psychiatric illness characterized by a distorted body image and an intense fear of gaining weight.1 Self-starvation and calorie restriction can be a way for anorexics to feel in control at a time in their life when things seem out of control. People with AN may also associate their ability to restrict calories and intake with feelings of self-worth and self-esteem. Unfortunately, these self-destructive behaviors do not address the underlying problems and can lead to greater emotional pain, isolation, and physical damage.2

Characteristics of anorexia:1-4
• A refusal to maintain a normal body weight for his or her height (<85% size="2">1-4
• Making him- or herself throw up
• Taking pills to urinate or have a bowel movement (diuretics or laxatives) or diet pills
• Unhealthy eating habits: not eating, eating very little, weighing food and counting calories, eating very small amounts of only certain foods, moving food around the plate instead of eating it, complaints of feeling full even after eating very little
• Inappropriate exercise: even in bad weather or when hurt, tired, or sick
• Physical changes: weakness, lethargy, muscle loss, amenorrhea (loss of menses), delayed sexual development, edema, delayed gastric emptying, constipation, low heart rate and blood pressure, osteoporosis, dry cracking skin, lanugo (fine, downy body hair growth all over the body), feeling cold all the time, dizziness, faintness, and headaches

Anorexia causes many detrimental effects to the body.2 Patients with anorexia continuously starve themselves, leading to malnutrition. In a state of malnutrition, the body essentially feeds on itself for nutrients and slows down to conserve energy. To the left is a diagram of the health consequences of AN. As you can see, AN affects almost every part of the body. Left untreated, more than 5% to 10% of patients with AN die.4

Recovery from AN is possible.2 If you, a friend, or family member suffer from anorexia, it is important to seek help from a health professional. Depending on the severity of the condition, AN may be treated in the hospital, with regular visits to the doctor, or a combination of the two.1 The road to recovery involves both physical and psychological therapy.2

Goals of treatment:1-4
• Reduce distorted body image
• Restore and maintain a healthy body weight
• Reduce or eliminate behaviors or thoughts that lead to unhealthy eating habits
• Establish and maintain normal eating patterns
• Treat the psychological issues related to the eating disorder
• Resolve contributory family problems
• Prevent relapse

Treatment initially focuses on restoring a healthy weight and eliminating food phobias.4 When the patient is medically stable, treatment becomes directed towards cognitive behavioral therapy (CBT), interpersonal psychotherapy, and nutritional counseling. These treatments are focused on finding and maintaining a positive body image and developing healthy coping strategies. Data supporting the use of drugs to treat anorexia is limited. Antidepressants, such as fluoxetine (Prozac®), can be used if depression, anxiety, obsessions, or compulsions exist after the person has achieved a healthy body weight. Treatment with risperidone (Risperdal®) or olanzapine (Zyprexa®), atypical antipsychotics, has shown some benefit in increasing weight and reducing anxiety and depressive symptoms. Lorazepam (Ativan®) and alprazolam (Xanax®) have been used before meals to reduce severe anxiety that can limit eating. Lastly, metoclopramide (Reglan®) can be used to reduce common gastrointestinal symptoms of AN (e.g. bloating, premature fullness, and abdominal pain). These therapies should only be initiated under close supervision of a medical professional.

Krista Williams, P4 on rotation and edited by Irene Hong, PharmD


Remember, anorexia is a serious, life-threatening condition. Below is a list of organizations you can contact if you need help or more information.

UIC Students: UIC Counseling Center
• Phone: 1-312-996-3490
• Crisis Hotline: 1-312-996-5535 (every evening from 6 to 10:30)
• Internet Address: http://www.vcsa.uic.edu/MainSite/departments/counseling_center/home/

The National Eating Disorder Association:
• Toll-free Hotline: 1-800-931-2237
• Internet Address: http://www.nationaleatingdisorders.org

National Association of Anorexia Nervosa and Associated Disorders
• Helpline: 1-630-577-1330
• Phone: 1-847-831-3438
• Internet Address: http://www.anad.org

U.S. Department of Health and Human Services, Office on Women’s Health
• Phone: 1-800-994-9662
• Internet Address: www.womenshealth.gov

National Mental Health Information Center, SAMHSA, HHS
• Phone: 1-800-789-2647
• Internet Address: http://mentalhealth.samhsa.gov

National Institute of Mental Health (NIMH), NIH, HHS
• Phone: 1-866-615-NIMH (6464)
• Internet Address: http://www.nimh.nih.gov

Academy for Eating Disorders
• Phone: 1-847-498-4274
• Internet Address: http://www.aedweb.org

References:
1. The National Eating Disorders Association. The National Eating Disorders Association educator tool kit. http://www.nationaleatingdisorders.org/uploads/file/toolkits/NEDA-Toolkit-Educators_09-15-08.pdf. Updated 2008. Accessed Feb 26, 2010.
2. The National Women's Health Information Center. Anorexia Nervosa. http://www.womenshealth.gov/faq/anorexia-nervosa.cfm. Updated 2009. Accessed Feb 15, 2010.
3. National Institute of Mental Health. Anorexia Nervosa. http://www.nimh.nih.gov/health/publications/eating-disorders/anorexia-nervosa.shtml. Updated 2009. Accessed Feb 28, 2010.
4. Stoner SC. Eating disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 7th ed. New York, NY: The McGraw-Hill Companies; 2008. http://www.accesspharmacy.com/content.aspx?aID=3194063. Accessed Feb 22 2010.