Anorexia nervosa    What is it? Anorexia nervosa is an eating disorder often marked by an unnatural fear of weight gain, compulsive exercising, self-starvation, a distorted body image, and amenorrhea, or absence of at least three consecutive menstrual cycles. There are two sub-types of anorexia nervosa – restricting and binge-purge. Restricting anorexia nervosa is characterized by strict diet and exercise. Binge-purge is marked by periods of compulsive eating with or without self-induced vomiting and the use of laxatives or enemas. Although many diagnosed with anorexia nervosa recover, the disorder can lead to death. Who gets it? About 90 percent of those with anorexia nervosa are young women ages 14 to 18. But men and women through their 40s are also at risk. Anorexia nervosa was once considered a disorder of the upper and middle classes. But, more recent studies show that cases of anorexia are becoming more common among young women of all races and social classes in the United States. Adolescents who aspire to be models, professional athletes or performers appear to be at higher risk for developing anorexia nervosa. Anorexia nervosa may be found in people also suffering with depression, anxiety disorders and obsessive-compulsive disorder. What causes it? The precise cause of anorexia is not known but is probably the result of a combination of psychological factors, social influences and occupational goals. The changes caused by puberty appear to be a strong influence. Some girls may have difficulty accepting the changes in their bodies in adolescence, especially fat accumulation. This may be coupled with teasing by peers. Other psychological contributors may include reactions to sexual abuse, a desire to appear weak and fragile to the opposite sex, family dysfunction, and an overemphasis on control and independence. Socially, young women from an early age are conditioned by the media and other sources to believe that only very thin women are considered beautiful. Many of the risk factors for women are the same for men, a group in which the number of cases is rising especially among homosexuals. What are the symptoms? One important sign that someone may be suffering from anorexia nervosa is grossly distorted body image, meaning that the person feels they are overweight and, in fact, appear thin. Other symptoms may include unnatural fear of weight gain, compulsive exercising, self-starvation, loss of energy, and, in girls who have started menstruating, amenorrhea, or absence of at least three consecutive menstrual cycles. Those with anorexia nervosa may begin to appear emaciated. Over time, the disorder may cause serious health problems including sudden death, congestive heart failure, dental problems, growth retardation, stomach rupture, swelling of the salivary glands, anemia, abnormalities of the blood, loss of kidney function and osteoporosis. Diagnosis Many anorexics deny that they have a problem and are usually brought for treatment by a family member. A physician may look for the following signs that a patient has anorexia nervosa: emaciated body, dry or yellowish skin, abnormally low blood pressure, history of amenorrhea, abdominal pin, constipation and lack of energy. The patient may also have developed lanugo, a soft, downy hair that grows on the arms and chest. If a patient has been vomiting, she may have eroded tooth enamel and Russell’s sign, or scars on the back of the hand. The physician will also assess whether a patient’s weight loss is less than 85 percent of ideal body weight. Other health concerns that present similar symptoms will need to be ruled out through a series of tests. Those other health conditions may include metabolic disorders, brain tumors, diseases of the digestive tract and mesenteric artery syndrome. Treatment The disorder has different levels of severity. The most critical cases may require hospitalization with group and individual therapy and, in some cases, force-feeding. Those with less severe cases may require outpatient psychotherapy and nutrition counseling. Family counseling may also be recommended. Although treatment with medications is debated among physicians, medications including antidepressants, anti-anxiety drugs or others may be recommended. The majority of anorexics will recover. However, some studies report that about one in 10 may die from complications of anorexia nervosa. Those causes of death include starvation, electrolyte imbalance, heart failure and suicide.