Anorexia Nervosa

Anorexia nervosa is a condition characterized by extreme weight loss, amenorrhoea, and a constellation of psychologic problems that have been described as "the relentless pursuit of thinness". [Bruch, H.]

The most common form of the disease is a single episode with full recovery, but anorexia nervosa can be episodic or unremitting until it causes death by starvation.

Unlike many other psychiatric disorders, anorexia nervosa tends to occur in intact families and is often precipitated by seemingly minor events during adolescence. Most theories of anorexia nervosa focus on psychologic trauma or unempathetic and overly domineering mothering as underlying causes of the disease. Socio-cultural theories suggest that the disease represents an exaggeration of the current inordinate weight consciousness of adolescent girls at a time when high-calorie foods are readily available and fewer calories are expended through exercise.

Typical symptoms of the disease include depression and obsessive-compulsive behaviors, it is not clear if these psychiatric problems preceded weight loss or occur as a result of semistarvation. Depression is often the first visible sign of anorexia nervosa. Abnormal hormonal patterns characteristic of starvation also occur.

The clinical features of anorexia nervosa are personality characteristics such as rigidity or perfectionism, fear of obesity preceding the onset of the disorder, and the symptoms of starvation accompanying it. Serious body image disturbance is common, manifested by a lack of recognition of the severe emaciation and a belief that one is too fat. Individuals are often preoccupied with food, thinking about it much of the time, and often engaging in bizarre eating rituals. Many anorectics engage in very extensive physical exercise. The disorder is also associated with a pervasive sense of personal ineffectiveness.

Anorectics are divided into two types, "restricters" who confine their eating disorder to restricted food intake, and "bulimics" who engage in bingeing and subsequent vomiting and purging. Bulimic anorectics tend to be older, manifest other impulsive behaviors such as kleptomania, alcohol and drug abuse, and sexual promiscuity.

Anorectics deny their weight-losing behaviors and the existence of any illness and avoid treatment even when they have become severely emaciated. Family members often have to insist on medical treatment. Some anoretic persons effectively hide their weight-losing behaviors even after they are forced to seek medical assistance.

Most persons with anorexia are resistant to entering treatment because of their fear of weight gain and are usually brought, by family members, under protest. Because starvation plays a significant role in the clinical portrayal of anorexia nervosa, clinicians begin treatment with a period in hospital designed to restore body weight. Such treatment that removes the patient from the environment may permit the use of behavioral rewards for weight gain and provides the opportunity to work on issues of control. Some medications have been helpful in the treatment of anorexia nervosa. These include cyproheptadine (an appetite stimulant), chlorpromazine (sedative, used in the treatment of psychotic conditions), and antidepressant medication.

  • Bruch, H., Eating disorders: obesity, anorexia nervosa and the person within. New York. 1979.

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