Many people with anorexia nervosa see themselves as overweight, even when they are clearly underweight. Eating, food, and weight control become obsessions. People with anorexia nervosa typically weigh themselves repeatedly, portion food carefully, and eat very small quantities of only certain foods. Some people with anorexia nervosa may also engage in binge-eating followed by extreme dieting, excessive exercise, self-induced vomiting, and/or misuse of laxatives, diuretics, or enemas.
Some who have anorexia nervosa recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic, or long-lasting, form of anorexia nervosa, in which their health declines as they battle the illness.
Anorexia nervosa displays the following symptoms:
- Extreme thinness (emaciation)
- A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
- Intense fear of gaining weight
- Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
- Lack of menstruation among girls and women
- Extremely restricted eating.
Other symptoms may develop over time, including:
- Thinning of the bones (osteopenia or osteoporosis)
- Brittle hair and nails
- Dry and yellowish skin
- Growth of fine hair all over the body (lanugo)
- Mild anemia and muscle wasting and weakness
- Severe constipation
- Low blood pressure, slowed breathing and pulse
- Damage to the structure and function of the heart
- Brain damage
- Multiorgan failure
- Drop in internal body temperature, causing a person to feel cold all the time
- Lethargy, sluggishness, or feeling tired all the time
Treating anorexia nervosa
Treating anorexia nervosa involves three components:
- Restoring the person to a healthy weight
- Treating the psychological issues related to the eating disorder
- Reducing or eliminating behaviors or thoughts that lead to insufficient eating and preventing relapse.
Some research suggests that the use of medications, such as antidepressants, antipsychotics, or mood stabilizers, may be modestly effective in treating patients with anorexia nervosa. These medications may help resolve mood and anxiety symptoms that often occur along with anorexia nervosa. It is not clear whether antidepressants can prevent some weight-restored patients with anorexia nervosa from relapsing. Although research is still ongoing, no medication yet has shown to be effective in helping someone gain weight to reach a normal level.
Different forms of psychotherapy, including individual, group, and family-based, can help address the psychological reasons for the illness. In a therapy called the Maudsley approach, parents of adolescents with anorexia nervosa assume responsibility for feeding their child. This approach appears to be very effective in helping people gain weight and improve eating habits and moods. Shown to be effective in case studies and clinical trials, the Maudsley approach is discussed in some guidelines and studies for treating eating disorders in younger, nonchronic patients.
Other research has found that a combined approach of medical attention and supportive psychotherapy designed specifically for anorexia nervosa patients is more effective than psychotherapy alone. The effectiveness of a treatment depends on the person involved and his or her situation. Unfortunately, no specific psychotherapy appears to be consistently effective for treating adults with anorexia nervosa. However, research into new treatment and prevention approaches is showing some promise. One study suggests that an online intervention program may prevent some at-risk women from developing an eating disorder. Also, specialized treatment of anorexia nervosa may help reduce the risk of death.