IMAGE DEADLY DELUSION

Anorexics see fat when they look in a mirror.

WRITER: RICHARD T. BOSSHARDT, MD, FACS

Anorexia nervosa is a uniquely female disorder. Although it can affect men, 85-95 percent of those with anorexia nervosa (usually simply called anorexia) are women. The Latin root of the word anorexia means loss appetite or desire for food. The medical condition of anorexia, however, has less to do with appetite or desire for food and much more to do with an abnormal attitude toward food coupled with a distorted body image.

The distorted body image is such that advanced anorexics, who look like someone who has suffered severe, prolonged starvation, can look in the mirror and still see a fat person. Anorexia also is about control. Many women with anorexia use the obsessive control over their eating as a means to cope with external stresses and emotional issues in their lives. This control can take one or more of several forms.

One of these include binging and purging. Anorexics will eat a meal and then turn around and induce vomiting and/or diarrhea. Vomiting can be induced by the simple technique of a finger down the throat. In time, women can learn to vomit almost at will. Chronic vomiting can produce dangerous tears in the lining of the esophagus, and the acidic stomach contents can damage the enamel of the teeth.

Laxative abuse is another way of purging, and women can become dependent on laxative use for their bowel function. Another form of control is excessive exercising. All of these are due to a fear of gaining weight.

Anorexia is a potentially fatal condition. The severe starvation can lead to all sorts of problems with electrolyte balance in the blood, heart and kidney function, weakening of the bones, and more. The famous singer, Karen Carpenter, died of complications of her anorexia. Depression often is seen in anorexics and can raise the specter of suicide as a concern.

Diagnosing Anorexia Nervosa

There is no specific test for anorexia nervosa. The diagnosis is made by a combination of a physical examination and a thorough medical history.

According to the Statistical Manual of Mental Disorders published by the American Psychiatric Association, the following criteria must be present for a diagnosis of anorexia:

Restriction of food intake - this means not eating enough to maintain a body weight that is at or above the minimal normal for the patient’s height and weight.

Fear of gaining weight - anorexics have an intense fear of gaining weight or becoming fat. They engage in persistent behavior, such as purging, even though they may be dangerously thin.

Having a distorted body image - this is classic anorexic behavior. Despite the fact that everyone else sees them as much too thin, they still perceive themselves as overweight or fat.

Treatment of anorexia requires a team of professionals and can be

Anorexia facts according to the National Association of Anorexia Nervosa and Associated Disorders:

• Anorexia is the third most common long-term illness among teenagers.

• Girls make up 85-90% of those who suffer from anorexia.

• 95% of patients are between the ages of 12 and 26

• Anorexia is the most common cause of death, 12 times more common than the second most common cause among young women aged 15-24 divided into three phases. These don’t run consecutively, rather, they usually overlap.

The first is to treat any medical issues due to food restriction. Treating heart problems, restoring normal kidney function and correcting electrolyte imbalances must be done, as these can be life threatening.

The second aspect of treatment is to restore a healthy body weight through diet and supplements. In severe cases, feeding may initially be done intravenously or by feeding tubes placed directly into the stomach.

The third tier of treatment involves dealing with the psychiatric/ psychological conditions that led to the anorexia in the first place. Some of this may be started in a hospital and then continued in either an inpatient or outpatient treatment facility for such disorders, depending on the circumstances.

There are no medications specifically for anorexia. Medications can be given to deal with anxiety and depression, and any medical issues the patient may have due to the anorexia.

Resources

For more information about anorexia nervosa, call womenshealth.gov at 800.994.9662 (TDD: 888.220.5446) or contact the following organizations:

Academy for Eating Disorders

Phone: 847.498.4274

National Association of Anorexia Nervosa and Associated Disorders

Phone: 847.831.3438

National Eating Disorders Association

Phone: 800.931.2237

National Institute of Mental Health (NIMH), NIH, HHS

Phone: 866.615.NIMH (6464)

National Mental Health Information Center, SAMHSA, HHS

Phone: 800.789.2647

IS ANOREXIA THE SAME AS BULIMIA?

No. Bulimia is a condition characterized by binging and purging. Binging is the act of eating a large amount of food in a short period of time. Purging is inducing vomiting and/or bowel movements to avoid gaining weight. Like anorexics, bulimics fear gaining weight, have control issues, and have a distorted body image. Unlike anorexics, bulimics are usually of normal weight for their height.

There also is a disorder in which individuals binge eat but do not purge afterwards. As might be expected, binge eaters tend to be overweight or obese, with all the problems those conditions can create

Both of these are primarily conditions of compulsion and control, thus psychiatric/ psychological counseling are integral to treatment, as with anorexia.