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.
