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Anorexia Nervosa: Understanding an Epidemic

© Tara Kuther

The recent popularity of extraordinarily thin actresses, such as Calista Flockhart, Courtney Cox, and (law and order), has brought anorexia nervosa back into the spotlight. Anorexia nervosa is an obsession with losing weight that is not satisfied with the loss of a few pounds; it's an eating disorder of self-starvation.

Prevalence

Despite the widespread press, the American Psychiatric Association reports that anorexia nervosa is diagnosed in less than one percent of the population. Anorexia afflicts people who are successful and who appear to have "everything going for them." Desires for success and perfectionist tendencies drive anorexia.

Many cases of anorexia nervosa persist without a diagnosis. Nearly 20% of school aged girls show symptoms of an undiagnosed eating disorder. Distorted body image, a primary feature of anorexia, is unfortunately common. Nearly three quarters of adolescent girls report unhappiness with their body shape and desire to be thinner. In one study, more than one-third of normal weight girls believed that they were overweight, including five percent who were actually underweight. It may not be surprising that anorexia nervosa is diagnosed in women ten times more often than in men. The average age of onset is 17.

Symptoms

According to the American Psychiatric Association, anorexia nervosa is diagnosed on the basis of the following symptoms:

• Excessive weight loss from dieting and exercising (15% below the minimum normal level for age and height).
• Distorted sense of body image. No matter how much weight she loses, the woman with anorexia nervosa perceives herself as heavy.
• Intense fear of gaining weight that is not alleviated with weight loss.
• Amenorrhea, the absence of at least three consecutive menstrual cycles.

Consequences of Anorexia Nervosa

The physical and psychological consequences of anorexia nervosa are devastating. The first physical signs of anorexia nervosa include emaciation, constipation, dry skin and brittle nails. Without sustenance, muscles soon begin to atrophy. As the heart muscle deteriorates, the rhythm often changes, placing the patient at risk for heart attacks. Malnutrition and starvation increase the risk of bone loss, infertility, and early onset osteoporosis. Starvation is stressful for the body, increasing the rates of kidney failure, heart failure, and respiratory infections.

As the disorder progresses, the psychological consequences become evident. The girl or woman who was previously a hard-working, over-achieving perfectionist becomes socially withdrawn and less interested in activities that once brought her pleasure. She experiences difficulty concentrating, loses interest in school, and focuses more heavily on exercise and dieting.

These psychological consequences of anorexia nervosa may be partially rooted in the physical changes that the brain undergoes with starvation. Brain scans show that the brain undergoes structural changes and actually shrinks with starvation. Nearly 20% of persons with anorexia nervosa die from the disorder itself, or complications arising from the disorder.

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