Anorexia nervosa

Anorexia Nervosa is a type of eating disorder which is primarily characterised by the suffer's obsession with food; the intentional restriction of their intake of it plus a general psychological obsession caused by starvation.

What anorexia is

Anorexia alters an individual's body-image to the point that they may see themselves as being fat and billious irrespective of their actual size: this distorted body image[?] is a source of considerable anxiety, and losing weight is considered to be the solution. However, when a weight-loss goal is attained, the anorexic still considers themselves to be overweight and requiring of further weight-loss.

The attainment of a lower weight is typically viewed as a victory, and the gaining of weight as a defeat. 'Control' is a factor strongly associated with anorexia, and an anorexic typically feels highly out of control in their life. However the nature of the condition with respects to such psychological factors is highly complicated.

It is often the case that other psychological difficulties and mental illnesses exist alongside anorexia in the sufferer. Mild to severe manifestations of depression are common, partily because an inadequate calorie-intake is a well-known trigger for depression in susceptible individuals. Other afflictions may include self-mutalation[?] and obsessive-compulsive disordered thinking (aside from such disordered thinking connected to their eating disorder). However, not all anorexics have any such other problems besides their eating disorder.

Many anorexics reach a lowly level of bodyweight where hospitalisation and forced-feeding[?] are required on a long-term or re-occuring basis in an attempt to keep them from literally starving themselves to death. It is an unfortunate fact that prolonged starvation will result in death as the body's systems shut down, this in itself being the major danger-factor of anorexia aside from mental suffering and the risk of suicide.

Some anorexics may incorporate bulimic behaviours into their illness; binge-eating[?] and 'purging[?]' (themselves, of food) on a regular or infrequent basis during certain times in the course of their disease. Alternatively, some individuals might switch altogether from having anorexia to bulimia. While bulimia poses less of a mortal danger to life and limb, many who have suffered both say that bulimia is worse from a mental-suffering point of view.

Anorexia alters ones body image to such an extent whereby one does not see the truth about themselves even when they look in the mirror - to the anorexic mindset, there is no such thing as too thin. Anorexics typically sit on a spectrum in respects to their acknowleging their condition - at one end they do not see their 'disease' as dangerous and resent being labelled as psychologically ill, at the other end they are more understanding and accepting that they have a problem, but yet the anorexia still takes control over their thinking to fluctuating degrees. In ways not too dissimilar from people who have had cult programming[?] or post-traumatic stress disorder, an anorexic may be 'triggered' into manical[?] disordered thinking by being exposed to certain words or conditions.

Who suffers from anorexia

While anorexia may occur in individuals across the demographic devides, it definetly appears to be far more prone to developing among those in certain groups, such as:

• females
• those of age 10 through to 25
• people who are active in dancing, modeling or gymnastics
• people of European racial descent
• students who are under heavy workloads
• those who have suffered traumatic events in their lifetime such as child abuse and sexual abuse*
• those positioned in the higher echelons of the socioeconomic[?] scale
• the highly intelligent and/or high-achievers

Anorexia is typically stereotyped as being a disease of teenage females. However, in real-life, almost any individual can be a sufferer, even children as young as 3 have been known to develop the disease. The most common times of onset are at puberty, and during times of transition such as moving from school to university.

The disease is believed to be far more common in some societies than others, especially those of Europe, the Americas and Australasia.

What causes anorexia

The cause(s) of anorexia is a matter of debate in medical circles and society in general. General perspectives fit between the poles of it being physiological or psychological (with the potential for sociological and cultural influences being a cause to various degrees) in origin. Many now take the opinion that it is a mix of both; in that it is a psychological condition which is often (though not inherently) borne of certain conducive neuro-physiological conditions.

There is increasing speculation that the onset of anorexia has a genetic component, with a certain gene linked to abnormalities with the neurotransmitter chemical serotonin being shown to be common among sufferers. The repercussions of this apparently equate to the perpetual rendering of overly high serotonin levels, thus causing hightened levels of anxiety and the like (presumabily as a result of an increased sensitivity to perceived 'threat'). When a person with this makeup is in a state of starvation, their levels of serotonin decrease, and thence increase again upon the consumption of food because of the tryptophan amino acids contained therein. This rases the spectre that the anorexic is conditioned into avoiding food to reduce their anxiety, and that there may be yet another layer of complexity with respects to the cause/effect relationship between physiological factors and the mental beliefs of the anorexic.

The mass media and advertorial marketing are also frequently viewed as being implicatable in triggering eating disorders in teenage girls although it has recently come to light that there appear to be girls exhibiting anorexic behaviours in remote parts of Africa that have not been exposed to modern forms of advertising. These girls link their self-starvation to religious causes¹.

Many individuals who have got obsessive-compulsive disorders have also got an eating-disordered parent, presumabily connected with shared genetic characteristics.

Victims of mercury, lead, beryllium and arsenic poisoning have been known to develop anorexia as a symptom thereof. Some psychological traits associated with anorexia are consistant with deficiencies in important vitamins and minerals[?], such as magnesium and the B vitamins. Zinc deficiency is common among anorexics, thereby resulting in hightened levels of copper which is associated with depression and nervousness. That these deficiencies (or untoward exposure to heavy metals) can produce powerful psychological effects, such as depression, anxiety, and loss of appetite, is not widely known. Conversely, overexposure is also harmful.

Signs that a person may have anorexia:

• they are too thin
• they are secretive about their eating and may try to not eat whilst being around others
• their eating is ritualistic in nature: this can encompass taking abnormally small bites, cutting food up into abnormally small pieces, being sullen during mealtimes, staring at their food whilst eating, holding cutlery[?] in odd ways or at strange angles at times, eating slowly - especially when putting food into the mouth
• looking longingly or paying abnormal attentions towards food but not eating it
• cooking wonderful meals for others but avoiding eating the food they've made themselves
• they say they're too fat when they are not
• suffering from poor health and sunken eyes
• they've grown lanugo[?] (a thin hair) over their body - this is a natural physiological reaction to starvation
• they possess an extensive knowledge about the calorie contents of the different types of food, and the calorie-burning effects of each form of exercise
• they faint or otherwise pass out (an effect of starvation)
• amenorrhoea (the absense of menstruation)

Although the anorexic is less likely to choose fattening foods to eat, this is not always so. They may set their food-restriction objectives by the calorie rather than by food-type - for example one may set a goal of 500 calories in a day and the food chosen to attain that number may very well be a chocolate bar one day and apples the next.

Treating anorexia

Successful treatment of, and recovery from, anorexia is possible but it can take many years. The earlier intervention arrests the course of the disease, the more successful the treatment is likely to be. Anorexia Nervosa has the highest death-rate of all mental illnesses, with around up to 20% of anorexics eventually dying, usually from heart/organ failure or low levels of potassium. Once an anorexic reaches a certain weight, death becomes a very real possibility. The BMI (or body mass index) where this starts becoming a danger is generally around 12 to 12.5.(As a point of reference, a normal BMI is between 20 and 23, most "centerfold" models have a BMI of 18, and most fashion models come in at 17. An anorexic weight is usually defined as being below 16. These BMI's are all for women; men have a much lower BMI naturally.)

Approaches include hospitalisation, psychotherapy, specialised anorexia treatment-centres, and family counseling. The prescription of psychotropic drugs such as antidepressants is also practiced.

Appropriate treatment of any present vitamin and dietary-mineral deficiencies, particularly in the common case of zinc deficiency, may be highly beneficial to the suffer's mental and physical wellbeing.

Anorexia is notoriously hard to treat, with sufferers often either infactically denying that they are ill or paradoxically, accepting that they have anorexia, but seeing nothing wrong with their "lifestyle choice". This latter view is evidenced by the growing number of "pro-ana[?]" websites and discusson groups where self-identified "anorexics" come together to reinforce their beliefs and behaviours, creating a positive feedback loop.

How to behave towards somebody who has anorexia

The best help an anorexic can receive is unconditional love and empathy. Anorexia is fundamentally less about food than an individual's psychological need to feel safe - in that they do not.

As is common among suffers of some eating disorders, an anorexic may be very secretive about their disorder. Being confronted by another about it for the first time may result in feelings of panic and distress, so an informed and considerated caution is recommendable. However it is important to remember that anorexia is a dangerous disorder that signifies chronic suffering in an individual - it is important to not delay in seeking help for the person whom you believe has anorexia or bulimia. Researching the condition and consulting your local eating-disorder support-network are good beginings.

External links

• The Something Fishy Website on Eating Disorders (http://www.eating-disorders.net)

¹see article in the New Scientist