Anorexia Nervosa (Part 1)

This is the first of three articles in the Westmeath Topic on anorexia nervosa, better known simply as anorexia. The most shocking fact about anorexia is that it has the highest mortality of any psychiatric disorder. This does not even take into account the short and long term health problems experienced by the people who survive the condition. Anorexia nervosa has a prevalence of 0.3% in women. This may seem low, but this actually means that approximately 7000 women in the Irish Republic and about 150 women in Westmeath alone are currently battling this condition. Bulimia nervosa is five times more common than anorexia so based on statistics, this means that approximately 750 women in Westmeath alone currently suffer from this condition.

Anorexia is more than twice as common in teenage girls as older women; it has an average age of onset of 15 years; 80 to 90% of anorexia sufferers are female. Anorexia and bulimia nervosa are the most common causes of weight loss in young women. They are the most common admission to child and adolescent hospital services. Anorexia takes an average of five to six years from diagnosis to recovery. Up to 30% of patients do not recover.

Research

Ironically, despite the fact that anorexia is the most lethal of any psychiatric disorder in terms of physical health and fatality, there is relatively limited knowledge and research on the condition. This is mainly due to the secrecy and denial of those who suffer from the condition. The fact it is so difficult to get anorexia sufferers to engage in treatment means that asking patients to take part in research and studies on their condition is extremely challenging.

There is much more research on the physical problems caused by starvation so there is a well-recognised pathway for the treatment of starvation; the problem with anorexia is that the sufferer may not accept they need treatment so will not engage in treatment.

Signs and symptoms

The main psychological feature of anorexia nervosa is the extreme overvaluation of shape and weight. People with anorexia also have the determination to tolerate extreme hunger and self-imposed weight loss. Food restriction is only one aspect of the practices used to lose weight. Many people with anorexia use over-exercise and over-activity to burn calories. They often choose to stand rather than sit; generate opportunities to be physically active; and are drawn to sport, athletics, and dance. Purging practices include self-induced vomiting, together with misuse of laxatives, diuretics, and “slimming pills.” The practise of “body checking” is another feature of many anorexia sufferers; this involves repeated weighing, measuring, mirror gazing, and other obsessive behaviour as reassurance that they are still thin. Losing weight becomes an addiction and like any addiction the point of complete satisfaction (with one’s weight in the case of anorexia) is never attained. Eating becomes an “evil” thing in the eyes of the sufferer. In this way, it is not that dissimilar to other addictive or psychological type disorders such as alcoholism, drug addiction, gambling addiction etc. Initially the person is able to lead a fairly normal life. It is often only in the end stages when the person becomes so physically and psychologically unwell that it is obvious there is a problem and the person can no longer lead a normal life.

It falls to family members and primary care services (eg. patient’s GP) to recognise and manage relapses as well as first episodes of the illness. General practitioners may need support from a specialist in eating disorders, and early referral for more detailed assessment and advice gives the person the message that their illness is of genuine concern.

Physical signs of malnutrition and purging apart from a low weight include thinning hair, swollen parotid gland (this is swelling of the salivary glands which shows as a swollen face), enamel erosion, hypothermia, bradycardia (slow heart rate), lanugo hair (this is the growth of soft downy hair on face, back and arms), dry skin, low blood pressure, cold hands and blue or uneven colour in extremities such as hands or feet, poor capillary return, carotenaemia (a yellowing of the skin caused by excess carotenoids, especially the palms of the feet and soles of the hands), insensitivity to pain, constipation, amenorrhoea (lack of periods in women) and shrunken breasts.

Causes

There is no one primary cause of anorexia but there are many factors that increase risk. There is some evidence of a genetic risk meaning that it may run in families; however there is not always an obvious genetic link. Anorexia nervosa is sometimes used as a coping mechanism against the like of developmental challenges, transitions, family conflicts, and academic pressures. Sexual abuse may precipitate anorexia but it doesn’t cause anorexia to any greater degree that it triggers other psychiatric disorders. There is some evidence suggesting that anorexia is linked to family history of obsessive, perfectionist, and competitive traits, and possibly also autistic traits; more research is required.

Diagnosis

Suspicion that anorexia is a possibility usually initially comes from family, friends or schoolteachers (in the case of younger people). The weight loss may be well concealed by the person so at times the first presenting features that bring the person in contact with medical professionals are psychological or physical problems such as depression, obsessive compulsive disorder, infertility or amenorrhoea (absence of periods). Basic medical investigations, blood tests, electrocardiography, weighing, and measuring the patient provide an opportunity for the patient to return (to discuss the results) and can uncover psychological problems. If the patient refuses to be weighed it is worth persisting gently and exploring their fears.

Eating Disorders Awareness Week

Eating Disorders Awareness Week is February 27th to March 5^th. If you want more information or support (for yourself, a loved one or a friend living with the condition), log on to www.bodywhys.ie; their LoCall helpline is 1890 200 444 or e-mail info@bodywhys.ie.

To be continued…next week

Disclaimer: Information given is general; please ensure you consult with your healthcare professional before making any changes recommended

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