Anorexia Nervosa: You Can Be Too Thin

Thursday, August 2, 2007 - 1:20pm

By John Messmer, MD

Their images are all over the media--actresses, models, and athletes who are rail thin. The not-so-subtle message is that women should aspire to thinness. Although the press sometimes says it is OK to be a full-figured woman, the more common message is that thin is preferred. In some cases, thinness is driven by other factors. Dancers, particularly ballerinas, seek very thin, lithe bodies. Athletes, either by desire or consequence of training, may seek excessive thinness, even among male athletes.

Thin and healthy vs. anorexia nervosa

But there is a difference between seeking a thin, but healthy body and the pathologic thinness seen in anorexia nervosa. Anorexics fear becoming fat and have a distorted sense of their bodies. Even in the face of skeletal thinness, they will focus on their bellies, prominent due to malnourishment, and claim they are too fat.

Anorexia nervosa: a worldwide epidemic

While anorexia nervosa is more common in Caucasian women, it is seen in all ethnic groups. It is reported more commonly in Western cultures, but increasingly studies are finding eating behaviors characterized by starvation in many other cultures. Perhaps the first description of anorexia nervosa was in 1689 when it was described "as a condition of ‘a Nervous Consumption' caused by ‘sadness, and anxious Cares.'"1

What are the health implications of anorexia nervosa?

So, while common thought is that our American obsession with thinness is the cause of anorexia nervosa, more likely it is a neuropsychiatric disorder akin to phobia, obsessive-compulsive disorder, and body dysmorphic disorder. Health consequences of anorexia nervosa are severe: abnormal growth, osteoporosis, loss of muscle mass including heart muscle from breakdown of body tissue for energy. Mortality is 12 times greater than the general population for the same age with 6-20 percent of affected people dying due to the disease.2

Signs of anorexia nervosa

Suspect anorexia nervosa in a female or male adolescent or young adult who refuses to eat or seems overly concerned about being overweight, particularly if already thin. Affected people tend to be obsessed with food, even though they refuse to eat. Girls will typically stop menstruating and tend to be cold. They may exercise excessively. There is a high rate of other psychological problems such as low self-esteem and depression in anorexics.

Treatment for anorexia nervosa

Fortunately, treatment is often effective. It is very important to seek professional help through a counselor experienced in treating eating disorders as the treatment takes a long time and may require hospitalization. Risk of relapse is high.

Medications do not treat the anorexia itself but are useful for the associated psychiatric problems such as depression. Generally, therapy focuses on helping the patient to develop comfort in eating and rewarding weight gain. Psychotherapy helps the person gain insight and understanding so she can continue to recover. Recovery rate is about 80 percent, but recovery can take many years.3

When anyone, female or male, displays an obsession with weight loss and refuses to eat, particularly in the face of normal or low body weight, professional help should be sought as soon as possible to reduce the risk of serious illness or death. A good place to start is with a patient's primary care physician or a counselor. If anorexia is diagnosed, someone skilled in eating disorders is the best person to help with recovery.

[1] Levy R, Williams-Wilson B. . Accessed July 21, 2007.

[2] Eating Disorders: Facts About Eating Disorders and the Search for Solutions. 2001 Accessed July 21, 2007.

[3] Strober M, et al. The long-term course of severe anorexia nervosa in adolescents: Survival analysis of recovery, relapse, and outcome predictors over 10-15 years in a prospective study. International Journal of Eating Disorders. 22(4):339-360. 1997.