Treating Anorexia Nervosa

2 October, 2009 - Blog, Uncategorized

The Agency for Healthcare Research and Quality (AHRQ) reported that hospitalizations for eating disorders have increased in the new millennium. The most common diagnosis was anorexia nervosa, accounting for 37% of hospitalizations in 2005 to 2006, an increase of 17% over those reported for 1999 to 2000. The next most common diagnosis was bulimia nervosa, characterized by binge eating followed by purging, which accounted for 24% of hospitalizations in the year ending 2006.

Anorexia nervosa affects nearly one in 200 Americans in their lives (three-quarters of them female). The term “anorexia” is derived from two Greek words, usually translated as “without appetite” — but that is something of a misnomer. Patients with this disorder do not lose their appetite; they struggle to subdue it. They are simultaneously afraid of gaining weight and convinced they are too fat, even when significantly underweight. As a result, they starve themselves to the point that they put their lives at risk.

In the most severe cases, patients develop life-threatening complications, such as cardiac arrhythmias, kidney failure, and liver failure. This is one reason that anorexia nervosa is one of the most deadly psychiatric disorders, killing 5.6% of patients for every decade that they remain ill. Treatment is challenging because starvation not only severely damages the body, but also harms the brain — causing changes in thinking, emotions, and behaviors that may be difficult to reverse.

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Anorexia nervosa is one of the most deadly psychiatric disorders.

A multidisciplinary approach is best, but treatment is challenging because starvation may cause permanent changes in thinking and behavior.

Although medications are often prescribed, little evidence supports their use in treating anorexia nervosa.

Risk Factors and Diagnosis

Anorexia nervosa is a complex, multifaceted disorder that may develop from about age 8 onward, most often beginning between ages 15 and 18. A large, nationally representative U.S. study found no new cases after respondents reached their mid-20s. This suggests that when adult patients seek treatment for anorexia nervosa, they usually have struggled with this disorder before.

Studies in twins suggest that anorexia nervosa is about 71% heritable (about the same as obsessive-compulsive disorder), indicating that genes contribute to susceptibility more than environmental factors do. In addition, certain personality traits, such as perfectionism, body dissatisfaction, and obsessive thoughts and behaviors may predispose patients to developing anorexia nervosa. Other risk factors include a past history of anxiety, depression, or substance abuse, or physical or sexual abuse.

Environmental factors, such as magazines that feature gaunt models and Web sites that share “thinspiration” pictures and stories, may initiate anorexia nervosa. These external cues may lead a susceptible individual to lose weight, which in turn sets in motion an escalating obsession with restrictive eating and body size.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) lists specific criteria for diagnosis (see below), and describes two subtypes of anorexia nervosa. In the restricting subtype, patients drastically reduce food consumption. In the binge-eating/purging subtype, patients lose weight by forcing themselves to vomit or by using laxatives, diuretics, or enemas. Patients with anorexia nervosa may also exercise excessively in an effort to lose weight.

Once weight decreases to the threshold required for a diagnosis of anorexia nervosa, patients may experience changes in thinking processes, such as difficulty concentrating. They may develop odd food rituals, such as cutting food into tiny pieces, eating only at certain times, and weighing food. Weight gain may eventually improve these psychological problems, but it seldom eliminates them completely — which is why maintenance treatment is so important.

Diagnostic Criteria for Anorexia Nervosa