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The vast majority of anorexia nervosa, approximately
90%, is seen in adolescent girls, although it can affect boys, but
is rarely seen after the 4th decade of life. Weight loss is slow
and progressive. Attempts to stop or confront the behavior is generally
met with intense anger and denial, combined with depression. After
confrontation, a variety of manipulative devices may be employed
in order to continue the behavior. She may insist she is eating,
but in actuality, she may be eating even less, subsequently losing
even more weight.
Once thought to be an illness of the wealthy, we do see anorexia
nervosa crossing all socioeconomic lines. However it should be noted
that there is greater prevalence in industrial societies, where
there is clearly enough food.
There are clearly familial issues associated with anorexia nervosa.
In all of the cases that this author has seen, there has always
been some family dysfunction in involved. What does this mean? It
is not uncommon for there to be an Axis II personality disorder
in the mother or father. This is more often seen in the father than
the mother, although research has not ferreted out the reason for
this. We all too often see fathers who are controlling, highly demanding
of high academic achievement, as well as either consciously or subconsciously
cuing their daughters that it is of paramount importance to look
good in public. The stress may be grossly overwhelming. It is also
not uncommon to see stress in the marriage, and the daughter may
become an extension of the marriage and a “pseudo-wife.”
Again, this is not true in all cases, but is commonly seen and needs
to be examined.
Some common personality disorders seen in the parents of individuals
with anorexia nervosa include narcissistic personality disorder,
anti-social personality disorder, and borderline personality disorder.
Family therapy is crucial in the treatment of anorexia nervosa.
What is most important is nursing the child back to health so that
we can literally save her from starvation. There is a high degree
of morbidity and mortality with severe cases of anorexia nervosa.
Once we have established weight gain, even in small increments,
then it is imperative to bring in the entire family for a look at
communication and dynamics.
The National Association of Anorexia Nervosa and Associated Eating
Disorders has a hotline. Please call 847-831-3438 Monday-Friday,
9 a.m. to 5 p.m. central time for further information.
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