What is Anorexia Nervosa?

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 are 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  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.

What are the symptoms of Anorexia Nervosa?

Children frequently feel direct and indirect pressure to seek high academic achievement as well as perfection in their life. There is a blatant body image distortion that at times borders on delusional behavior. These children get put down by their parents, usually their father. They obsess around certain body parts or their entire body image. It is not uncommon to draw on magazines of models, cutting away certain body parts to fantasize what they want to look like.

They frequently have strong, unshakable denial. When confronted they dig in their heels and refuse and genuinely do not see the weight loss. These children and young adults can reach a point of being a medical emergency. Their electrolytes are imbalanced causing heart arrhythmias and even death. Clearly refusal to eat, or eating small portions, bulimia can be associated with it as well as purging.

It is common to see these individuals as very sensitive, easy to cry, as well as very angry. They may defend their parents to the end; making it very difficult to go forward in family therapy.

What is the treatment for Anorexia Nervosa?

Medical care and assessment is the FIRST priority. If one is not healthy or so emaciated that they cannot function, admission must be considered. This is actually part of therapy and part of the intervention. Mortality and morbidity are very real entities. This disorder must be taken seriously. The recidivism rate is high, and family dynamics must be addressed. Individual therapy must target the shattered sense of self, the distorted view and the family dynamics that are clearly the driving factor. In 2010 it was discussed on NPR about the recent knowledge that group, specifically family therapy has proven very beneficial. Excuse me, in 2010 we are seeing research studies confirming what we knew to be true in 1986 hmmm.

There are many clinicians that see anorexia as an organic illness and not related to the inner workings of the family. Even if there is an organic basis, there clearly needs to be family therapy to address the impact this has on siblings, friends and families.

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.