Symptoms and Complications
People with anorexia nervosa may appear severely emaciated due to malnutrition, sometimes so severe their ribs can be seen through the skin. Other common symptoms of anorexia include:
- dry, scaly skin
- faintness or weakness
- inability to concentrate
- intolerance to cold
- loss of body fat
- low blood pressure
- missed, or absence of, menstrual periods
- psychological fears of obesity and weight gain
- slow heartbeat
While most people feel hungry and uncomfortable when their calorie intake is low or restricted, people with anorexia suppress this discomfort and usually lose the ability to appreciate normal hunger cues. As they begin to starve, they may experience a feeling of euphoria, similar to how a runner or jogger gets the well-known "runner's high."
If the onset of anorexia occurs before puberty, a girl's sexual development will stop and menstruation won't begin. Severe anorexia leads to chronic malnutrition, which has damaging effects on the body, especially the bones, thyroid, heart, and digestive and reproductive systems. Anorexia can be fatal. Half of those who die with anorexia die of suicide, and the other half die of medical complications.
Some people with bulimia may experience episodic weight loss, while others maintain a normal weight or may even be overweight. In some cases, menstrual cycles may be affected and stopped, but menstruation is usually preserved. Possible symptoms of bulimia include:
- dehydration (due to excessive use of laxatives or frequent self-induced vomiting)
- tooth decay and erosion (due to the acids that are brought up from repeated self-induced vomiting)
- low blood pressure
- swollen saliva glands in the cheeks (like mumps)
- abnormal hormone levels
- stomach and esophagus problems
- irregular heartbeat
A variety of complications can result from the constant vomiting. For example, inflammation of the esophagus (called esophagitis) and severe dental problems can occur. At its worst, constant purging can lead to heart damage. People with bulimia may have a history of anorexia or obesity. They may also have psychiatric problems such as depression, panic disorder, social phobias, and anxiety disorders, as well as addictive behaviors like alcohol or drug abuse.
Making the Diagnosis
To diagnose eating disorders, doctors generally only need signs and symptoms based on a physical exam and a detailed medical or personal history. In the case of a person with anorexia, continued weight loss at a low or normal weight, obsessive exercise, progressive food restriction, depression, and falling grades at school or poor work productivity should raise suspicion.
The medical diagnosis of anorexia nervosa is made when the person's weight has dropped to at least 15% below the minimum normal weight for their age and height due to a pathological fear of obesity. Blood tests reveal abnormalities in hormone levels that help confirm the diagnosis for both anorexia and bulimia. However, there is no test that is diagnostic and the diagnosis of anorexia is made by clinical assessment.
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Treatment and Prevention
People with anorexia rarely seek or want treatment, since they usually don't acknowledge or admit they have a problem. It's often left to family members and friends to recognize the eating disorder and to urge them to get treatment.
Anorexia doesn't get better without treatment. People with anorexia need medical and professional help to get better. The biggest obstacle to treating anorexia is the person's unwillingness to undergo treatment.
The primary goal of therapy is to get the person to eat again and gain weight. In general, people with anorexia don't consider their behavior to be abnormal or unhealthy, so it's very difficult to convince them that they have a serious problem and to get them to eat normally. If the condition is severe to the point of emaciation, hospitalization is usually necessary.
Counseling for both the individual and the family is commonly part of a treatment plan. This involves cognitive behavioral therapy, where patients are counseled about body image issues, weight management, normal eating habits, nutrition, and the effects of starvation. Drug therapy with medications such as antidepressants is only useful for associated problems such as depression, anxiety, or obsessive-compulsive disorder (OCD). About 70% of people who receive therapy in a timely manner will make a full recovery. But in some cases, anorexia becomes a lifelong problem and may require long-term counseling and management.
People with bulimia usually want and seek treatment, since they recognize their eating disorder is abnormal and is harmful to their health and happiness.
People with bulimia rarely require hospitalization. They're usually treated with a combination of cognitive-behavioral therapy and medications. Antidepressants are often prescribed, which may reduce food craving and binge-eating episodes. Psychotherapy is used to create awareness and to educate about eating patterns and behaviors, as well as to deal with distorted thoughts about body image and weight. Group and family therapy are commonly used to manage bulimia and are quite effective. As with anorexia, many people with bulimia who get early and prompt treatment will have a full recovery and suffer minimal long-term ill effects.
Paul Ballas, DO, Attending Psychiatrist, Friends Hospital, Philadelphia PA. Review provided by VeriMed Healthcare Network.