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Anorexia Nervosa

by Dr. Eva Bell
(Bangalore)

The Beauty Cult has taken the world by storm. Today Youth and Beauty are paramount. Media projections of ‘Slim is beautiful’ and ‘Slim is a recipe for health, success and happiness’ is making a tremendous impact on young minds. Teenagers and adolescents go to extremes to look good. Youngsters want to be models or film stars. Dieting to control weight gain sometimes progresses to an eating disorder called Anorexia Nervosa. According to the US National Institute of Mental Health, about 0.5% to 3.1% suffer from this disorder sometime in their lives. These are usually dancers, models, actors or athletes.

But when teenagers become obsessed with dieting, there is cause for concern. Almost 98% of those suffering from anorexia are females. They belong to middle and upper socioeconomic groups. Some metrosexual males have also begun to show signs of anorexia. A few cases have been reported in pre-teens and also in ambitious, professional adults.

What is Anorexia?

It is an eating disorder where a person restricts food intake. Gradually the appetite decreases until there is a total loss of appetite. Initially the person may take pills to kill the appetite or may exercise vigorously. Weight loss gives a sense of control over the body. The person develops an intense fear of getting fat even though she is underweight. She is in denial and refuses to accept that she has a problem.

Why Anorexia?

Not everyone who slims is an anorexic. A genetic component has been blamed for this disposition.

Emotional disturbance from various causes may trigger the illness.
1. Imagined tendency to get fat or a desire to look beautiful, or a belief that thinness enhances sexual activity.
2. A poor self image.
3. A love affair gone awry.
4. High expectations from parents.

Imbalance in the neurotransmitters of the brain.
Dysfunction of the hypothalamus which regulates metabolism, may be some of the causes which lead to anorexia. The person feels that being thin is to be in control of herself, and is a solution to the problems at home, school or in the workplace.

Signs:
• The person is grossly underweight
• She may be irritable, depressed and withdrawn. In the early stages, physical and mental activity is normal. But as the illness progresses, lethargy and weakness set in.
• Abdominal discomfort. The person may induce vomiting to get relief.
• Constipation.
• Amenorrhea (Stoppage of periods) She feels that when she starts to menstruate, the body develops feminine characteristics and she will lose control over her body. Starvation is a way of regaining control by turning back the clock to pre-puberty state.
• Food phobia. The person has an appetite but ignores it. In many cases there is a great interest in recipes, menus and photographs of delicious dishes. But there is no interest in sampling the food.

Side Effects:
1. Almost every system in the body is affected. Blood pressure falls, pulse becomes slow, extremities feel cold.
2. Gradually there is a loss of bone density. Normally adolescence is the time when bone density rises by 40-60%. But in anorexia, bones may become weak and fracture easily.
3. Electrolyte imbalance, potassium deficiency and tendency to develop Diabetes Insipidus.
4. Anaemia.
5. Skin acquires a yellowish tinge. There is a downy hair growth on limbs.
6. Cholesterol rises.
7. Erosion of dental enamel leading to breaking of teeth.
If treatment is not given, these symptoms may progress and the person may succumb to complications.

Management:
Hospitalization is important. The person must be removed from home surroundings.
Nutrition: Correction of malnutrition through regular meals and supplements of vitamins, minerals and zinc is necessary. Unless there is weight gain, there can be no improvement in strength. The aim is to achieve a weight gain of one to one and half kilo per week, until she reaches normal weight. Appetite will gradually return. However, all meals should be under supervision, as the person may pretend to eat and throw away the food slyly.

Counseling: This is a long process and should be undertaken by a trained counselor with a lot of patience. The person must understand the reason for her rejection of food and her need to change. When personal problems are solved, the recovery is quicker. But until she begins to eat and is improving, the psychological origin of the problem should not be discussed. Recovery depends on her eating regularly and subsequent weight gain.

Less physical activity until strength returns.

Social Activity: She is encouraged to meet friends and well wishers.

Hypnotherapy: In certain cases, hypnotherapy helps. Post hypnotic suggestion of a positive feeling towards food in place of revulsion, will be therapeutic.

Hobbies: Art, music, or dance provide a good outlet for pent up feelings.
Medication when necessary but only under doctor’s advice.
Management of Anorexia must be the combined effort of doctors, dieticians and psychologists. There must be good support from the family. Recovery is a slow process and cannot be rushed, as this might cause a relapse.
Post hospital stay, counseling must be continued until the person is on a full diet and is able to perform her normal duties.

BULIMIA NERVOSA is another eating disorder, where the person is a secret, compulsive eater. Famous women like Princess Diana, Marilyn Monroe and several other actresses have been known to suffer from this illness. It has a psychological basis like anorexia. 45% of anorexics may be bulimic. Binge eating may be triggered by stress or depression. Most people who suffer from Bulimia have other compulsions. They may be addicted to drugs, alcohol, gambling or shopaholism or may be exercise freaks. Studies have shown that 40% of bulimics have alcohol or drug related problems. 10% of bulimics are men.
The subjects gorge on food when no one is around. Eating gives them a euphoric feeling, which makes them forget their problems temporarily. After eating, the stomach bloats. So they induce vomiting or take an enema or a diuretic, and hope to retain their slim figures.
Treatment is on the same lines as for anorexia. There must also be a total prohibition of laxatives and enemas, and snacking in between meals.