The physical complications of anorexia nervosa
Anorexia nervosa can result in many physical complications. Some of these may be life threatening.
- Low blood pressure which can cause dizziness and fainting spells.
- Underactive thyroid gland.
- Lethargy and cool intolerance.
- Dry skin.
- Brittle hair and nails.
- Joint swelling.
- Menstrual problems.
- Bleeding problem due to fragile blood vessels.
- Electrolyte imbalance due to vomiting or misuse of diuretics. Severe electrolyte imbalance can cause abnormal heart rhythm, leading to death.
- Erosion of the dental enamel by gastric acid as a result of vomiting.
- Tearing and bleeding of the stomach and esophagus (the tube that connects the throat to the stomach) due to self-induced vomiting.
- Osteoporosis due to the lack of calcium.
- Anaemia due to iron deficiency.
Psychiatric conditions associated with anorexia nervosa
- People with anorexia nervosa are usually depressed. They become socially withdrawn, irritable, tired and lose their interest in the usual pleasurable activities. They may suffer from insomnia, feeling of hopelessness, concentration difficulty and short-term memory problem.
- Obsessive-compulsive problems that are either related or not related to food are common among those with anorexia nervosa. For example, some may compulsively collect recipes or hoard food. Others may develop obsessive-compulsive disorders relating to cleaning, counting or checking.
- Overall, about 10% of anorexia nervosa sufferers die from suicide.
The causes of anorexia nervosa
The causes of anorexia nervosa are unclear. However, there are certain factors that are associated with a higher risk of developing the disorder. These are:
Personal factors. People with anorexia nervosa tend to be individuals who are strong-willed and disciplined with a strong need to control. They are tenacious and do not give up easily. The more they perceive that things around them are becoming disorderly, they more they want to exert their control. Puberty, body changes, family stresses and other vicissitudes of life are threatening to these individuals. Consequently, they exert their control by a tight regulation over their food intake and their body weight.
Family factors. People with anorexia nervosa may come from families with intrusive and over controlling parents. Their family culture is one that does not encourage open expression and exploration of feelings. The individual develops anorexia nervosa as a way to combat the parents’ intrusiveness and control.
Social factors. Anorexia nervosa is common in industrialized societies where thinness is extolled. It is common among those who pursue the professions of modeling, acting, dancing and gymnastic where thinness is a symbol of beauty and success.
Treatments of anorexia nervosa
Treatments should be multimodal and focus on a number of areas.
Weight gain to an acceptable level. This can be achieved through sound nutritional advice and proper diet. Once the person has put on the weight, the depressed mood, obsession with food and other negative personality traits also improve.
Family therapy. This is particularly important as the whole family is usually affected by the anorexia nervosa. Initially, the family needs to be educated about the illness. Later, the issues of boundary, control and autonomy can be addressed. Family therapy should also focus on helping the person to maintain the gains made through treatment.
Individual therapy. This is important because the issues of identity, self-esteem, self-worth and self-image can be addressed through this forum. Most people do not benefit much from deep individual therapy until their weights are restored to a more normal level.
Medication. Medication is not very helpful in the treatment of anorexia nervosa. However, medication may be useful if other psychiatric illnesses such as depression and obsessive-compulsive disorders are present.
Stress management. This is particularly helpful once the person has recovered from the anorexia nervosa. Learning to deal with stress will help to reduce the chance of future relapse.
The outcome of people with anorexia nervosa
The short-term outcome is good as up to 90% of the sufferers gain weight. However, the result after five years is not so encouraging. Only 50% of the sufferers continue to maintain their gains whilst the other 50% continue to struggle with their poor eating behaviour and weight loss. Generally, those sufferers who are older than 18 years, lose excessive weight before seeking help, resort to vomiting and purging to lose weight and have severe family problems tend to have a much poorer outcome.
So, the important thing to remember about anorexia nervosa is this:
Anorexia nervosa is not simply a poor eating habit; it is a very serious illness!