Anorexia nervosa is a life threatening eating disorder defined by a refusal to maintain fifteen percent of a normal body weight through self-starvation (NAMI 1). Ninety-five percent of anorexics are women between the ages of twelve and eighteen, however, in the past twenty years, this disorder has become a growing threat to high school and college students(Maloney and Kranz 60). Anorexia produces a multitude of symptoms, and if not treated, anorexia can lead to permanent physical damage or death.
Anorexic behavior is complex because it is all about the need for control. Someone suffering from anorexia has a distorted body image of himself or herself. He/she believes to be overweight, even though twenty percent of the time he/she is not (Yancey 59). The image of being overweight causes a low self-esteem. Symptoms of low self-esteem are loneliness, inadequacy in talents, a lack of trust in people and themselves, insecurity, identification with a specific peer group, and sadness. The media displays the ideal human body as thin and beautiful. Anorexics lives are full of confusion and lack of control. To the anorexic, to be thin is to be in control. The state of control to the anorexic is the ideal life without confusion and difficulties. In most cases, the anorexic is intelligent; popular among his/her peers, athletic, talented, and viewed as a role model to most people he/she comes in contact with. In reality, the issues in daily living are too difficult for the anorexic resulting in a lack of control in his/her life. The anorexics answer to a confusing life is to starve the body. The behavioral symptoms of the anorexia are counting calories, eating little food, baking treats for everyone and giving them away in hope of controlling not only the anorexics intake of his/her food, but also others. Playing with food at meal times is common behavior of the anorexic. When the meal is complete, the anorexic has disguised food intake by pushing the food around on the plate and hiding food in napkins. To dress in layers to hide the distinct weight loss and to avoid social activities where eating is involved are common behavioral symptoms. Behavioral symptoms of the anorexic can go unnoticed by most people. These symptoms are very secretive and oblivious to outsiders because the behavior is not out of the ordinary. Although the behavioral symptoms of the anorexic appear to be ordinary, the sum of the behaviors is dangerous because it leads to physical and psychological symptoms that are life threatening.
Severe symptoms of anorexia are classified as such because they result in devastating physical side effects and death. The dropping of body fat due to self-starvation can cause amenorrhea, an absence of the menstrual cycle. Amenorrhea can put stress on tiny bones that result in breakage if untreated and can interfere with fertility as well as estrogen, the reproductive hormone that protects the body against heart diseases and osteoporosis. The absence of the menstrual cycle from starvation can cause loss of bone density. Osteomalacia, the outcome of poor nutrition in anorexia, causes breakage of bones, and the lack of calcium intake to the body results in brittle bones. Kidneys will shut down if the body weight becomes low enough. The anorexic will go into kidney failure and die. Kidney failure is also caused by dehydration because inadequate fluid flowing to the kidneys can lead to cardiac arrhythmia. A normal heartbeat is also essential to the human body. A change in the normal pattern of the heartbeat may be a complication of an electrolyte imbalance produced from anorexia. The principal reason for potassium loss and an irregular heartbeat is an electrolyte imbalance. As a result of potassium deficiency, it is common to have muscle spasms, muscle atrophy, and pain. Muscle spasms and muscle atrophy are typical symptoms of a musculoskeletal problem, and if not treated, permanent damage can occur. Other severe physical symptoms that may be permanent are the judgment of the brain. The neurotransmitters of the brain can be altered, leaving the perception affected. Hypothermia can occur due to the loss of fat tissue from starvation. An anorexic suffering from hypothermia has a slow reaction time, is clumsy, lethargic, has blurred thinking, and hallucinations. The severe symptoms of hypothermia can produce the anorexic to wander off, fall down or die. Malnutrition can affect the brain and the central nervous system by slowing down the anorexics thinking process and making the anorexic delirious and forgetful. If this malnutrition continues and is not treated with proper nutrition, the malnutrition can lead to permanent brain damage. In the bodys reaction to the lowered intake of calories, the bodys heart rate, blood pressure, and body temperature drops. This is the only attempt the body can make to survive in response to the starvation of an anorexic body. There is a direct correlation to the severe physical symptoms in the anorexic and the psychological changes that follows.
Psychological symptoms in the anorexic can lead to depression. Depression in anorexia far exceeds the feelings of every day sadness or grief. The healthy body can recover in a short time whereas the anorexic body cannot. The anorexic suffers from guilt and shame. Even though the anorexic may have lost fifteen percent of his/her body weight and is emaciated, the anorexic continues to feel shameful about the state of being overweight (NAMI 1). Guilt from consuming any food is a result of a loss of control to the anorexic. The anorexic loses hope from his/her sense of failure to control his/her eating. Obsessive thoughts and preoccupation with the anorexics unhealthy physical state and obsessive rituals of the eating pattern occurs because he/she is in a vicious cycle of lack of control in his/her life. This lack of control in the anorexic exacerbates the alienation and loneliness already present. Motivated by the belief that the anorexic is not worthy of friendships with certain peers, the anorexic is consumed by food. The fear of discovering that he/she is anorexic is terrifying. This terror of discovery produces social anxiety and sometimes nervous breakdowns. The depression resulting from the anorexics psychological symptoms can lead to suicide. In cases of depressed anorexics the lack of control to overcome the state of control of self-starvation produces the feelings of failure and desperation and often leads to suicide. Treatment for the anorexic is a long-term process that includes psychotherapy. Treatment must begin with an evaluation of the anorexic patient. Here the evaluator must learn as much information about the anorexic patient by exploring the family history, health status, and how the anorexic perceives himself/herself and the anorexic patients lifestyle. Establishing a treatment plan designed for the specific individual anorexic patient is important for success. Initially, antidepressant medication can help in treating the anorexic because treating the state of depression is essential to the psychotherapy. Psychotherapy helps with the underlying emotional issues in the anorexics mind. Cognitive, interpersonal, nutritional, and behavioral therapy are all parts of psychotherapy.
Cognitive therapy helps the psychotherapists learn how the anorexic patient thinks and feels involving self- analization of the anorexic to understand the reason he/she has developed anorexia nervosa. Through cognitive therapy, the anorexic patient can realize how the anorexic behavior is distorted and negative. The therapist can teach the patient to substitute positive and realistic solutions for the negative and unrealistic. Anorexics learn to build self-esteem by focusing on his/her strengths while in an atmosphere where food is absent.
Interpersonal therapy success is based on improving the socialization of the anorexic. In interpersonal therapy, the psychotherapist teaches the anorexic patient how to resolve harmful relationships. New coping skills with mood disorders such as loss of control is attained by suggesting to the anorexic patient a better plan to improve the existing lifestyle and socialization. It is imperative that the psychotherapist is non-judgmental. This entails hours of listening from the psychotherapist.
Nutritional therapy is necessary to aid in the anorexics distorted attitudes toward food and eating. The nutritional therapist teaches and introduces the anorexic patient to food by working on defining what foods are healthy and replacing the self-taught unhealthy eating habits with a healthy way of eating.
Behavioral therapy focuses on changing the negative behavior of the anorexic by teaching the patient how to cope with the stress and thoughts that coincide with anorexia nervosa. Writing letters, exercising, reading, and establishing new friendships are encouraged when the anorexics mood rises to an unhealthy level.
Voluntary self-starvation, anorexia nervosa, is physically and psychologically dangerous. Loss of the body fat from the severe weight loss can impair the body by putting stress on the bones from lack of calcium. Dehydration can be deadly because the body needs the correct water balance, and without this proper balance, the kidneys can shut down. Malnutrition can lead to brain damage. Amenorrhea can cause infertility and put stress on tiny bones making them prone to breakage. Amenorrhea can also produce an interference of the reproductive hormone that protects the body against heart failure and osteoporosis. Severe depression in anorexics occurs from hopelessness and shame and can lead to suicide. Even though the behavioral, nutritional, cognitive, interpersonal, and psychotherapy treatment for anorexia is a long-term process, it is crucial to the anorexic person to receive treatment, or the physical consequences and psychological consequences can lead to permanent damage and sometimes death. Notable research on the treatment of the anorexic continues worldwide.
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