Anorexia nervosa (an-o-REK-see-a ner-VO-sa), commonly referred to as anorexia, is an eating disorder involving excessive dieting; preoccupation with food; distorted body image; fear of getting fat; and rapid, significant weight loss. The disorder primarily affects young women.
Wendy had taken ballet classes since she was five. For as long as she could remember, her dream was to dance professionally after she graduated from high school. When Wendy was 13, her ballet company planned a performance of Swan Lake, and Wendy hoped to be chosen for the lead part.
But at that time, Wendy was also going through puberty * . She noticed that her hips and thighs were getting rounder. Constantly in front of the mirror in the dance studio, Wendy could not help seeing every new curve of her body, and she felt self-conscious about how her developing breasts looked in her leotard. She became very worried about gaining weight. What if she got too heavy for her dance partner to lift? With tryouts for the spring ballet fast approaching, Wendy feared a smaller dancer would be chosen for the lead instead of her. She began longing for the body she had at the age of 11 years: tiny and light, like the perfect ballerina she dreamt of being.
For a month, Wendy was on a crash diet, keeping a strict record of everything she ate. She weighed herself morning and night. When there was time, she jogged after dance class. She was relieved to have lost some weight and wanted to lose more. She allowed herself only the tiniest portions of food and started to skip lunch altogether. Pleased with her weight loss, Wendy decided to cut back to just a small salad for dinner and maybe just a yogurt for breakfast.
No one sets out to have anorexia. It takes hold slowly and might start with a simple desire to lose a few pounds. However, in fully developed cases, people with anorexia are malnourished, often depressed, obsessed with food or exercise, and are still convinced that they are fat.
People with anorexia refuse to eat enough food to maintain normal healthy body weight. Because they fear becoming fat, people with anorexia use extreme dieting to lose a lot of weight rapidly. They also may exercise excessively to burn off calories. People with anorexia lose at least 15 to 20 percent of their normal body weight. For example, a girl who starts out at 130 pounds might drop to 100 pounds. Anorexia involves a distorted awareness of the body. People with this condition become preoccupied with thinness, and may continue to believe that they are fat even though others see them as unnaturally thin. Over time, the weight that people with anorexia want so desperately to control becomes frighteningly out of control for them.
Anorexia is much more common among girls and women (90 to 95 percent of cases), but boys can have it too. It has been estimated that between 1 and 4 of 100 young women in the United States have anorexia nervosa and that a considerably higher number have less severe eating disorder symptoms. The disorder usually begins during adolescence. Girls who participate in activities that value thinness, such as dance, gymnastics, or figure skating, are at higher risk than others of developing anorexia.
No single factor causes anorexia. Emotional problems, family difficulties, social pressure, and biological variability all play a role. Widespread glamorization of thinness in fashion magazines and among Hollywood stars influences many girls to diet excessively. Once started, some extreme dieting practices can be hard to stop. Girls who have a high need for perfection and control may see dieting as a way to be the prettiest, thinnest, and most perfect person among their peers; to live up to their parents' expectations for perfection; or to look like fashion models or movie stars they admire. A girl who feels controlled by others and longs for independence may use control of eating as a way to assert herself. In other cases, anorexia may develop because of pressure to be extra-thin when certain sports or activities demand it.
Anorexia can cause a number of serious medical problems, such as disturbed heart rhythms and vitamin and mineral deficiencies that can harm vital organs. With anorexia, the body is literally starving. Bone and muscle begin to waste away. Blood pressure and body temperature drop because the body cannot maintain proper levels. Hair, nails, and skin become dry and brittle. Girls with anorexia often stop menstruating * , and overall body growth and development can begin to slow down. Without treatment, anorexia can cause irreversible damage to the body. It can lead to heart failure * and sometimes death. Yet some research suggests that as few as 10 percent of those needing it receive treatment for their eating disorder.
Help is available for people with anorexia, but they need to be convinced that they need it. Family members or friends may ask about the weight loss. A girl with anorexia may be ashamed or self-conscious and may say she does not have a problem. Many girls with anorexia resist getting help because they do not want to gain weight. Seeking help sooner, rather than later, can be life-saving, but the distorted body image that is part of anorexia can make it hard for people with the condition to realize how dangerously thin they are.
Treatment for anorexia typically includes several stages and a few different health professionals. Treatment may begin with a medical visit to evaluate nutritional status and overall health. The doctor may ask about weight loss, order blood tests, and ask about the patient's eating habits and beliefs about her body. Nutritional counseling helps with planning and following a healthful diet. Individual psychotherapy allows the person to talk about feelings and problems that led up to the anorexia, come up with new solutions, and work on body image. Group therapy brings together people with similar concerns to share their experiences and receive support. Medications are sometimes used to reduce anxiety * * . Individuals with anorexia who are in a severe health crisis may have to be hospitalized in order for their condition to be stabilized. They may need to receive adequate nourishment before other aspects of treatment can begin.
See also Anxiety and Anxiety Disorders: Overview • Body Image • Bulimia Nervosa and Binge Eating Disorder • Eating Disorders: Overview • Menstruation and Menstrual Disorders
Arnold, Carrie. Decoding Anorexia: How Breakthroughs in Science Offer Hope for Eating Disorders. London: Routledge, 2012.
Poppink, Joanna. Healing Your Hungry Heart: Recovering From Your Eating Disorder. Newburyport, MA: Conari Press, 2011.
Treasure, Janet, and June Alexander. Anorexia Nervosa: A Recovery Guide for Sufferers, Families and Friends. 2nd ed. London: Routledge, 2013.
HealthyWomen. “Eating Disorders.” http://www.healthywomen.org/condition/eating-disorders (accessed June 16, 2015).
National Association of Anorexia Nervosa and Associated Disorders. PO Box 7, Highland Park, IL 60035. Telephone: 847-831-3438. Website: http://www.anad.org (accessed June 16, 2015).
National Eating Disorders Association. 603 Stewart St., Suite 803, Seattle, WA 98101. Toll-free: 800-931-2237. Website: https://www.nationaleatingdisorders.org (accessed June 16, 2015).
* puberty (PU-ber-tee) is the period during which sexual maturity is attained.
* menstruation (men-stroo-AY-shun) is the discharge of the blood-enriched lining of the uterus. Menstruation normally occurs in females who are physically mature enough to bear children. Most girls have their first period between the age of 9 and 16. Menstruation ceases during pregnancy and after menopause. Because it usually occurs at about four-week intervals, it is often called the monthly period.
* heart failure is a medical term used to describe a condition in which a damaged heart cannot pump enough blood to meet the oxygen and nutrient demands of the body. People with heart failure may find it hard to exercise due to the insufficient blood flow, but many people live a long time with heart failure.
* anxiety (ang-ZY-e-tee) can be experienced as a troubled feeling, a sense of dread, fear of the future, or distress over a possible threat to a person's physical or mental well-being.
* depression (de-PRESH-un) is a mental health state characterized by feelings of sadness, despair, and discouragement.