What is Anorexia Nervosa?
Anorexia nervosa, or simply anorexia, is a psychiatric and physical illness in which the sufferer basically starves herself. Clinically, a person is anorexic if she has 85 percent or less of the normal body weight for someone of her age and height, yet continues to fast or diet. An estimated 1-2 percent of teenage girls and women in their twenties have the disease. It’s a serious condition that can cause grave health problems if untreated: one in 10 cases of anorexia end in death. Although the disorder is less common in men (who make up about 5 percent of all cases), they too can develop it.

Most of us have heard at least one story of an emaciated teenage girl who starves herself because she’s convinced she’s fat. But despite anorexia’s TV-talk-show familiarity, misconceptions about itabound. As a result, many sufferers can often go months or even years before someone notices that they’re sick and steers them toward help. The nature of the disease is such that an anorexic person can almost never bring herself to consciously acknowledge that she’s ill. This is why it’s important for family, friends, and healthcare providers to be aware of the symptoms and offer aid.

Experts have identified two different kinds that are equally common; in fact, people often alternate between them. They’re the restricting type, in which someone severely limits her food intake, and the binge-eating or purging type, in which she eats a lot of food and later vomits or uses a laxative to get rid of it. The second kind is very similar to bulimia nervosa, an eating disorder that’s closely related to anorexia.

Causes
Although no one knows exactly why some people develop eating disorders, research indicates that it’s probably due to a combination of several factors. These include certain personality traits (among other things, anorexics tend to be perfectionists and to have low self-esteem) and the nature of the family and home environment (they frequently come from families that place a lot of emphasis on looks, demand perfection, or don’t allow the expression of negative feelings like anger in the home). Societal forces, including the enormous pressure on women to be thin or even underweight, are also thought to play a role.

Often anorexia gets started when a teenager or young woman goes on a normal diet to lose a little weight. Spurred on by the compliments she gets, she may become obsessed with dieting. She may think to herself, “If losing a little weight is good, losing a lot must be great.”

Even though they might appear to be outgoing and happy, people with anorexia typically have low self-esteem. It’s this that drives them to struggle toward perfection. They may feel powerless and unable to control their own lives, often because of family dynamics. A young person who doesn’t have some control over her life, is discouraged from expressing anger or sadness, doesn’t have the chance to set normal interpersonal boundaries, and is exposed to unrealistically high expectations, is an environment that may contribute to the development of an eating disorder. She might find that denying herself food becomes an expression of power and control, and in many cases she believes that the “perfect body” will bring the perfect life.

Some people with anorexia suffered sexual, physical or emotional abuse as children. Recent studies suggest, however, that anorexics are not more likely to have been abused than other women who suffer from depression or anxiety.

It can take many different forms. The description below lists psychological and physical traits that are common among girls and women with anorexia, but someone you love who doesn’t fit the profile could still be suffering from this or another type of eating disorder.

The typical anorexic is a middle-class-teenager around 15-years-old, intelligent, perfectionistic, and a very high achiever. She’s usually thin but obsessed with her weight anyway. She may exercise compulsively. Although she often refuses food, she thinks about it all the time, counting calories and fat grams and studying diets. She may lie about what she eats by hiding uneaten food or telling her family that she’s already had lunch. If confronted, she’ll deny that she’s sick.

Symptoms
One of the things that make it hard to recognise anorexia nervosa is that a person who has it will go to great lengths to keep her family and friends from realising that she’s sick. She herself doesn’t think she is, but she knows on some level that her behaviour would be disapproved of. She may lie about her food intake and wear baggy clothes to hide her shrinking body.

Despite these difficulties, it’s important that an eating disorder be diagnosed as soon as possible. An illness like anorexia can cause serious health problems and even death. It’s also harder to cure the longer someone has it.

Here are the typical symptoms of anorexia nervosa…

• Marked weight loss
• Amenorrhoea, or the loss of menstrual periods
• Fear of getting fat, even when underweight
• Denial of hunger, accompanied by an obsession with counting calories or studying cookbooks
• Excessive exercise
• Frequent weighing
• Distorted body image
• Hyperactivity
• Constipation
• Dry, sallow (yellowish) skin
• Cold hands and feet
• Fatigue or chronic insomnia
• Loss of sexual desire
• Thinning hair
• The growth of fine body hair, especially on the arms and legs
• Fainting spells
• About half of all anorexics also binge and purge (usually by vomiting after meals or misusing laxatives)

Treatment
Confronting the person is likely to be tricky, because she almost certainly won’t acknowledge that she’s sick. It must be done, however, and the sooner the better. First, say experts, learn everything you can about the disease. Then pick a good time to talk, preferably when the two of you are alone and there are no distractions. As non-judgementally as you can, tell her that you’re concerned about her and want her to get help. It’s a good idea to cite specific examples of behaviour that illustrate your point; for instance, you might say, “I’ve noticed that you’ve lost a lot of weight and seem to be preoccupied with dieting.”

Be aware that she may react angrily and deny that she has a problem. She’ll most likely feel embarrassed and humiliated at realising that someone is onto her secret. Keep that in mind, and be careful to avoid getting into an argument with her. Don’t try to cure this illness yourself; if your loved one has anorexia, she needs professional help.

If you’re a friend or relative and the person you suspect of being anorexic has denied it, stay supportive and make it clear that you’re still concerned about her. If you think she’s in danger, consider contacting her family.

Avoid making any comments, positive or negative, about losing or gaining weight; they could have the effect of reinforcing her anorexia. This is a dangerous and complex illness, so don’t try to make her eat or attempt to solve her problem for her. If you see any signs of physical deterioration, get her professional help as soon as possible.

Lastly, don’t forget to take care of yourself. Anorexia is hard on family members and friends, too.

Clinically, you must be 15 percent below your normal weight and must have amenorrhoea (a condition in which your periods stop or are erratic) to be diagnosed as anorexic. (You don’t have to meet these criteria in order to get help for the disorder, though)

The semi-starvation that may result from the disease can damage most organ systems. It may cause anaemia, kidney dysfunction, cardiovascular problems, changes in brain structure, hormonal disturbances, amenorrhoea and osteoporosis (bone weakness due to lack of calcium). The mortality rate among people with eating disorders (including bulimia nervosa) may be as high as 10 to 15 percent. That includes deaths from related heart attacks and intestinal haemorrhaging, as well as suicide.