Diagnosis

The DSM-IV requires the following criteria to diagnose Anorexia Nervosa:

• refusal to maintain body weight at or above a minimally normal weight (a body weight of less than 85% of that expected)
• having an intense fear of gaining weight, while actually being underweight
• faulty self-evaluation of one’s own body weight or shape, or denial of the seriousness of current body weight status
• absence of three consecutive menstrual cycles

Anorexia Nervosa has two subtypes: the restricting type and the binge-eating-purging type. Anorectics of the first type continuously and strictly limit their intake of calories, while those of the second type follow the calorie limiting regimen most of the time but they occasionally binge on small amounts of food, followed by consistent purging.

Epidemiology

Ninety to ninety-five percent of persons suffering from the disorder are female. In fact, the typical individual with Anorexia Nervosa, if there is such a thing, is female, teenaged, white, middle-to-upper class, a perfectionist, and introverted, sometimes described as a “model child.” Anorexia most frequently originates during adolescence (13 to 18 years old), with 75% of cases beginning in that stage. An anorectic generally fears losing control and has a distorted perception of how she looks.

Etiology

There are two main categories of theories regarding origins of the disease: psychosocial and biological theories. The three psychosocial theories are 1) biopsychosocial, based on the ideal of thinness and the patient’s obsession with it; 2) psychodynamic, focusing on the dependence vs. independence conflict that might have been operating in her life; and 3) family theory, involving some form of dysfunction within the nuclear family. Biological theories are 1) genetic, in which there is an inherited tendency toward depression and other mood disorders, and 2) biochemical and anatomical, involving endocrine abnormalities.

Treatment

Appearance and achievement aside, Anorexia is a life-threatening disease with potentially serious medical complications and a mortality rate of approximately 5%. Nearly half of those diagnosed with anorexia nervosa, however, do recover and almost a third improve, but effective treatment is crucial to the patient’s recovery and even her survival. It is also very challenging for doctors, clinicians, and family, because the anorectic usually does not want to be helped, refuses treatment, and may resist anyone trying to provide medical assistance or therapy.

The main goal in any treatment plan is to keep the anorexia patient alive, and, since they can be difficult to manage when in treatment, hospitalization is many times necessary and, with critical cases, it is always required.  Strategic steps in the process are 1) to get the patient to bring her weight up to a normal level and 2) to introduce cognitive behavioral therapy. Family therapy is usually recommended as well, once the patient is out of danger, as is individual and/or group therapy. The patient may also need medication, especially for depression.