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Anorexia nervosa is an eating disorder that occurs when an individual is unrealistically concerned about being overweight or feels an overwhelming need to be so thin that in either case she/he eats so little she/he becomes malnourished. Anorexia nervosa is an illness with both physical and psychological components. Its victims can literally starve themselves to death. Others may suffer from cardiac arrest as a result of malnutrition, while still others commit suicide.

The cause of anorexia nervosa is not clear. It appears to result from a number of different psychological, social, and biological factors acting together. However, so far no biological factor has been identified as causative, and the physical abnormalities found in people (mostly girls) with anorexia nervosa are the result of malnutrition.

Factors that increase the risk of anorexia nervosa include concerns of identity and separation from parents and home. There may be a parental history of depression or alcohol abuse, anorexia may be present in siblings, or the family may magnify the cultural emphasis on weight, eating, and fitness. Excessive family expectations and cultural pressure for high performance may also contribute to the cause.

What are the Symptoms of Anorexia Nervosa?
Severe weight loss and refusal to maintain a healthy weight is present. Severe restriction of food, and obsession with food (preparation, calorie counting, etc.) may be present, as may be a rigid schedule of obsessive exercise, even when in physical pain. In women, amenorrhea (loss of monthly menstrual cycle) due to insufficient body fat may occur, which can lead to loss of calcium from bone, and eventual osteoporosis. Dry skin, brittle hair and fingernails, and the development of a layer of soft downy hair called “Lanugo” on face, back, and arms may become evident. Constipation, anemia, swollen joints, and muscle atrophy may occur. As the anorexia becomes more severe, individuals can experience lethargy, insomnia, increased feelings of worthlessness and hopelessness, and other symptoms of depression. Breathing, pulse, and blood pressure rates fall.

How is it diagnosed?
Both physical and psychological factors are considered in arriving at a diagnosis of anorexia nervosa. These include a refusal to maintain body weight over a minimal normal weight range for age and height, e.g., weight loss leading to maintenance of body weight 15 per cent below that expected. An intense fear of gaining weight or becoming fat, and a distortion in the way in which the patient’s body weight, size, or shape is experienced is evident. And, in women, the absence of three consecutive menstrual cycles when otherwise expected to occur.

How is anorexia nervosa treated?
A variety of treatment approaches are being used nowadays, alone or in combination, and no one treatment plan fits every individual. Simply restoring a person to normal weight is not enough. Being able to eat without obsessing about food, weight, and appearance is the ultimate goal of treatment. Behavior modification and individual, group, and family psychotherapies may be employed alone or in combination. Support groups and self–help groups are often helpful. Medications are sometimes useful for the symptomatic relief of depression or anxiety, but they have little effect on the basic processes underlying anorexia.

How can I help a friend with anorexia nervosa?
Watching someone you care about slowly kill themselves can be horrifying. You may get angry with them or may be too frightened and confused to do anything. The first and most important step you can take is to educate yourself about anorexia. If you decide to talk to your friend alone, do approach your friend gently, but persistently. Focus on the reason why he/she could benefit from help. Be supportive, and give non–judgmental feedback based on observations about her/his eating habits and weight. Don’t feel obligated to keep your friend’s “Secret” when his/her health and thinking are impaired. Don’t be deceived by your friend’s denial of the problem. Don’t change your own eating habits when your friend is around, but do cooperate with your friend’s requests regarding availability of certain “Problem” foods. Remember that professional help is available for your friend, as well as support for you. Finally, don’t expect your friend’s behavior to change quickly. Recovery from eating disorders can be a lengthy process.

How can I take care of myself if I have anorexia?
If you’ve been having this problem, we urge you to seek help. A few people can change their eating disorders all by themselves and never have relapses, but for the majority, the problem is too big to fix themselves. You deserve to be happy and healthy. You are not alone and you do not have to live like this forever. Join a support group, it’s a good way to be around other people who understand what you are going through. See a health care provider on a regular basis, and a nutritionist to educate yourself on eating for a healthy life. Get your rest, exercise in moderation, and balance work with recreation and social activities.

What can be done to help prevent anorexia nervosa?
Challenge cultural attitudes and values which promote the development of eating disorders. Explore your own values about body, image, self–worth, and self–acceptance. Advocate the importance of self esteem based on inner beauty and personal strengths, rather than on appearance or weight. Promote attitudes and behaviors towards food, body image, and exercise that encourage psychological and physical health. Work to eliminate what the Eating Disorders Awareness and Prevention Organization calls the 3 Ds: Body Dissatisfaction, Dieting Behavior, and Drive for Thinness. Become aware of your own internal judgment about others bodies and work to change it. Accept yourself for who you are, not how you look. Don’t “Weigh” your self–esteem.