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Understanding Anorexia Nervosa
 A
disorder characterized by a distorted body image, an
extreme fear of getting fat, and a rejection of food, with a relentless pursuit
of thinness. To reach an "ideal" weight, a female may
follow increasingly restrictive diets, often accompanied by hours of
aerobics,
weight training, calisthenics, or
running. Food becomes a major
preoccupation. The woman fails to realize there's a problem even as her body
wastes away. Around 30 percent of anorectics have this problem for their whole
lives, and almost that many have at least one life threatening bout. Many die
prematurely, and at least 5-18 percent of those hospitalized with anorexia later
die of starvation or suicide.
The average age of onset for anorexia is 17, and it is rare in women over the
age of 40. It can be triggered by a major stressful event, such as leaving for
college, and progresses differently in different people. It may have a short
course, from which the patient recovers. But anorexia is usually a chronic
illness that comes and goes or worsens over many years.
Ninety percent of anorexia sufferers are women. For every 200
women in the general population, one to six will be affected by
anorexia. Five to 18 percent of these affected women will die from
this disorder.
It is the leading cause of death among people seeking psychiatric
help.
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Symptoms
The symptoms of malnutrition that accompany anorexia include constipation,
digestive discomfort, and bloating; dehydration, muscle cramps, and tremors;
downy body hair on the face, back, or arms; flattened breasts; dull, brittle,
thinning hair; cracked or dry skin;
icy hands and feet; irregular heartbeat; and depression
and anxiety.
What to Do
 Treatment
of anorexia must focus on more than weight gain. In fact, weight gain should be
secondary to the more serious underlying issues facing the anorexic. For those
women whose weight loss has become so severe or has seriously impaired other
body systems, hospitalization may be necessary.
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Work with a specialist- Treatment of eating disorders with
medication requires the guidance and monitoring of a psychiatrist or other
health care professional who has specialized training in the treatment of
eating disorders.
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 Consume
more calories- Increasing the patient's weight by closely monitoring the
patient's fluid and food intake. Their weight are
monitored daily, and caloric intake is gradually increased. For standard
weight gain the diet will be of around 3000 calories per day. The weight
gain will normally be controlled to between 1.0 and 1.5 kilos per week. In
the first week or two the weight gain may
exceed this because of physiological changes, mainly of fluid balance. After
this period any weight gain above 1.5 kilos per week will be controlled by a
reduction in dietary intake.
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 Identify
and avoid food allergies - Skin prick testing or blood (RAST) allergy
testing can help confirm or exclude potential triggers. These include
carefully reading the labels of foods in supermarkets for terms indicating
the presence of allergen. Eating away from home poses some risks. It is
often wise to inform your host or restaurant chef about your allergy and the
importance of avoiding contamination of your meal with allergen.
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Learn about celiac disease (problem with gluten sensitivity), which
can worsen anorexia; have your AGA antibodies tested. If elevated, eliminate
gluten foods - When people with
 celiac
disease consume gluten, the absorptive villi in the small intestine are
damaged, preventing the absorption of many important nutrients. The
long-term effect of untreated celiac disease can be life threatening.
However, with a completely gluten-free diet, the intestinal lining will heal
completely allowing most patients to live a normal, healthy life as long as
they remain free of gluten in their diet. Plain rice of all types (including
wild rice), tapioca, potatoes, corn, and legumes are safe for a gluten-free
diet. Most celiac patients can also tolerate soy products, except soy sauce
which is usually fermented with wheat.
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 Enjoy
some mild exercise every day - Anorexic patients will not be allowed to
exercise in the early part of their stay partly
to facilitate weight gain and partly because it may be damaging while they
are at low weight. Short walks accompanied by a nurse or close friend will
be allowed fairly early on and supervised exercise to establish a normal
pattern will be started later in treatment. Especially beneficial are
modalities such as weight lifting,
walking, and
stationary cycling.
These can be easily structured to start with lighter workloads and slowly
progress to higher ones. This conditions the clients' bone density and lean
tissue to progress accordingly. Building and maintaining muscle and bone
mass requires weight-bearing exercise. Individual requirements vary
depending on age and level of fitness.
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 Have
regular massage therapy- Once a regular eating pattern is established
and weight is beginning to return within a normal healthy range, the
underlying feelings will begin to emerge. The sessions include using a range
of specific techniques to explore and challenge automatic responses.
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Do anything that builds self-esteem- According to some experts,
anorexia nervosa is caused
 by
feelings of self-hatred and unworthiness. Not eating is supposed to be
self-inflicted punishment. Purging is seen as relieving oneself of inner
negative feelings. This type of logic is often associated with low
self-esteem and feelings of guilt seen in victims of abuse.
Building self esteem involves clearing
out the junk-This means anything hurtful and unconstructive that you’ve been
told by someone you care(d) about (or even some you didn’t) is to be taken
with a grain of salt. Then begin with counting your blessings, which can
include things people actually take for granted, such as food and shelter,
access to a computer, etc. Also, surround yourself with positive people
(think of volunteer or professional organizations that have something in
common with your interests, for example).
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 Eat
breakfast- Eat nutritionally rich breakfast
everyday. Nutritionists believe breakfast is the most important meal,
providing needed energy throughout the day.
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Eat slowly and chew well. Have small meals.
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Have your doctor run amino acid screens. Persistent dieting can
deplete tryptophan, which may encourage relapses.
 Diet:
Regular eating patterns are necessary: either small frequent meals throughout
the day or three meals daily, whichever is realistic and the individual will
follow.
Avoid: Refined sugar, white flour, heavy starches, and fruit juice or
caffeinated beverages, as they disrupt normal body chemistry. Avoid allergic
foods.
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