Health Questions and Answers

Question: What are the characteristics of anorexia nervosa?


Anorexia nervosa was first described in 1874. Characteristically a disease of women and starting in adolescence, it can occur in men as well , and can have its onset as late as the third decade. The ultimate cause is unknown. It tends to occur in middle class young women and there may be family pattern which is “anorexogenic.” This must be taken with a bit of skepticism; the patient is frequently from what appear to be abnormal family and the signs of dysfunctional family behavior may be so subtle as to be undetectable by anyone other than the therapist who makes the diagnosis

Whatever the cause, the result is marked food avoidance. typically, these patients have body weights 15-20% below normal. they have a highly distorted body image and they have an extreme fear of becoming fat. The patient will honestly think she is fat when she is 15-20% below ideal body weight. As one patient put it, if her iliac spines or her ribs could not be easily seen, she was putting on fat. She wanted to be thin enough to see all of her bones. Any sign of roundness was quite threatening. It is highly instructive to interview a “stable” anorectic later in life, when they have come to terms with their disease. These individuals generally have extremely frugal eating habits. They often express negative feeling about others who overeat- which is most other people, by their standards. While they have learned to eat enough food to keep themselves healthy, they will often eat no more than necessary and they have to force sufficient food intake by a conscious effort of will. All of this points to an extreme resetting of the body’s appetite mechanisms. It is still not clear whether this is psychologic or physiologic in origin; the disease has features of both

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