Anorexia Nervosa in Adolescents and Teens

What is anorexia nervosa?

Anorexia nervosa (AN), a form of self-starvation, is an eating disorder characterized by a distorted body image that leads to restricted eating and other behavior that prevents a person from gaining weight. Anorexia nervosa is sometimes referred to as anorexia.

What causes anorexia nervosa?

The cause of anorexia nervosa is not known. Anorexia usually begins as innocent dieting behavior, but gradually progresses to extreme and unhealthy weight loss. Social attitudes toward body appearance, family influences, genetics, and neurochemical and developmental factors are considered possible contributors to the cause of anorexia. Adolescents who develop anorexia are more likely to come from families with a history of weight problems, physical illness, and other mental health problems, such as depression or substance abuse. Teens with the disorder come from families that are challenged by appropriate problem solving, being too rigid, overly critical, intrusive, and overprotective. Teens may also be dependent, immature in their emotional development, and are likely to isolate themselves from others. Other mental health problems, such as anxiety disorders or affective disorders, are commonly found in teens with anorexia.

Who is affected by anorexia nervosa?

The majority of those affected are females (90 to 95 percent), although those statistics are changing as males are now more frequently affected. Initially identified in upper- and middle-class families, anorexia is now known to be found in all socioeconomic groups and a variety of ethnic and racial groups.

What are the different types of anorexia?

There are two subgroups of anorexic behavior aimed at reducing caloric intake, including the following:

• Restrictor type. An individual severely limits the intake of food, especially carbohydrates and fat containing foods.

• Bulimia (also called binge-eating or purging type). An individual eats in binges and then induces vomiting and/or takes large amounts of laxatives or other cathartics (medications, through their chemical effects, that serve to increase the clearing of intestinal contents).

What are the symptoms of anorexia nervosa?

The following are the most common symptoms of anorexia. However, each child may experience signs differently.

Symptoms may include:

• Low body weight

• Intense fear of becoming obese, even as individual is losing weight

• Distorted view of one's body weight, size, or shape; sees self as too fat, even when very underweight; expresses feeling fat, even when very thin

• Refuses to maintain minimum normal body weight

• In females, absence of three menstrual cycles without another cause

• Excessive physical activity in order to promote weight loss

• Denies feelings of hunger

• Preoccupation with food preparation

• Bizarre eating behaviors

The following are the most common physical symptoms associated with anorexia--often that result from starvation and malnourishment. However, each child may experience symptoms differently. Symptoms may include:

• Dry skin that when pinched and released, stays pinched

• Dehydration

• Abdominal pain

• Constipation

• Lethargy

• Dizziness

• Fatigue

• Intolerance to cold temperatures

• Emaciation

• Development of lanugo (fine, downy body hair)

• Yellowing of the skin

People with anorexia may also be socially withdrawn, irritable, moody, and/or depressed. The symptoms of anorexia nervosa may resemble other medical problems or psychiatric conditions. Always consult your child's doctor for a diagnosis.

How is anorexia nervosa diagnosed?

Parents, teachers, coaches, or instructors may be able to identify the child or adolescent with anorexia, although many people with the disorder initially keep their illness very private and hidden. However, a child psychiatrist or a qualified mental health professional usually diagnoses anorexia in children and adolescents. A detailed history of the child's behavior from parents and teachers, clinical observations of the child's behavior, and, sometimes, psychological testing contribute to the diagnosis. Parents who note symptoms of anorexia in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

Anorexia, and the malnutrition that results, can adversely affect nearly every organ system in the body, increasing the importance of early diagnosis and treatment. Anorexia can be fatal. Consult your child's doctor for more information.

Treatment for anorexia nervosa

Specific treatment for anorexia nervosa will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history

• Extent of your child's symptoms

• Your child's tolerance for specific medications or therapies

• Expectations for the course of the condition

• Your opinion or preference

Anorexia is usually treated with a combination of individual therapy, family therapy, behavior modification, and nutritional rehabilitation. Treatment should always be based on a comprehensive evaluation of the adolescent and family. Individual therapy usually includes both cognitive and behavioral techniques. Medication (usually antidepressants) may be helpful if the adolescent with anorexia is also depressed. The frequent occurrence of medical complications and the possibility of death during the course of acute and rehabilitative treatment requires both your child's doctor and a nutritionist to be active members of the management team. Parents play a vital supportive role in any treatment process. Hospitalization may be required for medical complications related to weight loss and malnutrition.

Possible complications of anorexia nervosa

Medical complications that may result from anorexia include, but are not limited to, the following:

• Cardiovascular (heart). While it is difficult to predict which anorexic patients might have life-threatening heart problems that result from their illness, the majority of hospitalized anorexic patients have been found to have low heart rates. Myocardial (heart muscle) damage that can occur as a result of malnutrition or repeated vomiting may be life threatening. Common cardiac complications that may occur include the following

  • Arrhythmias (a fast, slow, or irregular heartbeat)

  • Bradycardia (slow heartbeat)

  • Hypotension (low blood pressure)

• Hematological (blood). An estimated one-third of anorexic patients have mild anemia (low red blood cell count). Leukopenia (low white blood cell count) occurs in up to 50 percent of anorexic patients.

• Gastrointestinal (stomach and intestines). Normal movement in intestinal tract often slows down with very restricted eating and severe weight loss. Gaining weight and some medications help to restore normal intestinal motility or movement.

• Renal (kidney). Dehydration often associated with anorexia results in highly concentrated urine. Polyuria (increased production of urine) may also develop in anorexic patients when the kidneys' ability to concentrate urine decreases. Renal changes usually return to normal with the restoration of normal weight.

• Endocrine (hormones). In females, amenorrhea (cessation of the menstrual cycle for at least three consecutive months when otherwise expected) is one of the hallmark symptoms of anorexia. Amenorrhea often precedes severe weight loss and continues after normal weight is restored. Reduced levels of growth hormones are sometimes found on anorexic patients and may explain growth retardation sometimes seen in anorexic patients. Normal nutrition usually restores normal growth.

• Skeletal (bones). People with anorexia are at an increased risk for skeletal fractures (broken bones). When the onset of anorexic symptoms occurs before peak bone formation has been attained (usually mid to late teens), a greater risk of osteopenia (decreased bone tissue) or osteoporosis (bone loss) exists. Bone density is often found to be low in females with anorexia, and low calcium intake and absorption is common.

Prevention of anorexia nervosa

Preventive measures to reduce the incidence of anorexia are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the child's normal growth and development, and improve the quality of life experienced by children or adolescents with anorexia nervosa. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.