The main criteria for a diagnosis of Anorexia are persistent restriction of dietary intake leading to significantly low body weight, intense fear of gaining weight or becoming fat with sustained patterns of behaviour that prevent weight gain, and body image disturbances such that weight and shape have undue influence on self-evaluation. This is accompanied by a persistent lack of recognition of the seriousness of the current low body weight.
Recent data distributed by the Victorian Government indicate that about one in 100 adolescent girls in Australia will develop Anorexia Nervosa, and one in ten sufferers of anorexia is male. The average age of onset is 17. Anorexia is an extremely serious psychological disorder, with a death rate higher than any other psychiatric disorder. Effective treatment is essential and usually urgent, and commonly long-term treatment is needed to minimise the risk of relapse.
Anorexia is so serious largely because of the considerable physical and psychological implications of being significantly underweight and/or undereating. Physical effects depend on the severity of the dietary restriction, and can include heart and circulatory effects due to loss of heart muscle, loss of bone density and muscle wastage, gastro-intestinal problems, hormonal problems and amenorrhea and difficulties in the regulation of temperature and sleep.
Psychological effects are generally less well understood in the general population. Knowledge about these effects have come from studies of starving populations and experiments in which volunteers adhered to dietary restriction over an extended period of time. This has led to a concept known as “starved brain syndrome”, which involves problems with thinking, emotional responding and behaviour. Problems with thinking include poor concentration, inflexible thinking and preoccupation with food and eating, often to the extent that other aspects of life are “squeezed out”, so to speak. Dietary restriction leads to low mood, increased irritability and a flattening-out of normal emotional experience. Anorexia is also associated with heightened obsessiveness, particularly in relation to food and eating such that sufferers may eat their food in very small bites, be extremely pedantic in food preparation, and eat alone and in a highly ritualised manner. In other areas of life this obsessiveness shows itself in reduced spontaneity, or concerns about tidiness and routines. Being underweight causes internal focus and this coupled with the reduced spontaneity and obsessive thinking usually results in quite significant social withdrawal. Often people with anorexia and their relatives believe these psychological phenomena reflect the sufferer’s personality but these psychological effects will largely resolve with sufficient weight restoration.
Treatment for anorexia will initially need to focus on weight restoration in order to reverse the effects of starvation on psychological function. Treatment can then address maintaining factors of the eating disorder such as over-valuation of weight and shape, perfectionism, depression and so on.
Getting timely and effective treatment for anorexia is extremely important. If you or someone close to you is engaging in dietary restriction, or is underweight or undereating please consider making an appointment with our specialised clinical psychologist. Please also review pages on Bulimia Nervosa, Eating Disorders, Treatment for Eating Disorders and Emotional Eating.
Author: Michelle Barratt