You notice that your 14 year-old daughter only “nibbles” at family dinners because she “ate earlier with friends.” She now exercises intensely, claiming that the extra 1-2 hours of running each day will get her in shape for her soccer games. You also think that you hear her vomiting in the bathroom. You tell yourself she couldn’t have an eating disorder. After all, she is too young for something as serious as that…
Actually, contrary to what many believe, Anorexia Nervosa may begin at age 13 or 14 (or even earlier) and can continue into adolescence and adulthood. This eating disorder cuts across all social classes and affects mostly females, although a small percentage (5-10 percent) of eating disorder patients are males.
To be diagnosed with Anorexia, an individual has to restrict their body weight to less than 85% of what would be expected for their age and height, show a significant fear of gaining weight or becoming fat (despite being underweight), show disturbances in perception of their weight/shape or in the severity of the problem, and have missed at least three consecutive menstrual periods. The restricting type of anorexia involves fasting, extreme dieting, or excessive exercise to maintain a low body weight. The binge eating/purge type is characterized by binge-eating and/or purging (e.g. engaging in self-induced vomiting or using laxatives, diuretics and/or enemas.)
Anorexics typically have significant body image concerns and view themselves as fat, even at exceptionally low weights. They may become intensely focused on certain body parts (e.g., legs, buttocks, arms) that they view as too large. Even at dangerously low weights, they may see others (who are not anorexic) as thinner than themselves. In the anorexic’s pursuit of thinness, daily weight loss is viewed as a “victory.” If daily weight loss does not continue, the anorexic worries that she will become obese. Consequently, anorexics may weigh themselves many times each day, not realizing that normal fluctuations in water retention will affect each weighing. The intense focus on dieting and calorie counting may lead the anorexic to cook her own food.
Anorexics are often self-critical, have high expectations of themselves, and work to excel in many activities (e.g., school, sports, dance). Many anorexics claim that their excessive focus on food and weight provides a sense of control over their lives and allows them to avoid uncomfortable emotions. They often state that their exceptionally low weight makes them feel “special,” where they can be noticed and stand apart from their peers. This makes it very difficult for most anorexics to want to seek treatment or “give up” their disorder. In fact, they may try to hide their disorder by wearing loose fitting clothing.
At the same time, many anorexics feel overwhelmed and controlled by their food and exercise regimes, and by their constant thoughts about food and weight. They may also experience a loss of friendships with those who do not develop an eating disorder.
There are significant medical complications that can result if this disorder remains untreated. These complications include physical weakness, dehydration, electrolyte disturbances (associated with purging), gastrointestinal disturbances, anemia, cognitive impairments, cardiovascular problems, arrested growth and sexual development, stress fractures, and osteoporosis, among others.
However, even without all the signs of anorexia, an individual may nevertheless have an eating disorder of some type or may be in the process of developing one. Therefore, if your child shows any significant changes in weight, eating habits, exercise routine, or in how she views her shape and weight, it is essential to seek help immediately. If the weight loss is severe or there are significant medical concerns, an inpatient stay in a hospital may be warranted. Outpatient treatment with one’s family doctor and dietician (which should always follow a hospital stay) would focus on restoring weight and normalizing eating patterns. Family therapy may also be a useful treatment component to help address relevant family issues. Individual therapy with a psychologist or therapist would be critical to help address the anorexic’s distortions about shape and weight, as well as the issues that led to the eating disorder in the first place. With appropriate professional treatment, many with anorexia can be helped to feel better about themselves and lead happier and healthier lives.