Anorexia is primarily an eating disorder of young women, which typically strikes individuals between 15-25 years of age. This is an extremely difficult disorder to deal with for several reasons: denial by the sufferer, difficulty in gaining accurate information from the family, and difficulty in differentiating the illness from other possible causes (i.e. depression), to name a few. This illness is extremely difficult to diagnose accurately and requires the practitioner to be knowledgeable about all facets of the disease, physical complications, family components, treatment and treatment issues.

Anorectics are typically classified into one of two sub types: those who severely restrict their eating, and those who binge and purge. Anorexia is associated with a 4% to 8% chance of serious illness and death for those who suffer from this disease. Where as the disease was originally thought to be restricted to white, upper-class adolescents, it has now spread to all socioeconomic levels (although 97 percent are still white). According to the DSM-4 (1995) females account for 95 percent of those who have this disorder.

The primary features include: refusal to maintain a minimum normal weight for their height and age; excessive fear of becoming fat or gaining weight, despite being underweight; distorted body image; and amenorrhea (loss of menstruation) in females.

According to Webster’s dictionary (1990) the term "anorexia" means "a loss of appetite, especially when prolonged (p.42)." This is a misnomer in and of itself, since loss of appetite is rare in this disorder. The disturbance in appetite is more akin to an inability to recognize hunger than a loss of appetite.

Familial studies indicate eating disorders tend to run in families, although no pattern of typical family interaction has been identified. The cultural causes of anorexia seem linked to societal pressure to be thin and an over-concern for physical appearance. Research suggests that teenage girls who have problems in communicating with their parents may be at higher risk for developing an eating disorder. The unrealistic feelings toward food and body image may be related to poorly developed self-esteem and the non-supportive family environment.

The most obvious symptom of the disorder is a phobic avoidance of eating that cannot be explained by any reasonable dieting and a striking thinness. The typical anorectic seems unconcerned with their deviant physical condition. Behavior may often appear withdrawn, critical, strange and little tolerant of others criticism. The anorectic’s body, which is often thin, emaciated and skeleton like, may show overly protruding bones. Facial muscles are often tight due to a loss of the fat layer that normally lines this area. Legs tend to lose form and often look like matchsticks, the breasts will atrophy and the stomach will become concave, and loss of hair may also be noted, in more severe cases.

The DSM-4 (1995) states that unusual behaviors regarding food are common. For example, a person with anorexia may prepare abundant and complex meals for the family, but then limit themselves to a few morsels of the lower-calorie items. The anorectic may also conceal, hoard, crumble, or throw food out.

Anorectics tend to be of average or higher intelligence. Common coping mechanisms are: repression, denial, isolation, and compulsive ritualism. Emotions tend to be avoided as much as possible and masochistic tendencies are prevalent in this population. Compulsive behavior is common with anorexics. Anorexics often consumed by cleanliness, orderliness, excessive studying and exercise. Anything less than perfection can be very upsetting and everything undertaken by the anorexic seems to be done to excess, including dieting. Anorectics are also surprisingly active, despite their withered physical condition. They are typically hard working employees and may become obsessive with work.

Distorted body image is a primary characteristic of anorexia nervosa and perhaps one of the most perplexing. The anorectic appears unaware of their changed bodily proportions despite evidence to the contrary, even when the anorectic is virtually starved. It is common for such a person to claim they look "just right" or "still fat." The anorectic may also have problems believing they are as thin as another anorexic of the same height, weight and build. The anorexic will see this other person as being too thin, but will fail to see themselves as thin.

A hallmark of anorexia nervosa is that individuals with this condition often withdraw from friends and family over time. Much of this withdrawal behavior arises out of fear that others will question the eating behavior of the anorectic. Some anorectics fall into binge and purging practices.

This is often brought on by a weakening of their control due to obsessing on food, intense hunger pains, family pressure, or other stressors.

Most often anorexics resist treatment and rarely seek help. Typically, anorexia is noted by teachers at school, therapists and doctors. The anorectic will 1ikel~y~see the doctor or psychologist as an enemy who is forcing them to eat and gain weight (get fat). This often causes the anorectic to falsify information and/or be treatment resistant in order to protect the illness.

Research has shown that anorectics, in particular, often present with positive histories of multiple substance abuse and various impulse-dominated behaviors, such as shoplifting, promiscuity, and self-mutilation. Substance abusing women with eating disorders often create a complicated treatment challenge to the clinician. When a patient has alcoholism (or drug abuse) concurrent with an eating disorder, the alcoholism generally needs to be treated first. But, if the eating disorder is severe, it may need to be treated concurrently. Many anorexics are referred to psychiatric hospitals that deal with both illnesses and can provide the most appropriate treatment plan. The most successful programs combine individual with family counseling and utilize a team approach, which includes a physician and a nutritionist.

Among those treated for anorexia, 50 percent regain normal weight an normal eating habits, 25 percent improve some, but have weight and/or eating habit problems remaining, and 25 percent are resistant to treatment. Early identification and intervention are crucial to successful treatment for this eating disorder.

5. Disturbed family relationships (either a poor relationship between the patient and other family members, or a troubled relationship between the parents)

6. History of previous psychiatric treatment

** If you know of someone who may have an eating disorder, get them assessed by a professional with experience in this disorder and into treatment as soon as possible to allow them the best chance of recovery.

 Writer:

Paul J. Cline, M.A. CAGS LMHC LADC is the Owner of

Advanced Counseling Services in Keene, NH. (603) 357-1708