300 Longwood Avenue Boston, MA 02115 (617) 355-6000 My Child Has: Anorexia Nervosa Programs that treat this condition Children's Hospital Neighborhood Partnerships   Outpatient Psychiatry Service   Eating Disorders Program   Richmond Psychiatry Inpatient Service   Group Therapy Team   Office of Clinician Support   Bone Health Program   Adolescent/Young Adult Medical Practice   Psychopharmacology Program   Psychosocial Treatment Program   Emergency Psychiatry Program   Social Work Training Program   What is anorexia nervosa? Anorexia nervosa (AN), a form of self-starvation, is an eating disorder characterized by low body weight (less than 85 percent of normal weight for height and age), a distorted body image, and an intense fear of 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. Further, often 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, obsessive compulsive disorders (OCD) or affective disorders are commonly found in teens with anorexia. Who is affected by anorexia nervosa? The occurrence of anorexia nervosa has increased over the past 20 years. Anorexia nervosa is the third most common chronic disease in the U.S., and 95% of cases occur in females. The onset of anorexia nervosa usually occurs during adolescence or young adulthood. It is estimated that 0.48% of 15-19 year olds have anorexia nervosa. Anorexics do not eat enough to keep their bodies working properly. They lose weight so that they become weak and unhealthy because of a poor diet. Often, people with anorexia nervosa exercise too much trying to burn up calories. They usually "feel fat" even when they are losing weight. Anorexia also has many emotional and psychological aspects, such as low self-esteem. Anorexia nervosa is dangerous and can be fatal. Early diagnosis and treatment are important. What are the different types of anorexia? There are two subgroups of anorexic behavior aimed at reducing caloric intake, including the following: Restricting type - severely limits the intake of food, especially carbohydrates and fat containing foods. Binge/Purge type (also called bulimia) - 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 nutrient loses 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 (less than 85 percent of normal weight for height and age) intense fear of weight gain, 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 normal body weight in females, absence of three consecutive menstrual cycles without another cause excessive physical activity 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 fatigue intolerance to cold temperatures (hypothermia) emaciation development of lanugo (fine, downy body hair) yellowing of the skin Persons 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 physician 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 persons 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. The evaluation of the adolescent in whom an eating disorder is suspected includes a careful patient and family history, physical examination, laboratory tests, and mental health and nutritional assessments. The patient history includes an assessment of weight changes, self perceptions of weight and desired weight, binging and out of control eating and purging, exercise and use of laxatives and diet pills. The social history includes a review of risk factors focusing on the home, education, and activities. A family history includes information about eating disorders within the family, obesity, alcoholism, depression, or other mental illness. The patient is asked questions about abdominal pain, bloating, constipation, esophagitis associated with bulimia, hair loss or texture change associated with anorexia nervosa, cold intolerance, fatigue, weakness, fainting, substance use, sexuality, depression, amount of physical exercise, and stress fractures. A general physical examination assesses blood pressure, pulse, temperature, weight and height, skin and hair changes, heart function, and the abdomen. 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 physician for more information. Treatment for anorexia nervosa: Specific treatment for anorexia nervosa will be determined by your child's physician based on: your child's age, overall health, and medical history extent of your child's symptoms your child's tolerance for specific medications, procedures, 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, nutritional rehabilitation and behavior modification. 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 physician and a nutritionist to be active members of the management team. Parents play a vital supportive role in any treatment process. Possible complications of anorexia nervosa: Medical complications that may result from anorexia include, but are not limited to, the following: cardiovascular (heart) 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. 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) - Amenorrhea (cessation of the menstrual cycle) is one of the hallmark symptoms of anorexia, when a menstrual period is missed for three or more consecutive months without any other underlying cause. 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) - Persons 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. Research In addition to our clinical services, Children's researchers are searching for answers to questions about eating disorders. What are the best treatments to prevent osteoporosis (low bone density) in adolescent girls? What is the right environment for middle schools to prevent eating disorders? What impact did the National Eating Disorder Screening Day in 2000 have on youth and their schools? What is the best outpatient and inpatient protocol to help young people with eating disorders recover from their illness? For more information go to the Center for Young Women's Health website. The information on this website should not be taken as medical advice, which can only be given to you by your personal health care professional. Copyright © Children's Hospital Boston. All rights reserved.