Anorexia Nervosa

Anorexia nervosa is a psychophysiological disorder especially prevalent among young women and characterized by refusal to eat or maintain normal body weight, intense fear of becoming obese, a disturbed body image in which the emaciated patient feels overweight, and absence of any physical illness accounting for extreme weight loss. The term anorexia is actually a misnomer, because genuine loss of appetite is rare and usually occurs only late in the illness. Most anorectics are actually obsessed with food and constantly deny natural hunger.

Characteristics

In anorexia nervosa, normal dieting escalates into a preoccupation with being thin, profound 26 7. Anorexia Nervosa changes in eating patterns, and weight loss of at least 25 percent, usually accomplished by severe restriction of caloric intake. Anorectics may couple fasting with emetics, laxatives, diuretics, and exercise.

The most consistent medical consequences of anorexia nervosa are amenorrhea (ceasing or irregularity of menstruation) and estrogen deficiency. The decrease in estrogens causes many anorectics to develop osteoporosis. Further complications arising from severe malnutrition include bradycardia, hypotension, lethargy, hypothermia, constipation, and various other metabolic and systemic changes.

Anorectics also display a relatively consistent cluster of emotional and behavioral characteristics and unusual eating habits that include monotonous or eccentric diets, hoarding or hiding food, and obsessive preoccupation with food and cooking for others. Emotionally, anorexic patients are often described as perfectionistic, dependent, introverted, and overly compliant. Frequently reported neurotic traits include obsessive-compulsive, hysterical, hypochondriacal, and depressive symptoms. A distorted body image is an almost universal characteristic of anorectics, with many patients insisting that they are overweight even when their bodies are extremely emaciated. As a result, most individuals with anorexia nervosa deny or minimize the severity of their illness and are thus resistant to therapy.

History

Anorexia nervosa’s past prevalence has been a subject of much historical debate. Some clinicians and medical historians have postulated that it was first identified in 1689 by Richard Morton, physician to James II. Others have dated the origins of anorexia nervosa even earlier, claiming that certain medieval female saints, who were reputed to live without eating anything except the eucharist, actually suffered from anorexia nervosa. Some historians, however, have argued that attempts to label all historical instances of food refusal and appetite loss as anorexia nervosa are simplistic and maintain that the historical record is insufficient to make conclusive diagnoses of individual cases.

The modern disease classification of anorexia nervosa emerged in the second half of the nineteenth century. In 1859, William Stout Chipley published the first North American description of sitomania, a type of insanity characterized by an intense dread or loathing of food. Although Chipley found sitomania in a broad range of social and age groups, he identified a special form of the disease that afflicted adolescent girls. Chipley’s work was ignored, however, and not until British physician William Withey Gull and 27 7. Anorexia Nervosa French alienist Charles Lasegue published two influential studies in the 1870s did physicians begin to pay significant attention to anorexia in girlhood.