Anorexia nervosa is an eating disorder that is almost exclusively a disease of young women, and as many as 1 in every 100 women in the United States between 13 and 30 may be affected. It is a disease of white Western society, and is almost unknown in American Negroes and British Indians. It is totally unknown in third-world countries.
The patient has an extreme dislike of food, due to an inappropriate body image which makes them feel grossly overweight, or have an abnormal fear of becoming overweight when in fact they may be very underweight. The dislike of food is usually accompanied by excessive exercising, especially since aerobics and jobbing became so popular. The fixation that they are obese, or may become so, cannot be easily broken, and mirrors, scales and other props seem to be disbelieved by the patient. The patient can become seriously undernourished and emaciated, to the point of death, if adequate treatment is not available. Other symptoms include a cessation of menstrual periods, diffuse hair loss, an intolerance of cold, a slow pulse, irregular heart beat and other complex hormonal disorders. Patients practice deceit to fool their family and doctors by appearing to eat normal meals but later vomit the food, use purgatives to clean out their bowel, or hide food during the meal.
The treatment is extraordinarily difficult and prolonged and requires the attention of psychiatrists and physicians who are expert in the field. Initial hospital admission is almost mandatory, and any relapses should also be treated by hospitalization. Punishment for not eating must be avoided, but friendly encouragement and persuasion by family and friends is beneficial in both improving the patient’s self-esteem and food intake. Medication is not successful without the accompanying psychiatric help. Tricyclic antidepressants are the most commonly used drugs.
Relapses are common, and suicide is frequently attempted. Psychotherapy to control and monitor the patient is required for many years, but even in the best centers deaths do occur.