What is anorexia, who is at risk and is there anything you can do?

The underlying causes of anorexia nervosa are not fully understood, but are likely to be complex.

Although anorexia nervosa (AN) is considered quite rare among the general population, with about 9 per 1000 females affected over their lifetime, it is quite common among adolescent girls, and increasingly among boys too. In fact, it is quoted to be the third commonest "chronic" or ongoing health condition affecting teenage girls, after asthma and obesity. It is also potentially extremely serious, with the highest mortality rate of all psychiatric conditions.

SO WHAT IS AN, WHO IS AT RISK, AND IS THERE ANYTHING THAT CAN HELP TREAT IT?

People who suffer from AN have a preoccupation with weight – either a fear of getting fat, or a desire to be very thin. They believe they are fat, even when they are dangerously underweight, and often report being terrified of becoming what, in other people's eyes, is in fact a normal weight or shape.

Features of AN often include weight loss measures (such as extreme dieting, over-exercising or both), distorted body image, and purging or self-induced vomiting. The extreme weight loss can lead to delayed or absent periods for girls, fatigue, fainting, withdrawal from social or family activities, low mood, anxiety, low bone density, as well as heart problems and seizures.

The underlying causes of AN are not fully understood, and are likely to be complex, including psychological, biological, developmental and sociocultural factors. We do know that certain things can increase your risk of AN, including:

* Being female – girls are much more likely to develop AN than boys; however, we are seeing increasing numbers of young men with this condition, and sadly they are less likely to be diagnosed, referred or properly treated than girls of the same age.

* Age – AN typically occurs during adolescence, but can occur in younger children too.

* Growing up in "western" society – although AN is more common in the westernised world, it can affect anyone, from any background or culture.

* Having a relative with an eating disorder, depression or substance abuse.* "Adverse events" in childhood can increase the likelihood of AN, including sexual abuse, criticism about weight or eating habits, pressure to "be thin" (example,  among dancers).* Personal characteristics are also thought to play a part in some cases, especially perfectionism, low self-esteem, anxiety, obsessional traits and difficulty resolving conflict.

However, there will be people who develop AN who have none of these risk factors, and who may look perfectly healthy, making it very difficult to predict.

It is thought that early diagnosis leads to improved chance of recovery, so it's important to be alert to this condition, especially among the young people in your life, and not to be afraid to ask the question if you have any concerns. Easier said than done, but if you or your children know someone who seems to be losing weight, or is preoccupied with food or exercise beyond a healthy level, asking them "Do you worry excessively about your weight" or even "Do you think you have a eating problem?" may give them the opportunity they need to get help.

In terms of treatment, referral to a specialist centre for a multidisciplinary management plan is essential. Talking therapies are the mainstay of treatment, and are often required for long periods of time.

Occasionally, in severe cases, admission to a ward may be required to correct electrolyte imbalances and dehydration. There is not much evidence for the use of medication in treating AN, however antidepressants can be helpful if there is co-existing depression or anxiety. Families and loved ones play a vital ongoing support role.

For more information on anorexia, or the other eating disorders, visit edanz on www.ed.org.nz or call 0800 2 EDANZ.

Cathy Stephenson is a GP and a medical forensic examiner. 

Article Resources:http://www.stuff.co.nz/