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Anorexia Nervosa
Both anorexia and bulimia are characterized by a morbid fear of gaining weight and losing control
over eating. A major difference seems to be that anorexics are more successful at losing weight.
Hence, people with anorexia are proud of both their diets and their extraordinary control. Marya
Hornbacher, for example, in her autobiography ‘Wasted’, writes:
“I distinctly did not want to be seen as bulimic. I wanted to be an anorectic, a person whose passions
were ascetic rather than hedonistic.”
Characteristics of Anorexia Nervosa

Anorexia nervosa is less common than bulimia

Anorexia is more likely to be the primary diagnosis than bulimia nervosa

Anorexics have an intense fear of obesity and relentlessly pursue thinness

The disorder commonly begins in adolescence

Weight loss is achieved via stringent calorific restriction, purging, exercise, or a combination
thereof
The DSM-IV-TR specifies two types of anorexic:
Restricting type: limit calorie intake
Binge-eating-purging type: will eat smaller amounts of food than a bulimic, and purges more often,
sometimes after every time she eats
Medical Consequences of Anorexia
Anorexia can have a profound impact on health; up to 20% of anorexics eventually die of their
disorder (Keel et al, 2003; Sullivan, 1995). Typical examples of damage to health might be:

Cessation of menstruation (amenorrhea)

Dry skin

Brittle hair or nails

Sensitivity or intolerance to cold temperatures
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
Development of lanugo; downy hair on limbs and cheeks
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Cardiovascular problems: chronically low blood pressure and heart rate

In anorexics who also purge, electrolyte imbalance and associated renal and cardiac
problems will be found
Treatment of Anorexia Nervosa
The initial aim is to restore the client’s weight to within normal BMI range (American Psychiatric
Association, 1993). Residential treatment is indicated if the client’s weight is below 70% of the
average, because severe medical complications are likely to occur if weight is not stabilized quickly.
Maintaining weight gain is problematic, as without attention to the patient’s underlying
dysfunctional attitudes about body shape as well as interpersonal disruptions in her life, she will
almost always relapse.

Family therapy has been found to be effective, especially with girls under age of 19 who
have a short history of being anorexic (Eisler et al., 1997). The aims of family therapy are: to
discuss attitudes towards body shape and image distortion; examine and modify negative
and dysfunctional communication regarding food; ensure that meals are structured and
reinforcing.
Strategies to achieve weight gain
This model (Hsu, 1990) for the attainment of weight gain is only suitable for in-patient treatment:

Weight restoration in conjunction with individual and family therapy

Development of trust between patient and treatment team, so that patient believes she
won’t be allowed to become overweight

Patient’s fear of loss of control is contained; to this end, four to six small meals (400-500
calories each) per day is helpful

Presence of a nurse at mealtimes to encourage patient to eat, and discuss patient’s fears
and anxieties around doing so

Patient to be weighed regularly and informed of weight gain or loss

Negative and positive reinforcements, such as a graduated level of activity and bed-rest
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
Patient’s self-defeating behaviour, i.e. secret purging or vomiting, is challenged and
controlled

Dysfunctional conflict between patient and family about food should not be re-enacted by
treatment team