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Anorexia nervosa, commonly called anorexia, is an eating disorder characterized by a refusal to eat enough to maintain a healthy weight. People who have anorexia typically have low body weight, an intense fear of gaining weight, and a distorted perception of their body weight, shape, and size. They often go to extreme measures to try to control their weight, which can lead to significant physical, emotional, and social problems. 
There are two sub-types of anorexia – restrictive type, in which people severely limit food intake and may exercise excessively, and binge/purge type, in which people eat lots of food in a short time then attempt to get rid of the effects of eating food by vomiting, taking laxatives, using enemas, exercising excessively, or refusing to eat. 

Anorexia is a complex disorder that can affect anyone, including children (both boys and girls), men, and women. It usually begins during the pre-teen and early teen years. The median age for anorexia to begin is between 12 and 13. Most people with anorexia are female, but between 5 and 15 percent of people with anorexia are boys and men. 

Effective treatment often involves both medical care and mental health intervention. Children with anorexia may need to be cared for at a children’s hospital that specializes in treating eating disorders in children. When anorexia is caught early, a pediatrician may be able to treat it. If you have a teen with an eating disorder, he or she may be best treated by an adolescent medicine doctor or a teen eating disorder specialist.

Although anorexia is an eating disorder, at its roots, it’s not about food. The eating habits associated with anorexia are often a way to cope with social and emotional problems and a poor self-image. People who have anorexia often believe being thin increases their worth. 

Eating disorders rarely occur alone. Most people who have an eating disorder also have a mental health condition, such as anxiety, depression, mood disorder, or substance abuse disorder. It’s also common for people with anorexia to also have signs and symptoms of other eating disorders, such as bulimia or binge eating. Your child may sometimes binge, with or without purging afterward.

Impacts of anorexia

Anorexia is a serious condition that can have severe consequences. About ten percent of people who have anorexia die from conditions related to it. The most common causes of death in people with anorexia are cardiac arrest, severe electrolyte imbalance, and suicide.

Some of the longer-term health consequences of anorexia are:

  • Reduced respiration rate
  • Low body temperature
  • Weak or thin bones, which can lead to frequent breaks or fractures
  • Cold sensitivity
  • Malnutrition
  • Organ damage, including damage to the brain, kidneys, and heart
  • Heart problems, such as an irregular heartbeat and low blood pressure
  • Problems with growth and development

Anorexia can also have serious emotional effects. 

Signs and symptoms of anorexia

Anorexia has several signs and symptoms, but not everyone with anorexia will have the same symptoms or behaviors. There are physical and emotional signs. The physical signs are symptoms of starvation, such as rapid weight loss, fatigue, or dizziness. Emotional and behavioral signs of anorexia may include excessive exercise or preoccupation with food. 

If your son or daughter shows any of the following signs, he or she may have anorexia.

Physical signs and symptoms of anorexia

  • Losing weight quickly, appearing thin, or not gaining weight as developmentally appropriate
  • Fatigue, tiredness, dizziness, or possible fainting
  • Low blood pressure
  • A blue-ish color under fingernails or yellowish skin
  • Swelling in the extremities
  • Thin hair that breaks easily or falls out
  • Irregular or absent menstruation
  • Abdominal pain
  • Constipation
  • Cold intolerance
  • Irregular heart rhythms
  • Dehydration
  • Knuckle bruising, callouses, tooth decay, or enamel erosion from inducing vomiting

Behavioral/emotional signs of anorexia

  • Behavior changes related to food, like avoiding meals, eating alone or in secret, monitoring food intake, only eating small amounts, anxiety around food, or high interest in calories or food
  • Cooking elaborate meals but not eating them
  • Denying hunger or making excuses not to eat
  • Wearing baggy clothes or multiple layers to hide weight loss
  • Fear of gaining weight, including frequently weighing themselves, looking in the mirror, or talking about body weight or shape
  • Being highly self-critical or having a negative self-image
  • Exercising compulsively or excessively
  • Taking laxatives, diet aids, or herbal remedies or using enemas for weight control
  • Spitting food out after chewing it
  • Lying about how much food they eat
  • An apparent lack of emotion or flat affect, or withdrawing from social contact, or irritability 
  • Insomnia

Causes of anorexia

Experts aren’t sure what causes anorexia, but most agree that many factors can come together to cause the disorder. It may be a combination of biological, psychological, interpersonal, sociological, and behavioral influences that cause anorexia. Family dynamics may also influence its onset.
Children who have anorexia often have other conditions as well, including depression, anxiety, feelings of helplessness, low self-esteem, or fear of becoming overweight.

Treatment options and interventions

Anorexia won’t go away without treatment. If a child truly has anorexia, he or she needs treatment from trained medical professionals who are experienced with treating anorexia and other eating disorders. All children with anorexia will need treatment to address their physical health and mental health. The sooner treatment starts, the more effective it is likely to be, so it’s important for parents to get help for their children as soon as possible. If you notice that your child has any signs or symptoms of anorexia (or other eating disorders), call your child’s doctor right away. As a parent, you know your child better than anyone. Go with your gut. If you think your child needs help, he or she probably does. 

Treatment for anorexia

The first goal of treating anorexia is to restore a healthy weight and eating habits. Some children may need to be hospitalized to accomplish this goal. Although it’s rare, some children may require tube feeding or IV nutrition during this period of treatment.  

If your child’s life is in immediate danger due to the effects of starvation, you may need to take him or her to the emergency room. There, doctors can treat electrolyte imbalances, dehydration, irregular heart rhythms, or life-threatening mental health conditions. Long-term hospitalization may be necessary for severe problems, like malnutrition, refusal to eat despite attempted interventions, or severe psychiatric problems that put them in danger.

An important part of treatment is addressing underlying psychological issues that are at the root of the anorexia. That treatment may include a combination of:

  • Antidepressant medication
  • Psychotherapy, including individual, family, or group counseling
  • Behavioral modification therapy
  • Nutritional counseling
  • Support groups
  • Medical support to address the side effects of the eating disorder

What to do if your child has anorexia

If you suspect that your child has anorexia, talk with him or her – and make a call to your child’s pediatrician. Make sure you son or daughter knows you are concerned and want to help. A non-judgmental approach is most effective. Children with anorexia may believe that they aren’t good enough or that they aren’t loved or liked as they are. It’s important not show compassion and concern rather than anger, frustration, or judgment.

Anorexia can be difficult to treat because people who suffer from it often don’t want treatment because they don’t think they need it, or they have an irrational fear of gaining weight and understand that treatment will focus on getting them to a healthy body weight.
Anorexia is a serious disease that must be treated by experienced professionals. If you even suspect your child might have anorexia, seek treatment from an eating disorder specialist right away. People with eating disorders can become quite skilled at hiding their eating habits and other signs of their condition, so parents must be vigilant. 

The Hough Center For Adolescent Health

The Hough Center for Adolescent Health uses a collaborative, "no blame" approach that involves you and your child, providing you with techniques to navigate the daily recovery process. Each adolescent is encouraged and empowered to take an active role in his or her recovery. Call 248-594-3142 to set up an appointment for your child.

To speak with an eating disorders specialist at the Hough Center for Adolescent Health, call 248-594-3142. For a referral to other Beaumont physicians who treat eating disorders, call 855-480-KIDS or find one online.