other mental disorders such as depression. Research
in this area is relatively new and the findings are
unclear. People with anorexia tend to feel full sooner
than other people. Some researchers believe that this
is related to the fact that stomach of people with
anorexia tends to empty more slowly than normal;
others think it may be related to the appetite control
mechanism of the brain.Psychological factors. Certain personality types
appear to be more vulnerable to developing anorexia
nervosa. Anorectics tend to be perfectionists who have
unrealistic expectations about how they ‘‘should’’
look and perform. They tend to have a black-or-
white, right-or-wrong, all-or-nothing way of seeing
situations. Many anorectics lack a strong sense of
identity and instead take their identity from pleasing
others. Virtually all anorectics have low-self worth.
Many experience depression and anxiety disorders,
although researchers do not know if this is a cause or
a result of the eating disorder.
Social factors. Anorectics are more likely to come
either from overprotective families or disordered
families where there is a lot of conflict and inconsis-
tency. Either way, the anorectic feels a need to be in
control of something, and that something becomes
body weight. The family often has high, sometimes
unrealistic and rigid, expectations. Often something
stressful or upsetting triggers the start of anorexic
behaviors. This may be as simple as a family member
as teasing about the person’s weight, nagging about
eating junk food, commenting on how clothes fit, or
comparing the person unfavorably to someone who
is thin. Life events such as moving, starting a new
school, breaking up with a boyfriend, or even enter-
ing puberty and feeling awkward about one’s chang-
ing body can trigger anorexic behavior. Overlaying
the family situation is the unrelenting media message
that thin is good and fat is bad; thin people are suc-
cessful, glamorous, and happy, fat people are stupid,
lazy, and failures.Signs and Symptoms
Anorexic behavior has physical and psychological
consequences. These include:
excessive weight loss; loss of muscle
stunted growth and delayed sexual maturation in
preteens
gastrointestinal complications: liver damage, diar-
rhea, constipation, bloating, stomach pain
cardiovascular complications: irregular heartbeat,
low pulse rate, cardiac arrest
urinary system complications: kidney damage, kid-
ney failure, incontinence, urinary tract infections
skeletal system complications: loss of bone mass,
increased risk of fractures, teeth eroded by stomach
acid from repeat vomiting
reproductive system complications (women): missed
menstrual periods, infertility
reproductive system complications (men): loss of sex
drive, infertility
fatigue, irritation, headaches, depression, anxiety,
impaired judgment and thinking
fainting, seizures, low blood sugar
chronically cold hands and feet
weakened immune system, swollen glands, increased
susceptibility to infections
development of fine hair called lanugo on the should-
ers, back, arms, and face, head hair loss, blotchy, dry
skin
potentially life-threatening electrolyte imbalances
coma
increased risk of self-mutilation (cutting)
increased risk of suicide
deathDiagnosis
Diagnosis is based on several factors including a
patient history, physical examination, laboratory
tests, and a mental status evaluation. A patient history
is less helpful in diagnosing anorexia than in diagnos-
ing many diseases because many people with anorexia
lie repeatedly about how much they eat and their use
of laxatives, enemas, and medications. The patientKEY TERMS
Diuretic—A substance that removes water from the
body by increasing urine production.
Electrolyte—Ions in the body that participate in
metabolic reactions. The major human electrolytes
are sodium (Naþ), potassium (Kþ), calcium (Ca
2 þ), magnesium (Mg2þ), chloride (Cl), phos-
phate (HPO 42 ), bicarbonate (HCO 3 ), and sul-
fate (SO 42 ).
Neurotransmitter—One of a group of chemicals
secreted by a nerve cell (neuron) to carry a chem-
ical message to another nerve cell, often as a way of
transmitting a nerve impulse. Examples of neuro-
transmitters include acetylcholine, dopamine,
serotonin, and norepinephrine.Anorexia nervosa