Anorexia: Risks, Symptoms, and Treatment Insights

Anorexia nervosa

Hello Dr.
Wang, I hope you don't mind me asking you a question.
I am 155 cm tall and weigh 42 kg, working at a desk job.
I have a smoking history of 25 years and a drinking history of 15 years.
I have been taking sleeping pills regularly for 5 to 6 years.
Three years ago, I started experiencing severe back pain, and despite consulting various internal and external medicine specialists, I found no relief and have had to rely on increasingly stronger painkillers.
Currently, my menstrual cycle is very infrequent or comes only after a long time.
My bone density is -2.2, my hemoglobin is slightly low, and my thyroid is mildly hyperactive.
I also take diuretics and laxatives.
I am very afraid of gaining weight, and I feel physically weak with nervous disorders.
It seems I may have anorexia.
I would like to ask for your opinion on this.
Additionally, can anorexia lead to death? What is the reasoning behind this? My blood tests have all come back normal.
Thank you for taking the time to respond.

Mandy, 40~49 year old female. Ask Date: 2008/03/12

Dr. Wang Zuoren reply Psychiatry

Hello Mandy,
You have a slight hyperthyroid condition, and treatment is recommended.
Additionally, based on your letter (you have been taking sleeping pills regularly for 5 to 6 years, have experienced severe back pain for the past three years with no resolution despite consulting various specialists, and have resorted to increasingly stronger pain medications; your menstrual cycle is very infrequent or occurs only after a long interval; your bone density is -2.2; your hemoglobin levels are low; and you have slight hyperthyroidism), you may not necessarily have anorexia nervosa.
Besides physiological issues, there may be anxiety and depression present.
I recommend an evaluation by a psychiatrist for treatment.
The diagnostic criteria for anorexia nervosa are as follows: First, refusal to maintain a minimum body weight or a body weight that is less than 85% of the ideal weight; second, an intense fear of gaining weight even when underweight; third, a distorted evaluation of one’s body shape; and fourth, the absence of menstruation or the absence of menstruation for three consecutive cycles.
The onset typically occurs during adolescence, with an overall prevalence of about 1% in the population, and females are approximately ten times more likely to be affected than males, which is related to societal and cultural pressures for women to have a slender physique.
The effects of anorexia on the body include long-term starvation and the use of laxatives, which can lead to low blood pressure, decreased heart rate, bone density loss, dry skin, brittle nails, hormonal changes, and mild anemia.
Some individuals may experience hair loss, the growth of fine, soft hair on the body, or electrolyte imbalances.
Severe untreated anorexia can lead to significant underweight and serious physiological dysfunction, which can be fatal.
You do not need to worry too much, but I recommend seeking a psychiatric evaluation and treatment as soon as possible.
Wishing you peace and joy,
Director Wang

Reply Date: 2008/03/12

More Info

Anorexia nervosa is a serious eating disorder characterized by an intense fear of gaining weight, leading to self-imposed starvation and excessive weight loss. It can have severe physical and psychological consequences, and understanding its risks, symptoms, and treatment options is crucial for anyone affected by it.

Risks and Symptoms of Anorexia
1. Physical Symptoms: Individuals with anorexia often exhibit significant weight loss and may have a body mass index (BMI) below 18.5. Other physical symptoms include:
- Severe dehydration
- Electrolyte imbalances, which can lead to heart problems
- Low blood pressure and heart rate
- Brittle bones (osteoporosis), which can be indicated by low bone density scores like -2.2
- Hair loss and dry skin
- Menstrual irregularities or amenorrhea (absence of menstruation), which you mentioned experiencing.

2. Psychological Symptoms: Anorexia is not just about food; it also involves complex psychological issues. Symptoms may include:
- Intense fear of gaining weight or becoming fat, even when underweight
- Distorted body image, perceiving oneself as overweight despite being underweight
- Preoccupation with food, dieting, and body size
- Withdrawal from social situations, especially those involving food
- Mood swings, anxiety, and depression.

3. Long-term Risks: Anorexia can lead to severe health complications, including:
- Heart failure due to electrolyte imbalances
- Kidney damage from dehydration and diuretic use
- Gastrointestinal issues from laxative abuse
- Increased risk of suicide due to co-occurring mental health disorders.

Treatment Insights
Treatment for anorexia typically involves a multidisciplinary approach, including medical, nutritional, and psychological support. Here are some key components:
1. Medical Care: Given your low weight and potential complications (like low hemoglobin and thyroid issues), medical supervision is essential. This may involve hospitalization in severe cases to stabilize weight and address any immediate health concerns.

2. Nutritional Counseling: Working with a dietitian can help you develop a healthy eating plan that gradually increases caloric intake and addresses nutritional deficiencies. This is crucial for restoring weight and health.

3. Psychotherapy: Cognitive-behavioral therapy (CBT) is often effective for treating anorexia. It helps individuals challenge and change distorted beliefs about body image and weight, develop healthier coping mechanisms, and address underlying emotional issues.

4. Support Groups: Engaging with support groups can provide a sense of community and understanding, which is vital for recovery. Sharing experiences with others facing similar challenges can be incredibly beneficial.

The Risk of Death
Anorexia nervosa can indeed be life-threatening. The risk of death is associated with severe malnutrition, electrolyte imbalances, and the psychological toll of the disorder. Studies indicate that individuals with anorexia have a higher mortality rate compared to the general population, primarily due to complications related to the disorder, including suicide.

Conclusion
Given your symptoms and history, it is crucial to seek professional help. Anorexia is a complex disorder that requires comprehensive treatment. If you suspect you have anorexia, please consult with a healthcare provider who specializes in eating disorders. They can provide a thorough assessment and develop a tailored treatment plan to help you regain your health and well-being. Remember, recovery is possible, and seeking help is the first step towards a healthier future.

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