Anorexia Nervosa

Approximately five to 15% of diagnosed anorexics are male. Darcy McLurg, BSc Pharm, Clinical Pharmacist, The Ottawa Hospital, General Campus

Anorexia nervosa is an eating disorder in which the person affected is excessively focused on body shape weight and food intake. They have an inaccurate perception of their own body size. A person with anorexia nervosa has an intense fear of weight gain and will severely restrict the amount of food they eat to the point of self-starvation. In addition, they may attempt to control their weight through over-exercising, bingeing, purging, or with medications such as diuretics or laxatives.

Anorexia nervosa is most commonly seen in young women living in industrialized societies. Approximately five to 15% of diagnosed anorexics are male. The cause of anorexia is unknown. People at risk for developing this illness may have a family history of anorexia or a family/personal history of depression or manic-depressive disorder.

Sever weight loss (i.e., less than 85% of expected weight), continuous dieting, and/or excessive exercise are the most obvious signs of anorexia nervosa. Other typical symptoms are fatigue, cold-sensitivity, loss of appetite, hair loss, depression, trouble sleeping, and irregular or absent periods.

The continued nutritional deprivation takes a heavy toll on the body. Anorexic patients suffer from muscle spasms, kidney problems and heart problems as a result of low sodium and potassium in the blood. Bone loss and an increased risk of bone fractures in the long term are a possibility. Extremely low weight is associated with low blood pressure, slow heart rate, and low body temperature. Inadequate protein in the diet may result in excessive facial or body hair. The most common cause of death in an anorexic patient is due to low potassium in the blood causing heart failure. Sever depression may also lead to suicide.

The treatment of a person with anorexia nervosa can be very difficult. the primary goal of treatment is weight gain. Patients with anorexia will often be initially unwilling to participate in their treatment and may have trouble maintaining motivation to continue the treatment program. Individual psychotherapy and family therapy are helpful. Medication is generally not effective in treating anorexia, but may have a role in treating anxiety and mood changes associated with the disease. However, efficacy of these medications is limited while nutrition remains inadequate. Fluoxetine (Prozac) has been shown to aid in the recovery of patients who have already attained greater than 85% of their expected body weight. Other agents such as zine, cyproheptadine (Periactin), and other antidepressants have not been show to improve symptoms.

The information in this newsletter was prepared and reviewed by pharmacists for the Canadian Pharmaceutical Journal.