Anorexia Nervosa

Anorexia nervosa (often referred to as anorexia) is a type of eating disorder characterized by an obsession with eating, food and weight control. Patients become very thin and underweight (at least 85 percent of expected weight) and are unable to achieve or maintain a normal body weight. They have an intense fear of gaining weight and see themselves as “overweight” even when they appear to others as starved or malnourished. Patients also minimize or don’t accept potential health consequences of being extremely underweight.

Anorexia can occur in both men and women, but 90 to 95 percent of patients are female. The National Eating Disorders Association estimates the disorder affects up to one percent of adolescent girls and women in the U.S. Anorexia takes a toll on the body and can lead to cessation of menstruation, brittle hair and nails, drying and yellowing of the skin, bone thinning, anemia, muscle loss, constipation, low blood pressure, low heart rate, inability to tolerate cold temperatures and development of fine hair over the body. The condition also impacts self esteem, interpersonal relationships and school/job performance. The Academy for Eating Disorders reports about 10 percent of patients with anorexia die from medical complications or suicide.

Getting Help

It can be difficult to get treatment for patients with anorexia because most don’t believe they have a problem, even when faced with serious complications from the condition. When patients accept treatment, doctors typically use a combination of psychotherapy/counseling and therapies to address medical needs and adequate nutrition.

The Academy for Eating Disorders estimates only about half recover from anorexia. About 33 percent of patients will have an improvement in symptoms, while 20 percent develop chronic problems. Even when treatment is successful, anorexia is a life-long battle for most patients. Some will eventually relapse and others may develop other types of eating disorders.

Anorexia affects more than the patient. The family is typically very stressed and burdened by the symptoms. For younger patients, family therapy and counseling plays an important role in recovery. But in adult patients, spouses or partners often bear the brunt of the emotional distress. Many treatment programs don’t include significant others in the therapy process. Thus, they don’t fully understand the difficulties faced by the patient and have a hard time providing adequate support.

The Couples Program

Researchers with the University North Carolina (UNC) at Chapel Hill have started a new six-month program, called “Uniting Couples in the treatment of Anorexia Nervosa,” or UCAN. The UCAN team includes a therapist, psychiatrist and dietitian. Clinical Psychologist Cynthia Bulik, Ph.D., says it’s important for partners to understand that eating disorders are not caused by a biological problem and the patient has no control over the condition and associated symptoms. Partners also need to understand the patterns associated with the eating disorder and triggers for the symptoms. The program also works on communication and listening skills to rebuild damaged relationships between the couples.

Bulik says partners of patients with anorexia usually want to help, but don’t know how. UCAN provides the education and skills to help partners learn to deal with the stress, provide support for their loved one and rebuild broken lines of communication.

UCAN is currently being tested in a clinical trial at UNC-Chapel Hill. All patients will receive free psychotherapy, psychiatric consultations and nutrition counseling. Half the couples will receive the newly designed couple’s therapy and half will receive standard family supportive therapy.

To get more information about the UCAN program, go to UNC’s website at: http://www.psychiatry.unc.edu/eatingdisorders/research%20eating%20disorders/ucan

For general information on eating disorders: Academy for Eating DisordersANAD National Association of Anorexia Nervosa and Associated Eating DisordersNational Eating Disorders AssociationNational Institute of Mental Health