Anorexia

Anorexia literally means “loss of appetite” and this can be for food, music, sexual intercourse etc. Of course, there is a different name for each of these disorders, but the word “anorexia” is mostly used interchangeably for “anorexia nervosa”, which is an eating disorder wherein the sufferer abstains from food to reduce weight. Such anorectics are excessively concerned about their body shape.

One might have heard those who are ill, complain about loss of appetite which remains during the acute infection and convalescent phase. The reason for this type of anorexia is cytokines that are triggered by bacterial cell walls and have an indirect effect on appetite. In most cases, the appetite is restored once the infection has subsided.

Some common causes of anorexia are:

• Acute infection
• Anorexia nervosa (a psychiatric disorder)
• Cancer
• Long standing pain
• Chronic heart failure
• Chronic kidney disease
• Drug addiction
• Depression
• Dementia
• Hepatitis
• Metabolic disorders

There are some well known drugs that stimulate appetite, but surprisingly, there are certain drugs that suppress appetite as well. Caffeine, cocaine, nicotine are common appetite suppressants and so are alcohol and antidepressants as well as opiate pain killers to some extent.

Quite often we notice people refusing food after a traumatic event in the family or during other stressful times, and that is because the emotional burden is believed to suppress hunger.

Some celebrities and sportspersons are seen suffering from anorexia nervosa as they are under pressure to maintain a certain type of public figure and profile. Victoria Beckham, Allegra Versace, Karen Carpenter, Christina Ricci are some celebrities who are known to have suffered from this disorder. Karen Carpenter, a noted US musician died of anorexia nervosa at the age of 34 years.

There is another peculiar abnormal fasting disorder called anorexia mirabilis where the person fasts till death. This disorder was apparently common during the Middle Ages and was mostly linked to various religious reasons. It was exclusively found in women and unmarried girls, many of whom died at a very young age. So early diagnosis and prompt management is extremely important.

Treatment of anorexia nervosa

The treatment for anorexia nervosa is multimodal and weight loss is an indicator of early complication. It is important to counsel the person and at the same time improve their weight gain. Typically a team of doctors that include the treating primary care doctor, a psychiatrist, a psychologist, a dietitian and a specialist counselor is formed.  In a few cases, inpatient therapy with forceful admission is required as the patient refuses treatment.

Serotonin reuptake inhibitors and olanzapine are the first line drugs for anorexia nervosa. Other related problems including dental hygiene, constipation, oesophagitis need to be treated alongside with appropriate drugs

Anorectics may slowly kill themselves without timely assistance and there are various helpline and support groups who work to prevent this. In the United States, National Eating Disorders Association (NEDA), the Academy for Eating Disorders (AED), and Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.) are some of the noted groups.