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Middletown Transcript
  • Dr. Jeff Hersh: Helping friend with eating disorder

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  • Q: I think my best friend, who is 16 like me, has anorexia. She is really skinny but she refuses to eat anything. Is there any way I can help?
    A: Restricting caloric intake even when someone is underweight for their age and size is one of the diagnostic criteria for the eating disorder called anorexia nervosa. The other criteria include:
    • A fear of gaining weight and/or behavior that prevents weight gain.
    • A disturbed self-body image that makes the person perceive themselves as overweight even when they are underweight for their age and height.
    Anorexic women who are old enough to have had onset of their menses commonly miss periods or even have their periods stop for a while.
    There are two types of anorexia;
    • Restriction type where caloric intake is limited; this may be accompanied by excessive exercise to burn off the limited calories taken in.
    • The purging type with throwing up after eating, laxative abuse and/or diuretic abuse to prevent weight gain.
    Anorexia is actually not about the patient’s weight; it is about reacting to psychosocial issues (such as depression, insecurity, feeling like they have no control of their lives and/or feeling like they cannot live up to the level of perfection they feel they need to) in an unhealthy manner. Anorexics take control of their eating as a way to exert control of some aspect of their lives; in fact some patients consider anorexia their “friend.”
    Anorexics will often hide their eating issue, sometimes having secret eating rituals. It is very common that they deny that there is any eating issue at all.
    There may be a genetic aspect to anorexia as it is more common in a sibling of an anorexic than the general public. Some studies have identified possible functional and/or structural abnormalities in the brains of anorexics. Cultural things, such as society’s identification of being thin as an “ideal” body image, add to the pressure anorexics feel, as does participation in certain activities such as ballet, gymnastics or modeling where being thin is again identified as “ideal;” all this may add to a patient’s distorted self-body image. People with anorexia have a higher incidence of certain psychiatric issues (depression, anxiety and/or personality disorders) as well as substance abuse.
    Anorexia is very common, affecting 1 to 4 percent of women in their lifetimes; it is 10 to 20 times less common in men than in women. Anorexia is most common in adolescent and young women between the ages 13 and 30, although it can affect anyone of any age.
    There are screening questionnaires that have a high accuracy of identifying people with a possible eating disorder (there is a link to screening for eating disorders at the National Eating Disorder Association website, nationaleatingdisorders.org). However, as noted above, there are certain criteria to make the diagnosis of anorexia nervosa, and this diagnosis should be validated by the patient’s healthcare provider.
    Page 2 of 2 - Anorexia may lead to significant medical consequences stemming from malnutrition and starvation. Furthermore, anorexics have a 20 times higher overall risk of death than their healthy peers, with suicide being a common cause of death for them; anorexics have one of the highest mortality rates of all psychiatric disorders.
    The goal of treatment of anorexics is to get them back to a healthy weight and then have them maintain it; to do this they will need to overcome their fear of gaining weight.
    The first step in treating someone with anorexia is for them to accept that there is a problem. They will then need to accept help.
    A medical evaluation is important to identify any acute medical issues, and if these exist (such as electrolyte abnormalities) they need to be addressed.
    The patient will then need counseling to better understand their condition. This will include helping them gain insights to achieve a healthier perception of their body image. They will also need to speak with a dietician.
    Over half of anorexics will recover with appropriate treatment, achieving and maintaining a healthy weight; another 25 percent get significantly better. Unfortunately, 25 percent do not respond well to treatment, and many anorexics (up to 5 percent or more) die prematurely.
    The most important step for someone with anorexia is to understand that they have a problem. The National Eating Disorders Association has a toll free hotline at 800-931-2237 and a website, nationaleatingdisorders.org, where patients and/or their friends and family can reach out for information, guidance and help.
    Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.

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