Anorexia nervosa is the third most common disorder in female adolescence. However, the eating disorder can also occur in later years of life – and in men. Anorexics sometimes starve themselves to a life-threatening underweight by severely restricting their food intake, doing excessive sports or vomiting. Dr. med. Hans Peter Hofmann, specialist for psychosomatic medicine, psychiatry and psychotherapy informs about causes, consequences and therapy of the disease.
Contents at a glance
Dr. med. Hans Peter Hofmann is a specialist in psychosomatic and psychotherapeutic medicine, as well as a specialist in psychiatry and psychotherapy. As head physician at Ananke, a center for psychosomatics and eating disorders in Freyung, Bavaria, he treats eating disordered patients who have been admitted as inpatients.
When is a patient considered anorexic??
Mr. Dr. Hofmann: The diagnosis "anorexia" is made when someone has a body mass index (BMI) below 17.5, i.e. the weight falls below a certain range. A BMI between 19 and 25 is considered normal, below 19 the range of underweight begins. However, the anorexics themselves do not notice this, usually it is parents, teachers or friends who point out that they keep losing weight.
We distinguish between the restrictive and the active type in anorexics:
- The restrictive type Adheres to diets and starves themselves in order to lose weight.
- The active type vomits in addition.
In addition, almost all anorexics exercise excessively to counteract weight gain. The high urge to exercise manifests itself, for example, by doing a workout at least twice a day or a long-distance run once a day. Starving and losing weight – as described in the term "anorexia" – has become an addiction over which sufferers have lost control.
Who is primarily affected by anorexia?
Women are affected significantly more often than men. In our daily practice, we have about five to ten percent male patients. Between the ages of twelve and 35, three to six out of every 1000 women suffer from anorexia in a twelve-month period. For men between 13 and 24 years, it is one in 1000 in twelve months.
The typical age at which anorexia occurs is adolescence – but it can also occur into old age. As a rule, the visible onset of the eating disorder is between twelve and 14 years of age. Also particularly affected are young girls, who are very athletic, performance-oriented and often do well in school or at work.
"As a rule, the visible onset of the eating disorder is between twelve and 14 years of age. In addition, young girls who are very athletic, performance-oriented and often do well at school or in their jobs are particularly often affected."
Dr. med. Hans Peter Hofmann
Specialist in psychosomatic medicine, psychiatry and psychotherapy
Does perfectionism play a role as a character trait??
A shot of perfection is often part of the equation, because most anorexia patients have a compulsive streak. As a rule Anorexia occurs together with other mental disorders such as obsessive-compulsive disorders, Anxiety disorders and depression on. Many sufferers deny their illness for a long time and only develop the motivation to beat it when they realize that their performance is significantly impaired.
Does anorexia occur more frequently in the Corona pandemic?
Those with a history of mental illness are particularly affected by the restrictive measures and contact restrictions in the pandemic. Due to the increased family contact, people feel more noticed or even observed. Those who have already had problems with eating disorders suffer relapses more frequently. Anxiety disorders and depression in particular occur more frequently during the pandemic.
Which triggers and causes are responsible for the development of anorexia nervosa??
Various factors play a role. In the Adolescence The body changes, it becomes sexually mature. For example, the developmental spurt causes the pelvis to widen or young girls to gain some weight. Appearances begin to play an important role. In our society, unfortunately, the formula still applies: Who is slim is sexy and who is sexy is successful.
At this age, the first weight loss attempts take place, which are often not noticeable to the outside world. Or are considered normal by their parents. It is not uncommon for mother and daughter to go on diets together. But these can become independent and thus trigger anorexia. In addition, there may be negative, offending feedback from outside or comparison with slimmer friends.
In addition, genetic disposition plays a very decisive role in the development of anorexia nervosa. The greater the genetic disposition, the fewer sociocultural trigger mechanisms – such as unstable self-esteem or external slights – patients need to become ill. Anorexia also occurs more frequently in families. Often a difficult family atmosphere, If, for example, the mother is already struggling with eating disorders or has had them.
"In our society, unfortunately, the formula still applies: Who is slim is sexy and who is sexy is successful."
Dr. med. Hans Peter Hofmann
Specialist in psychosomatic medicine, psychiatry and psychotherapy
What does therapy for anorexia look like?
In therapy, the aim is to jointly overcome the sound barrier that the affected person has set for themselves: Anorexics have a certain weight in mind that is logically unquestionable. So they can’t explain why they stick to that weight number, but have a massive, paranoid fear of exceeding it.
Therapy therefore consists of two strands of action:
- It becomes a Eating contract is concluded: Patients are told to gain weight. A BMI of 19 should be reached, this marks the border to being underweight. For this we work on the normalization of eating behavior.
- In the Talk therapy Fears and worries are discussed during the treatment. Various approaches are possible: for example, a depth psychological, behavioral or family therapeutic approach.
When is outpatient treatment, when is inpatient treatment??
There is a guideline from the professional association: If the BMI is below 15, inpatient treatment is required; above that, outpatient treatment is possible. Many anorexics are massively underweight when they are admitted to a clinic. In some cases, her BMI is already at ten and thus in a life-threatening range.
© iStock / Viktoria Korobova
What consequences can anorexia have?
The electrolyte and water balance of the body is disturbed by the lack of food intake and possibly by additional vomiting. This can lead to slowed heartbeat, cardiac arrhythmias and kidney dysfunction lead. In the worst case a cardiac arrest can be the consequence. Due to the vomiting Tooth enamel damaged. In addition Circulatory problems and concentration disorders occur.
Another very serious consequence is the Osteoporosis. In severe anorexia, the lack of nutrients leads to irreversible bone loss. Chronic anorectic patients are therefore more prone to bone fractures.
In the case of severe underweight, the so-called Lanugo hair. The fine fuzz of hair forms to prevent the body from cooling down.
Ultimately, there is underactivity in all areas of the body, which can be maintained for different lengths of time in different individuals. At some point, patients may be dependent on a wheelchair. Even a mild infection can lead to a dangerous electrolyte imbalance and thus to death. The chronically anorectic patients have up to 16 percent increased risk of dying from anorexia nervosa.
Furthermore, if anorexia begins early in life, it can lead to problems in development lead. Bone growth may be disturbed, and menstruation may not even occur or be absent.
"The chronically anorectic patients have up to 16 percent increased risk of dying from anorexia nervosa."
Dr. med. Hans Peter Hofmann
Specialist in psychosomatic medicine, psychiatry and psychotherapy
What are the chances of recovery from anorexia??
Treatment is complicated because most patients suffer from multiple mental illnesses. About 50 percent of those treated are cured – but often an inpatient stay is not sufficient for this.
Among the remaining 50 percent, there is a part that will always have problems with eating disorders. Anorexia can develop into bulimia or binge-eating disorder, for example. The other part remains chronically ill with anorexia and thus has an increased risk of death. Among other things, this is also due to the fact that patients with addiction and anorexia have the highest risk of suicide in the field of mental illnesses.
How should relatives or friends of anorexics behave?
You should address anorexia in a well-meaning, inquiring and non-reproachful tone. A family doctor should also be involved, who regularly checks the weight, keeps an eye on the electrolytes and carries out an ECG. He can refer to a specialist for eating disorders. There is also a lot of helpful information for parents and patients on the Internet, for example the Bavarian therapy network for eating disorders.
Counseling centers exist throughout Germany. Both those affected and their relatives can contact us here. Parents come to our clinic even without their child for a preliminary talk and get advice. In any case, one should not look away, but ask questions!