In anorexia, the problem is not seeing your body wrongly
The familiar story says people with anorexia look in the mirror and see a bigger body than they have. Recent research points elsewhere: they can judge their size accurately, but rate severely underweight bodies as the most attractive. The disturbance lies in dissatisfaction, not in eyesight.
Anorexia nervosa is an eating disorder marked by heavy food restriction, fear of gaining weight despite usually being underweight, and an intense drive to be thin, often leading to serious malnutrition. The DSM-5 describes a disturbance in how weight or shape is experienced. People may deny they are ill, weigh themselves often and limit themselves to small amounts of particular foods as a way of controlling their appearance. Some also binge and purge.
It tends to begin in adolescence or early adulthood, and its causes vary from person to person. Major life changes and stressful events commonly precede a worsening. Genes matter too: identical twins share the illness more often than fraternal twins, pointing to many genetic risk factors. Culture weighs heavily, with higher rates where thinness is prized, and it is common in sports that reward low body weight, such as gymnastics, figure skating, running and ski jumping.
The physical toll can include weakened bones, infertility, heart damage, lost periods and, in men, lower testosterone. Anorexia carries one of the highest death rates of any mental illness; about 5 percent of patients die within ten years, from medical complications first and suicide second. It directly caused around 600 deaths worldwide in 2013, up from 400 in 1990. Western estimates put lifetime occurrence at 0.3 to 4.3 percent of women and 0.2 to 1 percent of men. Diagnoses have risen since the twentieth century, though it is unclear whether cases have truly increased or detection has improved.
Treatment aims to restore a healthy weight and address the underlying psychology, often through talking therapies such as cognitive behavioural therapy or Maudsley family therapy, in which parents take charge of feeding. A low daily dose of olanzapine can boost appetite, and medication for accompanying anxiety or depression may help, but no drug cures the disorder. Severe cases may need tube feeding, though its benefit is unclear. Relapse is most likely in the first year after discharge, and roughly 31 percent relapse within two years. Many complications improve once nutrition and weight recover.
Source: Anorexia
