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Anorexia Nervosa

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Who is at risk for developing anorexia nervosa?

People who become anorexic often were good children --

eager to please, conscientious, hard working, and good

students. Typically they are people pleasers who seek

approval and avoid conflict. They may take care of

other people and strive for perfection, but underneath

they feel defective and inadequate. They want to be

special, to stand out from the mediocre masses. They

try to achieve that goal by losing weight and being


Some clinicians believe that the symptoms of anorexia

are a kind of symbolic language used by people who

don't know how to, or are afraid to, express powerful

emotions directly, with words. For example, making

one's body tiny and thin may substitute for, "I'm not

ready to grow up yet," or "I'm starving for

attention." Refusing to eat may translate to "I won't

let you control me!"

People who develop anorexia often feel stressed and

anxious when faced with new situations. Many are

perfectionists who have low tolerance for change

(including the normal physical changes their bodies

experience at puberty), feeling that it represents

chaos and loss of control. Some set rigid, unrealistic

standards for themselves and feel they have failed

totally when they cannot achieve and maintain the

degree of excellence they demand of themselves.

In addition to restricting food, classic anorexics

also restrict other areas of their lives. They are

risk-averse individuals, preferring to live closely

circumscribed lives, with few changes in established

routines, to which they tightly cling. They need to

become more adventurous and learn how to cope with

expanded horizons.

Although people who have anorexia nervosa don't want

to admit it, many fear growing up, taking on adult

responsibilities, and meeting the demands of

independence. Many are overly engaged with parents to

the exclusion of peer relationships. They use dieting

and weight preoccupations to avoid, or ineffectively

cope with, the demands of a new life stage such as

adolescence, living away from home, or adult


What causes eating disorders?

There are many theories and no one simple answer that

covers everyone. For any particular person, some or

all of the following factors will be woven together to

produce starving, stuffing, and purging.

Biological factors

Temperament seems to be, at least in part, genetically

determined. Some personality types

(obsessive-compulsive and sensitive-avoidant, for

example) are more vulnerable to eating disorders than

others. New research suggests that genetic factors

predispose some people to anxiety, perfectionism, and

obsessive-compulsive thoughts and behaviors. These

people seem to have more than their share of eating

disorders. In fact, people with a mother or sister who

has had anorexia nervosa are 12 times more likely than

others with no family history of that disorder to

develop it themselves. They are four times more likely

to develop bulimia. (Eating Disorders Review. Nov/Dec


Studies reported in the New England Journal of

Medicine (3/03) indicate that for some, but not all,

people heredity is an important factor in the

development of obesity and binge eating. Now there are

suggestions that women who develop anorexia nervosa

have excess activity in the brain's dopamine

receptors, which regulate pleasure. This may lead to

an explanation of why they feel driven to lose weight

but receive no pleasure from shedding pounds. (Journal

of Biological Psychiatry; July 2005. Guido Frank, et


Also, once a person begins to starve, stuff, or purge,

those behaviors in and of themselves can alter brain

chemistry and prolong the disorder. For example, both

undereating and overeating can activate brain

chemicals that produce feelings of peace and euphoria,

thus temporarily dispelling anxiety and depression. In

fact some researchers believe that eating



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