Anorexia is among the psychiatric conditions with the highest mortality rate, with an estimated 6% of anorexia victims dying from complications of the disease.  The most common causes of death in people with anorexia are medical complications of the condition including cardiac arrest and electrolyte imbalances.  Suicide is also a cause of death in people with anorexia.
Early diagnosis and treatment can improve the overall prognosis in an individual with anorexia.  With appropriate treatment, about half of those affected will make a full recovery.  Some people experience a fluctuating pattern of weight gain followed by a relapse, while others experience a progressively deteriorating course of the illness over many years and still others never fully recover.  It is estimated that about 20% of people with anorexia remain chronically ill from the condition.
As with many other addictions, it takes a day-to-day effort to control the urge to relapse.  Many individuals will require ongoing treatment for anorexia over several years, and some may require treatment over their entire lifetime.

Anorexia may be treated in an outpatient setting, or hospitalization may be necessary.  For an individual with severe weight loss that has impaired organ function, hospital treatment must initially focus on correction of malnutrition, and intravenous feeding may be required.  A gain of between one to three pounds per week is a safe and attainable goal when malnutrition must be corrected.
The overall treatment of anorexia, however, must focus on more than weight gain.  There are a variety of treatment approaches dependent upon the resources available to the individual.  Because of increasing insurance restrictions, many patients find that a short hospitalization followed by a day treatment program is an effective alternative to longer inpatient programs.  Most individuals, however, initially seek outpatient treatment involving psychological as well as medical intervention.
Different kinds of psychological therapy have been employed to treat people with anorexia.  Individual therapy, cognitive behavior therapy, group therapy, and family therapy have all been successful in treatment of anorexia.  Those with anorexia can be treated by a medical doctor, a clinical psychologist, or both, depending upon the progression of the disorder.  A psychiatrist with both medical and psychological training is perhaps the best treatment provider.  An appropriate treatment approach addresses underlying issues of control and self-perception.  Family dynamics are explored, and often the family is included in the treatment plan.  Nutritional education provides a healthy alternative to weight management for the patient.  Group counseling or support groups often assist the individual in the recovery process.  The ultimate goal of treatment should be for the individual to accept herself/himself and lead a physically and emotionally healthy life.
While no medications have been identified that can definitively reduce the compulsion  too starve themselves, some of the selective serotonin reuptake inhibitor (SSR) antidepressant drugs have been shown to be helpful in weight maintenance after weight has been gained, and in controlling mood and anxiety symptoms that may  be associated with the condition.

• Kidney (renal) function may appear normal.  However, there are significant changes in kidney function in many people with anorexia, resulting in potassium deficiency, increased urination, or decreased urination.
• Anorexics who use a large quantity of laxatives or who frequently vomit are at great risk for electrolyte imbalance, which can have life-threatening consequences.
• Anemia is frequently found in anorexic patients.  Suppressed immunity and a high risk for infection are suspected, but not clinically proven.
• Physical symptoms, other than the obvious loss of weight, can also be seen.  Anorexia can cause dry, flaky skin that takes on a yellow tinge.  Fine, downy hair grows on the face, back, arms, and legs.  Despite this new hair growth, loss of hair on the head is not uncommon.  Nails can become brittle.  Frequent vomiting can erode dental enamel and eventually lead to tooth loss.

Most of the medical complications of anorexia nervosa result from starvation.  Few organs are spared the progressive deterioration brought about by anorexia.

• Heart and circulatory system: Although not life-threatening, an abnormally slow heart rate (bradycardia) and unusually low blood pressure (hypotension) are frequent manifestations of starvation and are commonly associated with anorexia.  Of greater significance are disturbances in the heart rhythm (arrhythmia).  A reduction in the work capacity of the heart is associated with severe weight loss and starvation.
• Gastrointestinal complications are also associated with anorexia.  Constipation and abdominal pain are the most common symptoms.  The rate at which food is absorbed into the body is slowed down.  Starvation and overuse of laxatives can seriously disrupt the body’s normal functions involved in the elimination process.  While liver function is generally found to be normal, there is evidence of changes in enzyme levels and overall damage to the liver.
• The glandular (endocrine) system in the body is profoundly affected by anorexia.  The complex physical and chemical processes involved in the maintenance of life can be disrupted, with serious consequences.  Disturbances in the menstrual cycle are frequent and can affect not only fertility but also bone density, which is very important to a woman’s health as she ages.  Hormonal imbalances are found in men with anorexia as well.  Continual restrictive eating can trick the thyroid into thinking that the body is starving, causing it to slow down in an attempt to preserve calories.

Next week we will continue to discuss the physical signs and symptoms of anorexia.