The Frankfurt psychiatrist Heinrich Hoffmann wrote *Struwwelpeter* in 1844. He intended the book to be a guide to good behavior for children. He devoted one chapter to “Suppenkasper.” In it, he tells the story of a boy who refuses to eat and rapidly loses weight. In the end, he dies.
The phenomenon of anorexia is therefore not a condition that first emerged in the modern world. Nevertheless, researchers suspect that the incidence of the disease is rising in line with modern ideals of beauty.
Approximately 0.5 to 1 percent of the population develops anorexia over the course of a year. Anorexia most commonly affects young women between the ages of 15 and 25. In this group, there are 50 to 75 cases per 100,000 women.
Anorexia: Diagnosis
Anorexia is a mental illness classified as an eating disorder. In the World Health Organization’s (WHO) diagnostic classification, it is coded as F50.0 Anorexia Nervosa.
A reliable diagnosis is typically made by:
- a specialist in psychosomatic medicine
- a neurologist or psychiatrist, or
- a licensed psychotherapist
The following examinations are necessary for this:
- a detailed interview (medical history)
- Calculation of the body mass index (BMI)
- Measurement of blood pressure, pulse, and temperature
- Check for edema
- Complete blood count
- Assessment of heart, liver, and kidney function
Symptoms of anorexia
The primary symptom of anorexia is strictly controlled and reduced food intake. At the same time, those affected try to burn as many calories as possible—usually through excessive exercise.
Patients often mask this refusal to eat by claiming a lack of appetite (“I’m not hungry.”) Or they make excuses to avoid eating with others (“I already ate at home.”)
Suppressing a basic need like hunger requires an enormous amount of discipline on the part of those affected. As the disease progresses, patients no longer perceive the sensation of hunger.
Starvation and weight loss lead to physical symptoms such as:
- low blood pressure
- water retention
- Osteoporosis (reduced bone density)
- dry skin
- Digestive problems
- Electrolyte imbalances and
- Changes in the brain (reversible atrophy)
Chronic cases are dangerous because they increase the risk of life-threatening conditions, such as heart failure.
Anorexia also manifests itself through psychological symptoms.
The following often occur:
- social withdrawal
- depressed mood
- inner restlessness, and
- compulsions
Treatment of Anorexia Nervosa
Psychotherapy is considered the first-line treatment for anorexia nervosa. In milder cases, outpatient therapy is sufficient.
However, hospitalization is often advisable. In cases of life-threatening underweight, emergency care (force-feeding) may be necessary.
The primary goals of therapy are:
- Weight normalization
- (Re)learning healthy eating habits
- Resolving conflicts, and
- Examining one’s own body image
Through individual or group sessions, those affected learn strategies—for example—to break compulsive patterns and resolve conflicts.
Nutrition counseling—such as through cooking groups—helps those affected return to a normal relationship with food.
It is also important to have a supportive environment that is familiar with the specific characteristics of anorexia and provides the necessary support. Comments such as “Why don’t you just eat more?” are inappropriate and are perceived as hurtful by those affected.
Since the illness usually begins during puberty or in young adulthood, the family plays an important role.
It’s important to remember that puberty and coming of age place enormous demands on everyone involved.
Parents and young people must navigate the process of separation. It’s important to find new ways of relating to one another in the future. Old wounds resurface, uncertainty sets in, and misunderstandings are commonplace. It’s a difficult phase for both sides.
When the family is involved in therapy, this is not an accusation but rather a key component of a comprehensive treatment plan.
Psychotherapy is the most appropriate treatment for anorexia @ Pormezz /AdobeStock
Digital Technology in Therapy
The nonprofit organization Jourvie offers apps for the early detection of eating disorders as well as digital therapy companions. The app for those affected is called Jourvie.
Among other features, it includes a food diary with an archive function, motivational exercises, and helps users cope with difficult situations. The Elamie app provides family members with important information on early detection.
The company partners with, among others:
- the AOK health insurance provider
- Therapienetz Essstörungen e. V. and
- ANAD e. V. (Eating Disorders Care Center in Munich)
Prognosis and Course
Contrary to the common belief that anorexia is a lifelong condition, a research group from Boston reports encouraging news.
The results of a long-term study from 2016 show that the majority of patients have recovered from the illness by adulthood.
This knowledge provides realistic grounds for hope—especially for patients with chronic anorexia. Until now, they were considered incurable.
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About the medical author
Sabine Schneider
Editor-in-Chief
Sabine Schneider – medical author: Explore expert articles and medical expertise in the Leading Medicine Guide.
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