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Ask the Mental Health Expert Archives 2001-2004

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Definition of Anorexia

Q. Why is anorexia always stated as a person who does not want to gain weight or one who does not like the way one looks? I have suffered with anorexia for many years and it has nothing to do with my weight or my feelings about the way I look. Anorexia comes and goes with me and it tends to stem from if I'm happy or not.

My son committed suicide 2 years ago and I have almost stopped eating. I only eat when I feel hunger and sometimes I still don't eat. I feel that happiness has a lot to do with anorexia. My daughter who is 33-years-old is suffering from many mental disorders along with anorexia. My daughter weighs 87 pounds. She has lost weight from 109 pounds.

I am very worried about her. I bought her liquid vitamins to take because she said her throat felt like it was closing up and she could not swallow. My daughter does not want to lose weight and neither do I. It is like this disease has overtaken both of us. How can you make yourself eat when you don't want to eat?

A. I can appreciate how confusing this issue of anorexia is to you, as well as to many others in the general public. The problem is partly the fault of doctors--we often use the same term (anorexia) to mean two very different things. The word itself is simply Greek for loss of appetite. Anorexia as a symptom may be due to a variety of medical and psychological causes.

For example, people with certain kinds of stomach problems, anemia, or too little activity in their adrenal glands may experience poor appetite and weight loss. Depression is also a very common cause of anorexia--that is, poor appetite and/or weight loss. Then we have the official diagnosis--anorexia nervosa. This is something entirely different!

In anorexia nervosa (AN), as your question implies, there is decreased food intake associated with a deep-seated psychological problem--the individual feels she is too fat, even when her body weight is far below normal. (About 9 in 10 patients with AN are female). A person with AN may weigh 80 lbs (at 5 feet, 7 inches tall) and look to others, like a concentration camp victim--and yet be convinced she is fat. This often borders on a delusion. Psychotherapy is the most effective treatment for AN.

But, back to you--have you had a thorough physical examination with appropriate lab tests? If not, I would strongly recommend this. In the context of what you have said, however, I would certainly wonder if your loss of appetite might have to do with clinical depression. The worsening of your appetite following so closely upon your son's death raises the question of whether you may have an unrecognized and untreated depressive disorder. Normal grief--which is certainly what any parent would feel after the loss of a child--is not the same as clinical (major) depression.

Other signs and symptoms of major depression (besides decreased appetite) include loss of interest in most activities; decreased energy; a change in sleep pattern (too much or too little); loss of pleasure in nearly all activities; feelings of low self-esteem; feelings of hopelessness; or the feeling that "there's no point in going on".

I would advise both you and your daughter to seek out appropriate professional evaluation to determine what--in each of your cases--is the cause of this anorexia. There are very effective treatments available, once the correct diagnosis has been made.

September 2001

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