Deadliest Psychiatric Disorder: Anorexia

Singer Karen Carpenter was probably the most famous person to die of anorexia nervosa, but this eating disorder has claimed many more lives. Indeed, a new study from England ranks anorexia nervosa as the most lethal of all psychiatric disorders, responsible for twice as many deaths as schizophrenia and three times as many as bipolar disorder (manic depression). The risk of death from anorexia seen in the study was highest among patients in their twenties - 18 times the normal risk in this age group.

Not surprisingly, the most common cause of death in anorexia patients is complications of malnutrition. However, about 20 percent of all these deaths are due to suicide. The English study, published in the July issue of the Archives of General Psychiatry, also showed that death rates from bulimia (a binge and purge eating disorder) and other types of eating disorders (which the authors didn’t specify) were also higher than normal.

Learn about those who dealt with eating disorders in the public spotlight.

Up to 10 million women and 1 million men in the United States suffer from anorexia nervosa, according to the National Eating Disorders Association.

Anorexia: Fear of Gaining Weight

Strictly speaking, the word “anorexia” means loss of appetite, but that’s not the problem with anorexia nervosa. Here, the term means a refusal to maintain body weight within 15 percent of what’s considered normal for a given individual. Typically, patients have an overwhelming fear of gaining weight, a distorted body image (no matter how thin, they think they’re too fat), and they tend to deny that they’re got a problem.

Some patients maintain a lower than healthy weight with very strict low-cal diets that they devise themselves. Food intake may be limited to a narrow range of foods, such as lettuce, carrots, popcorn and diet soda; or extreme picky eating. Anorexics may also exercise excessively.

Is picky eating considered an eating disorder in adults?

No one knows what causes anorexia nervosa, but the disorder seems to run in families - those with an affected relative are at 10 times the normal risk. Medical studies have yielded certain biochemical clues: the neurotransmitters serotonin and norepinephrine are lower than normal in anorexics; patients also have higher than normal levels of cortisol, a stress-related hormone and of vasopressin, a brain chemical that also tends to be high in those with obsessive compulsive disorder. 

Warning Signs

The most obvious warning signs of anorexia nervosa include being much too thin and overly preoccupied with food. Some other telltale symptoms to watch for:

• Not menstruating or missing three or more consecutive cycles, in women of reproductive age
• Brittle nails and hair
• Dry, blotchy, yellow looking skin
• Thinning bones (osteoporosis or osteopenia)
• Feeling cold all the time (because body temperature drops when you’re too thin)
• Growth of baby fine hair on the body.
• Ritualistic eating habits (refusing to eat in front of others, cutting food into tiny bites or cooking big meals for others but not eating themselves).
• Depression, anxiety or substance abuse

Who’s at Risk?

More than 90 percent of anorexics are teenage girls or young women, but the disorder can occur at any age - in kids as young as seven and women as old as 80. The disorder is far less likely to occur among men than among women, but it happens. Patients tend to be perfectionists striving for the “ideal” slim body of actresses and models. Other risk factors include:

• Depression, anxiety, obsessive-compulsive disorder
• A big life change, such as moving or going to a new school
• Participating in sports (or professions) that prize a lean body
• Problems dealing with stress
• History of sexual abuse or other trauma

A study published in the June issue of Pediatrics found that teenagers who eat at least five meals a week with their families are 35 percent less likely to develop eating disorders than teens who don’t participate in family meals as often. Commenting on the study, author Barbara Fiese, PhD, professor of human development and family studies at the University of Illinois, said that family meals enable parents to spot signs of eating problems so that they can take steps to prevent a full-blown disorder from developing.

Treating Anorexia

Treating anorexia nervosa can be tricky since most patients don’t recognize that they have a problem. The first goal is to restore patients to normal weight and healthy eating habits, but depending on the severity of the case, this may require a healthcare team: a medical doctor to deal with any symptoms resulting from malnutrition, a nutritionist to help patients regain lost weight (if and when they do, symptoms often resolve) plus psychotherapy, family therapy and group therapy.

The outlook for successful treatment is best among younger patients. In other cases, anorexia can become chronic and a life-time problem. And for the unluckiest 10 percent, it can be deadly.

Find out how to recognize the symptoms of anorexia nervosa.

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