Anorexia is no longer a problem isolated to just younger women; it is an affliction that is growing in its reach and numbers to people of all ages and walks of life. Anorexia Nervosa is characterized by self-starvation and excessive weight loss. Anorexia may in some cases be associated with bulimia. Girls whose families criticize their weight or eating habits may develop lasting problems with body image and self-esteem. Adolescents with restrictive eating disorders have high rates of psychiatric comorbidity and medication use.
   This web article discusses anorexia treatment.

Anorexia symptoms include
Refusal to maintain body weight at or above a minimally normal weight for height, body type, age, and activity level
Intense fear of weight gain or being “fat”
Feeling fat or overweight despite dramatic weight loss and thinness
Loss of menstrual periods
Extreme concern with body weight and shape.
People with anorexia nervosa have an abnormal brain response to hunger signals. When most people are hungry, they are motivated to eat but individuals with anorexia can be hungry and still restrict their food intake.

Anorexia treatment
This involves behavioral techniques, psychotherapy for improved self-esteem, and a variety of approaches including nutritional therapy, massage, and relaxation exercises. Treatment of anorexics is especially difficult because these individuals are resistant to getting help. More than 95% of anorexics deny that they have a problem and view anorexia treatment as an attempt to "make them fat." They believe that their low body weight is the solution, not the problem. This means that those who are close to the anorexic individual must take an active role in getting help. They may need to accompany the anorexic to appointments to make sure that the his or her behaviors are adequately described. When a person with suspected anorexia consults a doctor for diagnosis and treatment, the doctor first makes sure that endocrine, metabolic, and central nervous system disorders do not explain the apparent weight loss. They do a physical exam and take a physical history. In an individual with anorexia, the physical problems are usually the result of not eating.

Teen Anorexia
Young girls with eating disorders whose growth is stunted by undernutrition may achieve catch-up growth in height if they regain weight soon enough -- but it takes several years. For most people with an eating disorder, weight loss begins at an age when little further growth is expected. Younger patients who have not yet completed puberty, however, may experience insufficient weight gain and stunted growth at an age when further increases in stature would normally be expected. To investigate whether such patients are at risk of permanent short stature, researchers measured catch-up growth in a study of 46 girls with eating disorders, such as anorexia nervosa. At the start of the study the girls, who were 13 years old on average and weighed about 77 pounds, had heights that were below what was expected, based on their prepubertal measurements. The girls quickly gained weight during their first year of treatment for the eating disorder, and continued to gain weight at a slower rate during the following years. However, the girls continued to lag even further behind in height during the first year, and it was only during their second to fourth years of treatment that they achieved catch-up growth. Three out of four girls began their periods during follow-up. By the last check-up, these girls achieved weights and heights similar to that of their peers in the general population and had resumed their pre-pubertal growth track. Those that had not begun menstruation experienced smaller increases in height and weight. International Journal of Eating Disorders, December 2005.

Anorexia and Osteoporosis
Women with anorexia are prone to develop brittle bones, but medical treatment either with the bone-strengthening calcium and vitamin D effectively reverses the degree of osteoporosis. To prevent bone loss and fracture risk, it is very important, albeit challenging, to restore normal weight but in the meantime, Calcium and vitamin D supplementation seems to be a good anorexia treatment for the bones.  International Journal of Eating Disorders, 2006.

Cause of Anorexia
The cause is not fully known. It usually begins as innocent dieting behavior, but gradually progresses to extreme and unhealthy weight loss. Social attitudes toward body appearance, family influences, genetics, and neurochemical and developmental factors are considered possible contributors to the cause of anorexia. Adolescents who develop anorexia are more likely to come from families with a history of weight problems, physical illness, and other mental health problems, such as depression or drug abuse. Mental health problems such as anxiety disorders or affective disorders are commonly found in teens with anorexia.
     Genetic factors account for more than 50 percent of the risk of developing anorexia nervosa, according to a report in the Archives of General Psychiatry. This information should provide some reassurance to patients and families that the disease is not the result of something they did wrong. The findings are based on a comparison of anorexia in identical and fraternal twins logged in the Swedish Twin Registry. The study featured 31,406 subjects, born between 1935 and 1958, who were screened for anorexia nervosa and other disorders from 1999 through 2002. Detailed information on all subjects was also provided in 1972 to 1973.  Anorexia statistics showed the overall prevalence of anorexia nervosa in women was 1.20 percent and in men, 0.29 percent.

Anorexia danger
Full recovery from anorexia nervosa is slow, and women with the disease have close to a nine-fold increased risk of death. Anorexia nervosa patients who are treated during adolescence fare much better than those who undergo treatment as adults. Women who fare poorly are more likely to also have sexuality problems such as low libido, and impulsivity. They also suffer from their eating disorder longer before receiving treatment for the first time.

Hair Analysis for Bulimia or Anorexia
Scientists at Brigham Young University have developed a test that may be able to diagnose anorexia and bulimia by analyzing the nitrogen and carbon content of just a few strands of hair. Right now, diagnosis of these disorders relies heavily on the patients' honesty about their eating habits and body image. This is a significant obstacle because women with anorexia or bulimia often deny that they have a problem. For hair to grow, proteins have to be added to the base of the strand, and the composition of these proteins is influenced by diet. So each strand essentially contains a record of dietary intake over time. For their study, Hatch and his colleagues measured the carbon and nitrogen ratios in hair samples from 20 women with anorexia, bulimia or both, and from 23 healthy women. They found that the test was able to identify those with an eating disorder 80 percent of the time. Rapid Communications in Mass Spectrometry, November 30, 2006.

Sign of anorexia
The main sign of anorexia nervosa is weight loss, accompanied by unusual behaviors related to food, eating, or exercise. A person for whom a healthy weight would be 130 pounds, for example, may drop 25, or even as much as 50 pounds below this normal weight. Even in this thin condition, the person with anorexia may insist that he or she is overweight. Additional anorexia signs include changes in menstrual cycle, mostly minimal or absent, cold hands and feet, dry skin, and thinning hair. Another sign of anorexia could be bloated stomach.

Dietary supplement use
Q. Should women with anorexia take a multivitamin, any suggestions on foods to gain weight?
   A. Yes, that would be a reasonable anorexia treatment for potential vitamin deficiencies. See how to gain weight suggestions.

Herbs for appetite increase
Q. Are there any herbs that improve appetite?
   A. I have not studied this area that much, and besides marijuana I am not familiar with other herbs that improve appetite. But there are potentially other herbs that may be of benefit.

Front Pharmacol. 2014 Dec 10. Rikkunshito, a ghrelin potentiator, ameliorates anorexia-cachexia syndrome. Anorexia-cachexia syndrome develops during the advanced stages of various chronic diseases in which patients exhibit a decreased food intake, weight loss, and muscle tissue wasting. For these patients, this syndrome is a critical problem leading to an increased rate of morbidity and mortality. The present pharmacological therapies for treating anorexia-cachexia have limited effectiveness. The Japanese herbal medicine rikkunshito is often prescribed for the treatment of anorexia and upper gastrointestinal (GI) disorders. Thus, rikkunshito is expected to be beneficial for the treatment of patients with anorexia-cachexia syndrome. In this review, we summarize the effects of rikkunshito and its mechanisms of action on anorexia-cachexia. Persistent loss of appetite leads to a progressive depletion of body energy stores, which is frequently associated with cachexia. Consequently, regulating appetite and energy homeostasis is critically important for treating cachexia. Ghrelin is mainly secreted from the stomach, and it plays an important role in initiating feeding, controlling GI motility, and regulating energy expenditure. Recent clinical and basic science studies have demonstrated that the critical mechanism of rikkunshito underlies endogenous ghrelin activity. Interestingly, several components of rikkunshito target multiple gastric and central sites, and regulate the secretion, receptor sensitization, and degradation of ghrelin. Rikkunshito is effective for the treatment of anorexia, body weight loss, muscle wasting, and anxiety-related behavior. Furthermore, treatment with rikkunshito was observed to prolong survival in an animal model of cachexia. The use of a potentiator of ghrelin signaling, such as rikkunshito, may represent a novel approach for the treatment of anorexia-cachexia syndrome.

Dietary supplements that can make it worse
Q. Could 5-HTP be helpful for anorexia treatment?
   A. It's difficult to say whether 5-HTP offers an effective anorexia treatment since 5-HTP helps with serotonin increase, but 5-HTP could also curb appetite. My guess is that 5HTP is not the right supplement as a treatment for anorexia nervosa.

Hormones
Q. My 19 year old daughter has suffered from anorexia for 3 years - she is not bulimic - she only restricts eating. Given news on the small studies regarding oxytocin as a possible treatment for anorexia, I am very interested in seeing if this would benefit my daughter. Do you know if it is by prescription? I have seen something labeled oxytocin nasal spray on Amazon. Do you know where we would look for information and/or clinical trials for this hormone?
   A. As far as I know real oxytocin, not fake, is only available by prescription. PubMed has info on this hormone.