Monday, January 18, 2010

Do you know an anorexic?

What killed Brittany Murphy? Ever since the 32-year-old actress died last month, rumors regarding the cause of her death have sprouted like weeds in spring. Media reports have suggested poorly controlled diabetes, prescription drug abuse, and complications from anorexia. As to the latter, Murphy was skinny, one look at the tabloid photos makes that clear, but was she anorexic? The results of her autopsy are pending but, realistically, we may never have a definitive answer to that question. Certainly, I am in no position to speculate one way or another. Nonetheless, this tragedy provides an opportunity to think about anorexia nervosa – a poorly understood and deceptively deadly condition. In a culture in which obesity is rampant, it is important to appreciate the distinction between applauding those who avoid the bulge and identifying and helping those who go too far.

Anorexia is more than just being skinny or being a diet or exercise nut – it is a psychological condition defined by distorted body image and associated with low self-esteem and poor coping mechanisms. It affects both women and men and usually does so at a young age. Anorexia comes in two major variations – the restrictive type (severely cutting back on food intake) and the binging and purging (bulimia) type. Both are associated with other psychological conditions and often go undiagnosed for years. Think you know someone with anorexia? You probably do – one out of every two people does. And although most anorexics struggle in secrecy there is a “Pro-ana” movement out there that defends anorexia as a lifestyle choice – which makes about as much sense to me as choosing to be a paranoid schizophrenic.

Make no mistake; anorexia is a serious illness with serious medical complications. People with anorexia can develop osteoporosis, thyroid problems, decreased infection-fighting capabilities, body salt imbalances, heart arrhythmias, severe bloating, and seizures. They are also at increased risk of suicide. In fact, the death rate among anorexics may be as high as 20% – meaning that one in five people with anorexia will die prematurely from complications associated with the disease. This mortality rate is far higher than rates associated with highly publicized health threats such as the swine flu and high blood pressure (hypertension). And this winter, while you’re worried about missing work because of a cold, consider that anorexics are at a far greater risk of dying during cold weather due to infection or hypothermia.

This case report from Medical Emergencies in Anorexia Nervosa (Jane Morris and Chris Freeman) paints a typical and tragic picture:

“A 26 year old hairdresser took up running, started an extreme diet and lost weight swiftly over eight months, steadfastly refusing help. She finally presented to the hospital with chest pains. At this stage her BMI [body mass index] was 13.5 [low end of normal is 18.5]…She declined all food in the hospital but tolerated an IV [intravenous] line. She believed that as a result of this she had gained weight. She died in her sleep the following week, the night after swimming ten lengths of her local pool.”

Are you concerned that someone you know is on the brink of this type of calamity? How do you know whether someone might be suffering from the anorexia? Here are some clues:

- Refusing to eat in front of others or eating slowly and very little

- Preparing elaborate meals for family and friends but not eating anything themselves

- Continued dieting, despite being very thin and having already achieved significant weight loss

- Obsession with exercise combined with extreme dieting

Unfortunately, identifying someone who needs help may be easier than persuading them to seek help. The key is to bring the issue to light, in a constructive rather than confrontational manner. Be aware that denial is common, especially when it comes to the serious health risks associated with anorexia. I spoke with Dr. Irina deFischer, a Kaiser family physician and eating disorder expert: “It is important to involve parents, other family members, loved ones, and friends in getting patients into treatment – these patients are often not motivated to seek treatment on their own because they don't perceive that the eating disorder is hazardous to their health – there is a strong societal message that eating ‘healthy,’ losing weight, and exercising a lot are good things, and they get a lot of strokes for being thin and looking good.” This re-enforcement, of course, is counter-productive, especially since treatment for eating disorders – whether it be therapy and/or medication – is far more effective early in the disease process than after the illness has been simmering for years.

So, if indeed Brittany Murphy suffered from anorexia, she likely had suffered for years and reached an age at which successful intervention would have been very tricky. Take a moment to consider that and whether there is someone you can help now – before it is too late.

Some web resources: