Body Cage

2. In developed societies, Anorexia Nervosa is the third most common chronic illness. It is ten times more common than Insulin Dependant Diabetes (IDDM).

3. Anorexia Nervosa causes severe depression, psychological distress, family disruption, physical morbidity and has the highest mortality rate of any functional psychiatric illness, with 20% of patients dead in twenty (20) year follow up studies.

Here is some data to justify these claims.

Although often dismissed as a "rare illness", anorexia nervosa is actually highly prevalent when compared with other serious diseases. Point prevalence for girls in the age group 15-19 is 0.5%, and about half that in women aged 20-24. After obesity and asthma, it is the most common disease in this population group, and it is a much more deadly condition than either of the others. It is 10 times more common than IDDM. Its prevalence rate of 0.5% in one age group should be compared with the lifetime risk of 1% of schizophrenia.

In NSW at least 400 new cases are diagnosed each year, and about 5,000 patients are affected by anorexia nervosa at any one time.

The mortality rate on a number of follow-up studies is about 20% at 20 years. This is completely unacceptable for a disease whose sufferers have an average age at onset of 17 years. The overall mortality rate for anorexia nervosa is 5 times that of the same aged population in general, with deaths from natural causes being 4 times greater (e.g. cardiac arrhythmia, infection), and deaths from unnatural causes 11 times greater than expected. The risk of successful suicide is particularly high, being 32 times that expected. These figures may be compared with major depression, in which the overall mortality risk is 1.4 times that expected, with deaths from unnatural causes being 7 times and those from suicide 20 times greater than expected.

Anorexia nervosa has a chronic course with the average duration of illness being 5 years. Even those who "recover" are unlikely to return to fully normal health. The risk of a first degree relative of a proband for developing the disease is 10 times that of the general population. Many patients become chronic, and the disease brings about a degree of social handicap comparable to schizophrenia. Certainly, because it usually occurs at the crucial stage in the victim's physical, psychological and social development, it causes serious impairment of functioning and interferes with education, work training, adaptation to peer relationships, sexual relationships and separation from the family of origin.

Persistent psychiatric morbidity is common, especially dysthymia, major depression and obsessive-compulsive disorder. The disease leads to brain atrophy and a disorder of myelination, and it may have a persistent effect on cognition. Cardiac arrhythmias are a common cause of sudden death in anorexia nervosa patients. Long-term physical morbidity is also common and serious. Growth retardation is present in some patients who have an early onset of disease. Anovular infertility is common in some women who have only partially recovered. Osteopaenia leading to osteoporosis is a serious complication of the active disease, but may also have long-term effects because bone mineralization in women terminates with the menopause. Those who have not accumulated sufficient bone in younger life are prone to developing osteoporosis with ageing earlier than their peers. More women die as a result of a fractured femur than of breast cancer. Renal and hepatic function are frequently permanently impaired by anorexia nervosa, and a neurogenic bowel with subsequent rectal prolapse is common, sometimes but not invariably associated with laxative abuse.

The effects of the disease on the family are horrendous. Unfortunately, parents have been blamed for causing the disease in their offspring. Anorexia nervosa is often claimed to result from sexual abuse, but this is less common than alleged. As a result, parents are made to feel guilty. The sick person imposes strain on all members and relationships within the family, leading to family dysfunction, marital discord and the relative neglect of siblings.

Compiled by Chris Thornton, Director of Eating Disorder Day Programs, Wesley Private Hospital, Ashfield, NSW.

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