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Ask the Experts

Question:

A female friend, who is 5' 2 "tall and weighed 103 pounds, has lost 20 pounds over 2 years. Her main complaint is burning in her GI tract. She believes it is reflux and gastritis, and her GI doctors call it visceral hypersensitivity.

This burning and a lack of response to traditional GI therapies have thrown her into a deep depression, acute anxiety and insomnia. She is afraid to eat because of the subsequent burning.

Nothing has worked for her. Is this an eating disorder? How do you get someone to eat if they are so afraid of pain from eating?

Answered by: Evelyn Attia

Anorexia nervosa (AN) is characterized by low weight, a reluctance to eat or gain weight, despite the fact that weight is low. In young women, these symptoms are often associated with loss of menstruation.

AN develops when a vulnerable individual loses a significant amount of weight for any reason. For many, the weight loss occurs following voluntary dieting behavior. For others, the weight loss can occur because of illness, change in activity level, or other causes.

Low weight AN is generally associated with worsened mood, heightened anxiety, increased obsessions about food and related topics. These symptoms are best understood as resulting from the low weight state, and require weight restoration for resolution. Nutritional rehabilitation and weight restoration are the essential first steps in helping individuals with AN.

Often, individuals who are reluctant to eat become more motivated when they learn that their mood, anxiety and obsessions will likely improve substantially with weight gain. Low weight patients should be evaluated by clinicians who are familiar with eating disorders so that a range of available treatments can be discussed with the patients.

Outpatient approaches are generally tried first; more structured programs (day treatment and hospital-based) are used if outpatient treatment is not successful.