Although eventual outcomes of anorexia and starvation are very similar, it is important to rule out one or the other. Anorexia is primarily psychological and not simply due to appetite loss whereas starvation may be due to physical, environmental or other factors. Although here we will discuss only anorexia, several of the treatments will also help overcome the effects of starvation. Anorexia is a serious eating disorder in which people deliberately starve themselves to lose weight. No matter how thin they become, they still believe they are overweight. Without proper treatment, the disorder can be fatal. More than 90% of people with anorexia are females, though a growing number of males now have the disorder. It usually begins between the ages of 13 and 18 and is often triggered by a severe emotional shock.

According to a study, 74% of women with bulimia and 33% of women with anorexia recovered fully after 90 months, and full recovery rates increased over time. Women with bulimia nervosa tended to recover more rapidly than women with anorexia nervosa. However, about 35% of bulimics and 40% of anorectics relapsed after full recovery. [Journal of the American Academy of Child and Adolescent Psychiatry July 1999;38: pp.829-837] The earlier the treatment begins, the more rapid the recovery.

Further possible symptoms that we have not asked you about include extreme weight loss due to self-imposed starvation; an obsession with food, such as collecting recipes; hoarding food; an unwillingness to eat in public; an irrational fear of gaining weight.

Common causes:

• An overwhelming sense of being out of control, and attempting to take control of one's life by regulating food intake
• Unrealistic fear of developing an adult body
• Severe trauma or emotional shock during puberty or pre-puberty
• Anorexia is known to run in families
• Abnormal levels of certain chemicals in the brain
• Frequent dieters stand an 8-times greater chance of anorexia
• Society's unrealistic emphasis on thinness places certain individuals such as cheerleaders, dancers, runners, models, jockeys, wrestlers, and actresses and actors at higher risk for anorexia.

While most people feel uncomfortable when their calorie intake is low or restricted, people with anorexia aren't sensitive to this discomfort or to normal hunger cues. As they begin to starve, they actually experience a feeling of euphoria, very similar to how a runner or jogger gets the well-known "runner's high."

If the onset of anorexia occurs before puberty, a girl's sexual development will stop and menstruation won't begin. Severe anorexia leads to chronic malnutrition, which has damaging effects on the body, especially the thyroid, heart, and digestive and reproductive systems. Untreated anorexia can be severe enough to be fatal.

A health care provider will generally ask questions about eating habits - how much and what is being eaten - and exercise patterns. He or she will do blood and other diagnostic tests to eliminate the possibility that weight loss is caused by medical problems. Referral to a therapist or psychiatrist who understands eating disorders is then possible.

It is best to get treatment as soon as the symptoms appear, from a psychiatrist specially trained both in treating the disorder and in nutritional counseling. You may receive cognitive-behavioral, group, relaxation, or psychodynamic therapy. Your health care provider will help you "relearn" how to eat correctly. In severe cases, hospitalization may be needed. Long-term monitoring and support is necessary.