Anorexia nervosa is generally regarded as a psychiatric disorder characterized by abnormal eating behaviors that may lead to an extreme weight loss and serious medical consequences. It is a relentless pursuit of thinness. Its etiology is unknown, and may be irrelevant, since its management does not depend on its etiology. We shall therefore study its evolution within a framework described elsewhere.
The refusal to eat is one component of a complex disease. It is called here disease indicator. It is not the disease itself. It is the best solution created by WOB in order to maintain the patient's life. This may come as a surprise since the patient virtually fades away. Despite her hunger she refuses to eat. One is inclined to regard her behavior as a psychiatric disorder. Obsession with food, self mutilation, or an obscure neurosis. In reality Anorexia Nervosa is a misnomer. It obviously is not a loss of appetite, since the girl is hungry and starving, and it does not originate in the nervous system. It ought therefore be called. Pernicious (self inflicted) Anorexia (PA).
Mind-PA and WOB-PA
We shall distinguish between Mind-PA and WOB-PA. There are two kinds of Mind-PA. 1. A benign Mind-PA, like the pursuit of a Barbie figure, or the dream to become a gymnast like Nadia Comaneci (www.nadiacomaneci.com), and 2. A malignant Mind-PA, which results from a biased attitude of the society to PA, which regards it as abnormal, and attempts to correct it by force feeding.
PA is first of all a WOB solution and we wonder what drives it? The forthcoming arguments will be illustrated with an attractive hypothesis by R. Wheatland according to whom PA is driven by a relative adrenocortical insufficiency.
PA proceeds through three
1. Full compensation when adrenocortical hormone is adequate, and patient feels healthy.
2. Decompensation, when adrenocortical hormone is inadequate, and patient is forced to starve, and reduce weight. Accompanied by amenorrhea or loss of secondary sex characteristics in males.
3. Total decompensation, which results from complications of prolonged starvation, e.g., pancytopenia, or cardiovascular complications, like dysrhythmias
Suppose that the child suffers from a relative adrenocortical insufficiency. As long as it is small, his adrenal produces enough hormones to keep it healthy. At puberty the delicate balance is offset. The growing body demands more adrenocortical hormones, which the adrenal fails to supply and the child enters a phase of decompensation..
Starts at puberty when WOB fails to supply enough hormone for the rising demand by the growing body. As the body grows relative hormone deficiency deepens, and an intercurrent disease may initiate an Addisonian crisis. The clinical manifestation of PA are an attempt by WOB to minimize the threat of an acute adrenocortical deficiency. It stops estrogen production (amenorrhea), and so retards growth. It informs the mind to eat less and select food with low caloric value, which is expressed by strange eating habits, and division of foods into "good/safe" and "bad/dangerous" categories.
Pancytopenia due to prolonged starvation. Vitamin deficiencies, Cardiac dysrhythmias, etc.
has two main responsibilities: To help where WOB failed, and
to improve patient's quality of life. All this without interfering too much with WOB solutions.
He has to work out a compromise
between WOB and mind demands. Since patient cannot be cured
the main objective is to slow down disease progression.
The first task of the physician is to study patients who live with PA in peace and good health, called here PA-Yogis. The Yogi suffix signifies patients who live in peace with their disease. What is their secret and how do they mange? Their knowledge might be applied to other patients. Since physicians are too busy and lack time to observe patients, PA patients are advised to join support groups where they may learn from the experience of PA-Yogis.
Once a patient realizes the nature of his condition he ought to realize that his/her life has changed and his mission is to become a PA-Yogi. First she ought to learn how to handle society prejudice. Her misery induced by societal bias, triggers psychological defense which requires adrenocortical hormones (stress) and deepens the relative deficiency. The patient might benefit from meditation, which has two advantages. It helps her to ignore the society and focuses her effort on handling WOB-PA. Both conserve hormones.
Slim is chic
For a PA-Yogi 'slim is
chic'. Since his adrenal is sluggish, he has to reduce weight until hormone production covers his needs.
The correct weight is determined by WOB. As long as he is relatively overweight,
WOB will complain and make him feel sick as if saying: " continue
reducing weight until
I can meet your demands." When attaining the correct weight he feels healthy, since
WOB will stop complaining. This is the meaning of living with
a disease in good health. Throughout
this difficult endeavor he will be assisted by his physician, whose task among other, is to design a low
calories diet, rich
in vitamins and minerals.
Muscle building should not be advised since raising the demand on hormone. Instead the patient ought to pursue an aerobic activity, which trains the organism to utilize adrenocortical hormones more efficiently.
Low doses of cortisol
supplements may slow down disease progression. Yet how small such
doses ought to be? External hormone supplement has two disadvantages:
1. It curtails internal hormone production,
aggravating the internal deficiency., 2. It enhances body growth,
and deepens the relative deficiency. Hormone replacement ought therefore be the last resort, like during acute intercurrent diseases.
What drives PA? The growing body regenerates all its tissues why does it fail in PA? In the past chronic adrenal deficiency was driven by tuberculosis. Today the culprit might be viral, or a fungus. Or, might the culprit hit only the pituitary? Only WOB knows!