Antibiotics for Anorexia

Many people with anorexia nervosa never seek treatment. However, anorexia rarely goes away by itself!

Anorexia nervosa is a psychological condition that causes individuals to restrict food in order to lose weight. This behavior can get out of control and result in extreme weight loss. Most people with anorexia have a distorted view of their body as fat, no matter how thin they are. They are often unusually sensitive about being perceived as fat and are terrified of gaining weight.
Common symptoms of anorexia include:

excessive weight loss in a short period of time
continued dieting, although already very thin
unusual interest in food or food rituals
eating very little and eating slowly
obsession with exercise

People with anorexia may develop unusual eating rituals such as weighing food, cutting up foods into small pieces, or refusing to eat in front of other people. It is not uncommon for people with the condition to collect recipes and prepare elaborate meals for family and friends, but not eat any of the meals themselves.

There are two types of anorexia. Most people know the restricting type, where individuals diet, fast, or excessively exercise in order to lose weight. The other type is the binge eating/purging type, where individuals eat a large amount of food in a short period of time (binge) and purge afterwards by vomiting or using laxatives. Although people with bulimia will also often binge and purge, they maintain a normal or above normal weight, while people with anorexia have below normal body weight.

Who suffers from Anorexia Nervosa?

Anorexia affects people from all ethnic and cultural groups as well as people of all sexual orientations. Most individuals with anorexia are young women, but anorexia can also be found in older women, girls, men, and boys. Estimates are that 10 percent of people with anorexia are male.

Causes of Anorexia Nervosa

It is not known what causes anorexia nervosa, but it is influenced by a number of factors. These factors include family and peer pressures, chemical imbalances, genetics, and emotional problems. Images of “ideal bodies” in the media often lead to unrealistic and unattainable body shape and weight goals. Individuals involved in gymnastics, ballet, wrestling, or other sports that stress low body weight may be at increased risk. Also, positive events (like beginning college) or negative events (like a loss in the family) can trigger anorexia. People with anorexia often suffer from low self-esteem and feelings of helplessness. Many with anorexia are perfectionists and have a strong desire to be in control. They often set unrealistic goals for themselves.

"Strep" Infection May Cause One Type Of Anorexia
Some cases of anorexia nervosa in youngsters may come on suddenly after a case of "strep" throat or other infection, suggests a study in the August issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Antibiotics may be useful in the treatment and prevention of these infection-triggered cases of anorexia, writes child and adolescent psychiatrist Dr. Mae S. Sokol of the Menninger Clinic in Topeka, Kansas. Dr. Sokol reports on three adolescents with anorexia nervosa that suddenly started or worsened around the time of streptococcal or other infection.

One teenage boy developed anorexia after a bad case of strep throat. His eating disorder decreased while he was taking antibiotics prescribed for a sinus infection. When the antibiotics were finished, the anorexia returned. The patient was put back on antibiotics, and he improved again.

This patient was treated with long-term antibiotics to prevent infections and had no further episodes of anorexia. In the other two patients reported, both the infection and anorexia got better on their own.

"This is another series of cases, first reported in this Journal, of psychiatric illness in children triggered by infection," stated the Editor of the Journal, Dr. John F. McDermott. "The first report, two years ago, described children with the sudden onset of obsessive compulsive disorder (persistent irrational thoughts and behaviors after a strep infection). This report, by a different group of child and adolescent psychiatrists, suggests a similar mechanism in certain cases of anorexia nervosa (a serious illness marked by refusal to eat, weight loss and obsessive fears of getting fat). The importance of these two studies taken together is three-fold. They suggest:

1. what we have suspected all along, that these two disorders with their overlapping symptoms, may have underlining connections, and in some cases a common identifiable cause -strep infection;

2. that the cause may lie in the brain cells or neurons in a certain region of the brain, being destroyed by the very antibodies the body produces to fight this infection in suceptible youngsters and;

3. that treatment with antibodies and modern immuno-technology can prevent or even reverse these difficult-to-treat illnesses and change what has been a poor outcome to a good outcome. In other words, these prelimenary studies, from independent groups of investigators in child and adolescent psychiatry, may lead to some of the most important breakthroughs in our field to date."

Patients found to have infection-triggered anorexia could be monitored closely for infections treating the infection early and giving preventative antibiotics as is done with rheumatic fever, might prevent the eating disorder from getting worse. The researchers also suggest performing a strep test (throat culture and blood tests) in children and teenagers with anorexia that has suddenly appeared or worsened.

Why is it important to seek treatment for anorexia nervosa?

Many people with anorexia nervosa never seek treatment. However, anorexia rarely goes away by itself. If untreated, the disorder can lead to serious health problems. Severe restriction of food can have dangerous effects on the body, particularly the heart, brain, and bones. The heart can weaken and serious heart problems can develop. The brain can shrink and cause changes in personality and the bones can lose calcium, making them weak and more likely to break. Taking vitamins, calcium, or other supplements does not protect from malnutrition. Anorexia is also associated with other psychological disorders like depression and obsessive compulsive disorder (OCD). Other problems may develop as a result of anorexia, including extreme sensitivity to cold, weak/brittle nails, a grayish appearance, hair loss, and growth of fine hair on the arms, face, shoulders, and back. Women with anorexia experience amenorrhea or the loss of menstrual periods. Men with anorexia can become impotent. It is possible to die from anorexia. Between 5 to 10 percent of people with anorexia eventually die from the illness, either by cardiac-related problems or suicide.

Treatment of Anorexia Nervosa

Many people with anorexia can be treated successfully by psychologists, social workers, family therapists, and psychiatrists with experience in eating disorders, along with their personal physician. In many instances a team is involved in treatment, including dietitians and case managers. In some cases of severe malnutrition, a hospital stay may be necessary. Treatment can be difficult and require hard work from the patient and the family. Treatment for anorexia may include a combination of individual and/or group psychotherapy, nutritional counseling, medications, and family education. Family or couples therapy may be a part of the treatment plan. Therapists can guide family members in understanding anorexia and learning new techniques for coping with it. Treatment is most successful if the problem is recognized early.

Autism and anorexia nervosa could not be less alike. But a trail of evidence has led scientists to a common culprit: a case of strep throat.

The infection itself isn't to blame, but rather the antibodies produced to fight it. In some people, these antibodies mistakenly attack the delicate tissue of the basal ganglia, an area in the brain that contributes to the control of movement and emotion.

This damage may lead to obsessive or compulsive behaviors: the autistic's penchant for repetition, the anorexic's rigid regulation of calories.

Immunology and psychiatry have crossed paths before, when scientists tied streptococcal infection to the development of obsessive compulsive disorder. Knowing of this link, psychiatrist Eric Hollander, M.D., tested blood samples of eighteen of the autistic children he treats at the Mount Sinai School of Medicine.

Indeed, most had had strep in the past, but that was not surprising. What was unexpected was that 78% of the autistic children had evidence of an elevated B-cell antibody, compared to 20% of a normal control group. This antibody, called D8/17, is historical evidence that the child may have a genetic vulnerability to autoimmune diseases.

Mae Sokal, M.D., of the Menninger Clinic, also knew about the OCD research and thought it might apply to her patients with anorexia nervosa, an eating disorder that she has always viewed as an obsession. Sure enough, levels of antibodies in these teenagers' blood were three to five times the normal average.

Both autism and anorexia are complex disorders with many causes, and a single antidote is unlikely. Still, Sokal has had impressive success treating elevated-antibody anorexics: they improved dramatically on a course of antibiotics.
source (psychologytoday.com)

What can you do if you have anorexia nervosa?:
Recognizing that you have a problem is the first step to getting better.
• Seek professional help. Talk with your personal physician, behavioral medicine specialist, or psychiatry department.
• Set realistic goals. Remember to be proud of every success no matter how small.
• Be patient. Setbacks are part of recovery.
• Don’t let the scale run your life. The numbers on the scale don’t reflect your self-worth.

How can you help someone with anorexia nervosa?:
• Educate yourself about anorexia nervosa.
• Let them know that you care and you want to help.
• Don’t pressure them about eating or talk about weight or food.
• Encourage them to seek professional help.
• Be patient. It is more than a matter of eating.
• Be prepared. They may deny the problem, get angry or refuse help.
• Remember that you can only do so much. Your comments may help them seek treatment in the future.