People with anorexia starve themselves until they look almost like skeletons. But their self-images are so distorted that they see themselves as fat, even when they are emaciated. Some refuse to eat at all; others nibble only small portions of fruit and vegetables or live on diet drinks. In addition to fasting, they may exercise strenuously to keep their weight abnormally low. No matter how much weight they lose, they always worry about getting fat.
This self-imposed starvation takes a heavy toll on the body. Skin becomes dry and flaky. Muscles begin to waste away. Bones stop growing and may become brittle. The heart weakens. With no body fat for insulation, it's hard to keep warm. Downy hair starts to grow on the face, back, and arms in response to lower body temperature. In women, menstruation stops and permanent infertility may result. Muscle cramps, dizziness, fatigue, even brain damage, kidney and heart failure are possible. An estimated 10–20% of people with anorexia die, either as a direct result of starvation or by suicide.
Researchers believe anorexia is caused by a combination of biological, psychological and social factors. They are still trying to pinpoint the biological factors, but they have zeroed in on some psychological and social triggers of the disorder. Many people with anorexia come from families in which parents are overprotective and have unrealistically high expectations of their children. The condition seems to run in families, which leads researchers to believe it may have a genetic basis. Anorexia often seems to develop after a young person goes through some stressful experience, such as moving to a new town, changing schools, or going through puberty. Low self-esteem, fear of losing control, and fear of growing up are common characteristics of anorectics (people with anorexia). The need for approval, combined with our culture's idealization of extreme thinness, also contributes.
The obvious cure for anorexia is eating, but that is the last thing a person with anorexia wants to do. It is unusual for the person himself or herself to seek treatment—usually a friend, family member, or teacher initiates the process. Hospitalization, combined with psychotherapy and family counseling, is often needed to get the condition under control. Force feeding may be necessary if the person's life is in danger. Some 70% of anorexia patients who are treated for about six months return to normal body weight. About 15–20% can be expected to relapse, however.