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Interviewer: Anorexia is an eating disorder that is more common than you would think. One out of a hundred women has struggled with anorexia at some point in their life. Has anorexia associated with mental illness? We'll find out next on The Scope.

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Interviewer: We're talking with Dr. Jason Hunziker Psychiatrist at the Ï㽶ÊÓƵ of Utah. Dr. Hunziker, how is anorexia related to mental illness?

Dr. Jason Hunziker: So anorexia is an eating disorder that often has fatal consequences. The disorder itself is a disorder of people who generally will restrict the intake of food to the point that it causes significant organ damage and eventually death. The way it's related to mental illness, is that often people who struggle with anorexia, have other mental illnesses that come along with that.
So as their bodies continue to decline in nutrients and muscle mass and their organs start to slow down and they're having trouble with their bowels, they start to get more and more depressed and they start to get more and more anxious. Often these patients struggle with severe anxiety around food. Their focus on food is so great that they will even buy cookbooks and they'll cook these fabulous meals for their families and their friends and not once eat any of that food.

Interviewer: Wow that's interesting.

Dr. Jason Hunziker: They'll exercise until they pass out on the treadmill, just to get thin. And that anxiety and that perfectionist behavior leads to more and more depression, more and more anxiety. Which then, ultimately sometimes, unfortunately, these patients get to the point that they want to kill themselves.

Interviewer: So bringing it back to the beginning, where does it all start? Like it's got to start from somewhere, right? In their teens...

Dr. Jason Hunziker: That's a good, that's a really good question. Often patients with anorexia have learned this from their environment. It's, there's really no good evidence of where exactly the anorexia comes from and why one person has anorexia and yet their sister doesn't. But what we do know is that there's a strong family history often in people with anorexia.
We do see this usually happen at puberty time so when people's bodies are changing and developing, we start to notice this illness getting more and more prominent. There is strong evidence of course in the teenage years that girls want to look like the other girls and they all feel like they need to be at a certain weight or certain height. And when they can't be that, they struggle and then they start adapting these maladaptive patterns of eating and exercise that eventually leads to anorexia.

Interviewer: So is it safe to say that maybe the root of the problem with anorexia comes from maybe... cultural norms?

Dr. Jason Hunziker: It comes from cultural norms, it comes from... we see it in things like ballet classes and gymnastics and cheerleading, in those environments where weight is put as a high priority. We also see it in young kids who have been very anxious their whole life. And so they worry that they're going to be different or look different or feel different, and so they change themselves or attempt to change themselves in the way they think.

Interviewer: When you see somebody with anorexia, you can kind of tell a little bit, can't you? But, are there other signs or symptoms that you kind of you look, and you might wonder.

Dr. Jason Hunziker: Things that you can find or see with that is that if you notice dramatic weight changes, if you notice that your significant other or your sibling or your girlfriend or boyfriend or whoever, is moving food around on the plate but doesn't really seem to eat it. Or is more interested in cooking these fantastic meals but you never really see them eating anything. Or right after meals, they're spending all this time in the bathroom. Or you start to notice laxative boxes in the garbage cans or those types of things, then you'll have those suspicions. They also tend to wear big baggy clothes to kind of hide their body.

Interviewer: But you're aware that you're thin, why would you want to hide it?

Dr. Jason Hunziker: Yeah that's a really good question and that's kind of the conflict is, they're not aware that they're thin. They feel like they're not thin enough.

Interviewer: What are some of the long term effects then? Because obviously we know that the short term effects is just weight and maybe depression...

Dr. Jason Hunziker: Depression, anxiety are really short term problems. But addiction becomes a problem. They'll start taking caffeine tablets and that'll advance to stimulants and then they're using all types of things to try to suppress their appetite, so that they can lose weight. Bone density problems are a big issue. They lose a lot of bone mass and they end up with fractures and broken hips at 25 years old because they just don't have the right bone structure. Heart problems because of changes in electrolyte balances. A lot of young women end up having heart attacks and other heart abnormalities because of the loss of nutrients.

Interviewer: Can this be treated?

Dr. Jason Hunziker: Definitely. The treatment is actually what they call re-feeding.

Interviewer: Okay.

Dr. Jason Hunziker: And so we have to give people the nutrition to get their brain functioning at a level that's high enough to actually engage in treatment. After you get them to the point that they're a little healthier, they have weight coming back, we do a lot of intensive therapy which has shown to be the most effective way to help people with anorexia. We examine their relationship with food and what it is about the food, and their thoughts about body and image and try to deflect away from weight, but some more focused on being healthy. How do we be healthy with who we are, and we often treat depression, that's associated with this. We treat the anxiety that's associated with this. We'll treat family issues that's clearly associated with this. So that everything is looked at as one big unit that we can focus on to help this person get well.

Interviewer: If the person doesn't want to get treated or they just don't come in for treatment, can that anorexia be something that is life threatening?

Dr. Jason Hunziker: Definitely, and that's usually the unfortunate part of this is that some people end up taking their own life because they get so despondent at the fact that they can't reach that goal that they've set for themselves, that they just get overwhelmed and end up harming themselves. Others unintentionally harm themselves by taking all those other supplements or stimulants or whatever else, that actually unintentionally overdose themselves. The bodies just shut down, unfortunately, with a lot of these patients. They end up being so malnourished that they just, is incompatible with life and their bodies just give up.

Interviewer: Any final thoughts?

Dr. Jason Hunziker: My final thought is I think we need to recognize this immediately. We need to provide support and not be accusatory or...

Interviewer: Don't be the police.

Dr. Jason Hunziker: Exactly. Don't make them guilty, don't be forcing food down, in their face because that's not going to help. Getting them to a professional, getting them to a therapist, there's eating disorder clinics available. If it's severe enough they need to be hospitalized and then start treatment. And just be understanding because this is a life long process that they're going to struggle with.

Announcer: We're your daily dose of science, conversation, medicine, this is The Scope. Ï㽶ÊÓƵ of Utah Health Sciences Radio.