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Anorexia Nervosa (Part 2)

How is anorexia diagnosed?

Your doctor or nurse will ask you questions about your symptoms and medical history. It may be difficult to talk to a doctor or nurse about secret eating or exercise behaviors, but doctors and nurses want to help you be healthy. Being honest about your eating and exercise behaviors with a doctor or nurse is a good way to ask for help.

Your doctor will do a physical exam and other tests, such as blood tests and a urine test, to rule out other health problems that may cause severe weight loss. Your doctor may also do other tests, such as kidney function tests, bone density tests, or an electrocardiogram (ECG or EKG), to see if or how severe weight loss has affected your health.

How is anorexia treated?

Your doctor may refer you to a team of doctors, nutritionists, and therapists who will work to help you get better. If you live with family members, they may be invited to participate in some of your treatment. Treatment plans may include one or more of the following:

• Nutrition therapy—Doctors, nurses, and counselors will help you eat healthy to reach and maintain a healthy weight. Some people may need to be hospitalized or participate in a residential treatment program (live temporarily at a medical facility) to make sure they eat enough to recover. Hospitalization may also be required to monitor any heart problems in people with anorexia. Reaching a healthy weight is a key part of the recovery process so that your body's biology, including thoughts and feelings in your brain, work correctly.
• Psychotherapy—Sometimes called "talk therapy," psychotherapy is counseling to help you change any harmful thoughts or behaviors. This therapy may focus on the importance of talking about your feelings and how they affect what you do. You may work one-on-one with a therapist or in a group with others who have anorexia. For young people with anorexia, counseling may involve the whole family.
• Support groups—Support groups can be helpful for some people with anorexia when added to other treatment. In support groups, individuals and sometimes their families meet and share their stories.
• Medicine—Studies suggest that medicines like antidepressants can help some individuals with anorexia by improving the depression and anxiety symptoms that often go along with anorexia.

Most people do get better with treatment and are able to eat and exercise in healthy ways again.¹ Some may get better after the first treatment. Others get well but may relapse and need treatment again.

How does anorexia affect pregnancy?

Anorexia can cause problems getting pregnant and during pregnancy.

Extreme weight loss can cause missed menstrual periods because you may not ovulate, or release an egg from the ovary. When you do not weigh enough to ovulate, it is difficult to get pregnant. However, if you do not want to have children right now and you have sex, you should use birth control.

Anorexia can also cause problems during pregnancy. Anorexia raises your risk for

• Miscarriage (pregnancy loss)
• Premature birth (also called preterm birth), or childbirth before 37 weeks of pregnancy
• Delivery by cesarean section (C-section)
• Having a low birthweight baby (less than five pounds, eight ounces at birth)
• Depression after the baby is born (postpartum depression)

If I had an eating disorder in the past, can I still get pregnant?

Yes. Women who have recovered from anorexia, are at a healthy weight, and have normal menstrual cycles have a better chance of getting pregnant and having a safe and healthy pregnancy.

If you had an eating disorder in the past, it may take you a little longer to get pregnant (about six months to a year) compared to women who never had an eating disorder.² Tell your doctor if you had an eating disorder in the past and are trying to become pregnant.

If I take medicine to treat anorexia, can I breastfeed my baby?

Maybe. Some medicines used to treat anorexia can pass through breastmilk. Certain antidepressants can be used safely during breastfeeding.

Talk to your doctor to find out which medicine works best for you. You can enter a medicine into the LactMed® database (Link opens in a new windowhttps://www.ncbi.nlm.nih.gov/books/NBK501922) to find out if the medicine passes through breastmilk and about any possible side effects for your nursing baby.

References

1. Eddy, K.T., Tabri, N., Thomas, J.J., Murray, H.B., Keshaviah, A., Hastings, E., et al. (2017). Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. Journal of Clinical Psychiatry, 78(2), 184–189.
2. Easter, A., Treasure, J., & Micali, N. (2011). Fertility and prenatal attitudes towards pregnancy in women with eating disorders: Results from the Avon Longitudinal Study of Parents and Children. BJOG: An International Journal of Obstetrics & Gynaecology, 118, 1491–1498.