Eating Disorders
Anorexia: The Most Deadly
Mental Illness

(September 10, 2004) -- Tabloids might obsess when celebrities such as Mary-Kate Olsen or Christina Ricci are reported to suffer from anorexia, but scientists have almost ignored the deadly eating disorder--until now.

More than the stuff of after-school specials or celebrity biopics, anorexia is the most deadly mental illness--more likely to kill its victims than depression, schizophrenia or bipolar disorder. Yet the disease is barely understood. In the past three months, there have been more than 300 articles published about Mary-Kate, who is one half of the $28 million money machine that is the Olsen twins, and her battle with the disease. Yet in the entire medical literature, there are only a dozen studies comparing different ways of treating it.

"With anorexia, we're where schizophrenia or autism were 20 years ago," says Walter Kaye, a researcher at the University of Pittsburgh who is studying the disease. At one time, Kaye says, people blamed autism and schizophrenia on upbringing and other social factors --but the causes turned out to be physical. Likewise, he says, anorexia is probably strongly based in biology, and by understanding it doctors may be able to learn how to help hard-to-treat patients. Studies with brain imaging technology indicate the disease is linked not to addiction, as some had speculated, but to anxiety. Already, some doctors are using low doses of the antipsychotic Zyprexa, made by Eli Lilly, to help patients gain weight and start eating--even though no studies exist to prove the drug works and the use is still very experimental.

Video New Uses For Schizophrenia Drugs As antipsychotics are prescribed more often, fears emerge about side effects like heart disease and diabetes.

Most patients don't need medicines to recover from the disease, which usually strikes between the ages of 13 and 16. Nine out of ten victims are women. The large majority of them can be treated either at home or in a hospital in programs that focus on ensuring that they eat.

Daniel le Grange, a clinical psychologist at the University of Chicago, has been able to help adolescent patients by training their families to make them eat. "This is really going back to getting the parents to do what they're good at and feed their kids," he says. Often, parents may have to supervise their children 24 hours a day, seven days a week, in order to make sure they eat enough--as much as 4,000 calories a day to replace lost weight--and don't exercise too much. In treating adolescents, he focuses on getting them to eat again, not on any underlying psychological issues. "You can't give psychotherapy to someone who doesn't have enough glucose in their brain," he says.

A pair of studies has shown that that kind of approach works 90% of the time, helping patients gain back their weight and keep it on. But the reason that anorexia is so fatal is that the 10% of patients who don't get better are likely to starve to death. When standard treatment is not working, le Grange brings in Jennifer Bremer, head of the University of Chicago's Eating Disorders Psychopharmacology Clinic, to consider prescribing medicines. One of her only choices is Zyprexa.

"We have no good data yet to support the use of any medications for anorexia nervosa," Bremer says. But even though there is a paucity of hard evidence, she is willing to prescribe the drug to patients whose families recognize its inherent risks. "We do this because we know how deadly anorexia is and are willing to use what appears useful in cases doing poorly, even when the data is not yet there."

One reason that Zyprexa is useful is what is normally an unwanted side effect in a large proportion of patients: the drug causes weight gain. That side effect also makes it likely that those in the most danger--anorexics in their twenties who have had the disease for years, have already been treated, and are much more difficult to cure--are likely to refuse to take the drug out of the fear that it will make them fat. Clinical trials rigorously testing the antipsychotic drug as an anorexia treatment are currently beginning.

Until now, other drugs haven't worked, says Pittsburgh researcher Kaye. For instance, antidepressants such as Paxil, Zoloft and Celexa may help patients from relapsing, but they don't help when people are underweight and definitive studies haven't been done. Low doses of antipsychotics such as Zyprexa may be the next step. But the biology that causes the disease is not understood at all. Kaye has done work showing that anorexics have naturally high serotonin levels, and as children are prone to anxiety, obsessive compulsive disorder or social phobia. Starvation can actually lower serotonin levels, and this may be part of what causes the disease--which Kaye says kills 5,000 American women per year.

A better understanding of the genetics of anorexia is needed. Kaye is conducting a study of families with more than one anorexic. (Those interested can go to www.angenetics.com to participate.) He says: "Once we understand the biology and genetics of these disorders, we'll be able to treat them."

Related Information

• Stress Management for Bulimia
• Couple Speaks of Daughter's Fatal Eating Disorder
• Learning About Real Me: Battling Eating Disorders and Depression
• New Anorexia Treatments Stress Eating
• New Treatment Achieves 75% Remission in Eating Disorders
• Recovering Was About Liking Myself
• Triumphant Journey: A Cyberguide To Stop Overeating and Recover from Eating Disorders
• How to Help a Friend with an Eating Disorder
• The Isolation of an Eating Disorder
• How to Help Your Child Stop Vomiting
• How To Recover From Bulimia and Other Eating Disorders

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