Treating Anorexia Like Addiction

If anorexics and bulimics can be thought of as dieting junkies, the best treatment may be a drug that is usually given to addicts.

A Detroit scientist tested naltrexone, the drug of choice for kicking the heroin habit, in 19 women with anorexia or bulimia. The women also underwent psychotherapy. All but one patient responded. The six-week course of drug and therapy reduced the bingeing and purging, and even the urge to binge, in bulimics. Anorexics stabilized their weight.

Mary Ann Marrazzi, Ph.D., believes that anorexics and bulimics may be biologically predisposed to an addiction cycle that is set into motion by chronic dieting. In response to self-starvation, she surmises, the brain releases opioids, known to cause a "high."

They also create a drive to eat to correct starvation, says Marrazzi, of Wayne State University. "They may also cause an adaptation to starvation by shutting down function to an essential minimum, thereby conserving energy until the starvation can be corrected."

As Marrazzi sees it, bulimics become addicted to the opioid-induced drive to eat. And anorexics become addicted to the opioid-induced adaptation to starvation. Because naltrexone stifles opioids by blocking their receptor sites in the brain, the drug breaks the addictive spiral.

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Drug treatment lessens starvation or bingeing and purging enough for counseling to convince the women not to diet. Once the dieting stops, Marrazzi believes, the tide of opioids is stemmed; the brain can relax and take in new information.

Marrazzi empathizes with those who are trying to kick the dieting habit. The heroin addict or alcoholic can practice total abstinence. Those with eating disorders can't simply go cold turkey on food.

The Skinny on Anorexia Recovery

For some women, anorexia is a lot like diamonds. It's forever.

In a study of 84 anorexic women, the recovery rate after 12 years is either a sobering 54 percent or a grim 41 percent. The death rate--no confusion there--is a tragic 11 percent.

The two recovery rates reflect an ongoing debate over exactly how to define recovery. In some studies, it's once women start menstruating and hit normal body weight. That yields the 54 percent. The 41 percent rate includes psychological and social well-being.

Psychiatrist Katherine Halmi, M.D., of the Cornell Medical Center in New York, says: "Recovery also means no longer expressing a fear of getting fat or being obsessively preoccupied with weight, and eating normally."

Anorexics whose disease began before the age of 12 or after 18 are less likely to recover, Halmi says. Ditto for those who binge and purge.

If there's one predictor of good outcome in anorexia, it's getting quality care early on. Individual psychotherapy and/or family therapy is essential. Don't let anorexia linger.

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