Eating Disorders Mental Health Psychology / Psychiatry

Anorexia nervosa: What you need to know

A serious psychological illness and a potentially life-threatening eating disorder is anorexia nervosa. Recovery, however, is possible with the right care.

The disorder usually includes mental problems, an unrealistic view of the body and an exaggerated fear of being obese or overweight.

It often starts during the teenage years or early adulthood, but in the preteen years it may begin. It is the third most prevalent chronic disease among teenagers.

About 30 million men and women in the United States suffer from eating disorders. Men and women may develop anorexia but in females it is ten times more common. At some point in time, about 1 in every 100 American women will experience anorexia.

Anorexia nervosa is distinct from anorexia, meaning loss of appetite or a lack of eating.

Important facts about anorexia nervosa:

Here are some key points about anorexia nervosa. More detail is in the main article.

  • Anorexia nervosa is a psychological condition that involves an eating disorder.
  • Symptoms include a very low body mass index (BMI), a refusal to eat, and attempts to lose weight, even when body mass index is very low.
  • It is thought to be triggered by a combination of biological, environmental, and genetic factors.
  • Treatment can take some time, but with a combination of counseling and other types of therapy, recovery is possible.

What is anorexia nervosa?

Anorexia can lead to a distorted body image and an unwillingness to eat.
Anorexia can lead to a distorted body image and an unwillingness to eat.

Anorexia nervosa is a psychological condition and an eating disorder in which the person, for their height and age, loses more weight than is safe. The person will maintain a body weight of 85 percent or less of their expected weight.

An individual with anorexia would deliberately limit their food consumption, usually due to a fear of becoming or being obese, even though their body mass index ( BMI) is already low. They can also perform excessive exercise, use laxatives, and vomit to lose weight, though to a lesser degree than those diagnosed with bulimia.

Complications can be severe. It is recorded that eating disorders have the highest mortality rate of any mental condition.

Treatment encompasses hospitalization and counseling.

Symptoms

A complicated diagnosis is anorexia nervosa, but the main symptom is typically extreme weight loss. Although objective tests, such as BMI, indicate that this is not true, the person can still speak about being overweight.

Behavioral changes may include a failure to feed, exercising excessively, and use of laxatives or vomiting after eating food.

Some physical signs and symptoms that arise from nutrient deficiency include:

  • severe loss of muscle mass
  • listlessness, fatigue, exhaustion
  • hypotension, or blood pressure
  • lightheadedness or dizziness
  • hypothermia, or low body temperature, and cold hands and feet
  • bloated or upset stomach and constipation
  • dry skin
  • swollen hands and feet
  • alopecia, or hair loss
  • loss of menstruation or less frequent periods
  • infertility
  • insomnia
  • osteoporosis, or loss of bone density
  • brittle nails
  • irregular or abnormal heart rhythms
  • lanugo, fine downy hair growing all over the body, and increased facial hair

Signs of vomiting include bad breath and tooth decay, due to the acid in the vomit.

Psychological signs and symptoms include:

  • excessive concern about being fat or overweight
  • frequently measuring and weighing themselves and inspecting their bodies in the mirror
  • obsession with food, for example, reading cookery books
  • lying about food intake
  • not eating or refusing to eat
  • self-denial
  • lack of emotion or a depressed mood
  • reduced sex drive
  • memory loss
  • obsessive-compulsive behavior
  • irritability
  • over-exercising

Food and eating is synonymous with guilt. It might be difficult to speak to the individual about a potential problem, since they would possibly fail to accept that something is wrong.

Causes

Media pressure and fear of gaining weight are sometimes, but not always, contributing factors.
Media pressure and fear of gaining weight are sometimes, but not always, contributing factors.

For anorexia nervosa, no single cause has been identified. As a result of biological, environmental , and psychological conditions, it probably happens.

It has been linked with the following risk factors:

  • being susceptible to depression and anxiety
  • having difficulty handling stress
  • being excessively worried, afraid, or doubtful about the future
  • being perfectionist and overly concerned about rules
  • having a negative self image
  • having eating problems during early childhood or infancy
  • having had an anxiety disorder during childhood
  • holding specific ideas regarding beauty and health, which may be influenced by culture or society
  • having a high level of emotional restraint or control over their own behavior and expression

The person may be overly concerned about their weight and form, but the main aspect is not really that.

A mood disorder, such as depression, is also found in between 33 and 50 percent of those with anorexia, and about half have an anxiety disorder, such as obsessive-compulsive disorder (OCD) and social phobia. This indicates that, in some situations, negative emotions and a low self-image can contribute.

Anorexia nervosa can be created by an individual as a attempt to take control over certain facets over their life. This feels like success when they exert control of their food consumption, and so the behaviour continues.

Environmental factors

The hormonal changes that arise during puberty, plus feelings of anxiety, stress, and low self-esteem, can include environmental variables.

The fashion industry and media messages that indicate that it is attractive to be thin can have an impact.

Other environmental factors may include:

  • physical, sexual, emotional or another types of abuse
  • family or other relationship problems
  • being bullied
  • a fear or exams and pressure to succeed
  • a stressful life event, such as bereavement or becoming unemployed

According to the UK ‘s Therapy List, people with anorexia “really need to be in charge of their lives; they need to feel unique and they need a feeling of superiority.”

Analysis published in the American Family Physicist defines a person with anorexia as using “caloric intake or intense activity to regulate emotional needs or discomfort.”

If a person thinks like he or she is out of control of one or more facets of his or her life, not eating can be one way in which they can at least regain charge of their health.

Biological and genetic factors

Studies have shown that certain people with eating disorders can have imbalances in some brain chemicals that regulate metabolism, appetite, and hunger. Further analysis is required in order to validate this.

Genetic factors may affect a person ‘s vulnerability to eating disorders as they may occur in families. About 50 and 80 percent of the incidence of anorexia is believed to be hereditary.

A vicious cycle

When a person continues to lose weight, low weight and lack of nutrition may lead to brain changes in a way that strengthens the behaviour and repetitive thinking associated with anorexia nervosa.

Changes may affect the portion of the brain that regulates appetite, or may raise the feelings of fear and shame that are associated with feeding.

In 2015, researchers found that individuals with anorexia nervosa might have different intestinal microbial populations than those without the disorder. The writers proposed that this could lead to fear, depression and more weight loss.

A 2014 study showed that individuals with anorexia nervosa are less likely to distinguish between different forms of positive feelings. As self-deprivation becomes associated with a sense of pride, this can lead to further weight-loss behavior.

Diagnosis

The likelihood of a positive outcome is improved by an early diagnosis and timely treatment. For diagnosis, a complete medical history will help.

The doctor will ask the patient about weight loss, how they feel about their weight, and about menstruation for females. Opening up and thinking honestly about themselves can be daunting for the patient. Confirming a diagnosis can take years, particularly if the individual was previously obese.

The doctor can order tests to rule out other underlying medical conditions with similar signs and symptoms if the doctor detects signs of anorexia nervosa.

These include:

These may include blood tests, imaging scans, and an electrocardiogram (ECG).

Diagnostic criteria

According to the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) of the American Psychiatric Association ( APA), the diagnostic criteria for anorexia nervosa are as follows:

  1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
  2. Intense fear of gaining weight or becoming fat, even though underweight.
  3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

The National Eating Disorders Association (NEDA) states that a person can have a severe eating disorder, even without meeting all these requirements.

Treatment and recovery

Emotional challenges
Anorexia nervosa is not only about avoiding food, but it brings emotional challenges, too.

Medication, psychotherapy, family therapy, and nutrition counseling may be used in recovery.

It can be hard for a person to recognize that they have anorexia, and it can be difficult to include them in therapy, since it is difficult to break the resistance to eating.

In their degree of cooperation and awareness that there is an issue, the patient can fluctuate.

It is important to tailor a detailed plan to suit the needs of the individual.

The treatment targets are:

  • To restore body weight to a healthy level
  • To treat emotional problems, including low self-esteem
  • To address distorted thinking
  • To help the patient develop behavioral changes that will persist in the long term

Treatment appears to be long-term, and, particularly during periods of stress, relapse is probable. For good and lasting results, support from family and friends is essential. If family members are able to recognize the disease and recognise the signs and symptoms, during the healing process, they can assist their loved one and help avoid a relapse.

Psychotherapy

Cognitive behavioral therapy ( CBT) involves counseling, which focuses on modifying the way the client thinks and acts. CBT may help a patient change their way of thinking about food and body weight and learn healthy ways to react to stressful or challenging circumstances.

Nutrition therapy attempts to help the client recover healthy eating habits. In maintaining good health, they learn about the importance of a healthy diet.

Medication

There is no particular treatment, but nutritional supplements may be required, and anxiety, obsessive-compulsive disorder (OCD), or depression management medications may be prescribed by the doctor.

Selective serotonin reuptake inhibitors ( SSRIs) are commonly used as antidepressants, but can only be taken by patients when their height and age are at least 95% average for their body weight.

Research has shown that olanzapine, an antipsychotic drug, can help patients achieve a higher body weight, after which they may use an SSRI.

Hospitalizing

If there is extreme weight loss or malnutrition, a persistent failure to eat, or a clinical emergency, hospitalization may be necessary.

Food intake will be progressively increased to allow for healthy weight gain.

Complications

Complications can impact any system of the body, and they can be severe.

Physical complications include:

Heart problems: These include low heart rate , low blood pressure , and heart muscle injury.

Blood problems: There is a greater risk of having a low white blood cell count or leukopenia, and anemia with a low red blood cell count.

Gastrointestinal problems: When a person is extremely underweight and eats too little, activity in the intestines slows considerably, but this resolves as the diet improves.

Problems with the kidney: Dehydration can lead to highly concentrated urine and further development of urine. As weight levels rise, the kidneys normally regenerate.

Hormonal problems: Lower levels of growth hormones during adolescence can lead to delayed growth. With a balanced diet, natural development returns.

Bone fractures: The risk of developing osteopenia or diminished bone tissue and osteoporosis or loss of bone mass is substantially greater in patients whose bones have not fully formed yet.

Around 1 out of 10 cases is fatal. There could be a greater chance of suicide, apart from the physical consequences of inadequate nutrition. One out of every 5 anorexia-related deaths is from suicide.

The risk of complications is minimized by early diagnosis and treatment.

Living with anorexia nervosa

Medical News Today (MNT) asked Maria Rago, Ph.D., President of the National Anorexia Nervosa and Associated Disorders Association (ANAD), what people , families, and family should do if they suspect they might have anorexia nervosa or a loved one.

She gave us these tips:

  • Be kind and respectful rather than judgmental.
  • Look into providers of treatment to find good matches, and meet with some of the people to decide who can best help.
  • Consider a treatment team including a dietitian, a therapist and a psychiatrist all who specialize in eating disorders.
  • Make sure that you get all of the education and support that you can.
  • Review your treatment and make changes when you think best.

“Remember that people get better every day. Remember that recovery takes time, so be patient with yourself and your loved one. Have hope, be creative and never give up. Be the captain of your recovery team. Try to understand the difference between your own voice and the voice of your eating disorder.”

Maria Rago, President of ANAD

Ms. Rago noted that ANAD has free support groups and rehabilitation mentoring programs, and they urge individuals to take advantage of the free resources. She said, “The right help will change your life, and even save your life.”