Anorexia Nervosa

Anorexia Nervosa

Anorexia Nervosa

Anorexia nervosa, or just anorexia, is an eating disorder characterized by the triad of abnormally low body weight, an intense fear of fatness, and a distorted body image. A person with the disorder might engage in radical methods to control their perceived body image — methods that often severely impact daily life. Body goals, even if reached, rarely remove anxiety about appearance.

Prevalence

At any given point in time, about 0.35% of young women and 0.1% of young men will suffer from anorexia nervosa.

Bulimia vs Anorexia

While there can be commonality between bulimia and anorexia, those with bulimia do not tend to appear underweight whereas those with anorexia are more likely to exhibit below average body weight.

Symptoms of Anorexia Nervosa & Warning Signs:

People with anorexia nervosa usually try to prevent weight gain or to induce weight loss by one or more of the following methods:

  • Try to control calorie intake by imposing severe restrictions on the food eaten and the beverages drunk
  • Vomit after eating
  • Abuse and misuse laxatives, diuretics, and/or enemas to attain or maintain an “ideal” body weight
  • Exercise excessively to burn calories

Because of measures some people take to conceal the condition, it can be a challenge to correctly identify anorexia, but some of the following are potential indicators:

  • Behavioral and emotional symptoms or signs:

    • Severely restricting food intake through dieting or fasting and may include excessive exercise
    • Bingeing and self-induced vomiting to get rid of the food and may include use of laxatives, enemas, diet aids or herbal products
    • Refusing to eat or making excuses to not eat, not swallowing food after chewing, missing meals, not being truthful about amount of food eaten
    • Won’t admit to hunger
    • Aversion to eating in public
    • Organizing food on the plate, dissecting the food, eating in sections according to a prioritized list, drastic reduction in food choices to options that are only low in fat or calories
    • Moderate to extreme obsession with food, eating according to a strict schedule
    • Afraid of putting on weight, wearing clothes in multiple layers to reduce the appearance of reduced weight, repeated verbalizing of unhappiness related to weight
    • Frequent checking in the mirror for perceived flaws, moderate to extreme obsession with checking body measurements and weight
    • Reduced to no social activity, reduced or no capacity to get pleasure from activities previously enjoyed
    • Emotionless or short tempered, depression
    • Reduced libido
    • Suicidal thoughts
  • Physical symptoms or signs

    • Looking thin, excessive weight loss
    • Extreme tiredness
    • Uncommon results from blood tests
    • Sleep issues
    • Lightheadedness, fainting
    • Menstrual period stopping
    • Visible signs of poor circulation in hands, aversion to the cold
    • Hair in notably poor condition, abnormal soft hair across the body
    • Skin discoloration
    • Visible issues with teeth and potentially on knuckles from self-forced vomiting
    • Bowel issues, including irregularity
    • Delayed growth spurt during teenage years
    • Regular dehydration and electrolyte deficiencies
    • Low blood pressure, heart arrhythmia
    • Swollen extremities
    • Brittle bones which break easily

Causes of Anorexia Nervosa:

The precise cause of anorexia nervosa is not known, but there can be a predisposition to it based on a person’s genetics, personality, and environment.

  • Biological – Certain traits like perseverance, a sensitive nature, and perfectionism, either modeled or genetic
  • Psychological – The thinking that acceptance and being liked or loved is based on appearance
  • Environmental – Not all cultures place the same values on body weight, but Western culture and media sends the message of tremendous value in being thin. This is held as being especially true by younger females and their peers.

Risk factors for Anorexia Nervosa:

Factors that can render an individual at increased risk of developing anorexia nervosa are:

  • Genetics
  • History of anorexia in immediate family
  • Female gender
  • Young age
  • Reactions from others regarding a person’s weight gain or loss
  • Stress because of daily circumstances or significant life changes
  • Being from a higher socioeconomic background
  • Professions or careers where one’s weight is a factor and weight loss is encouraged
  • Exposure to cultural portrayals of beauty in the media and film industry

Anorexia Nervosa Complications:

Anorexia nervosa has the highest rate of mortality of any psychiatric disorder, and multiple body functions can be irreversibly damaged even if the person recovers.

The complications of anorexia nervosa include:

  • Heart defects such as abnormal heart rhythms – arrhythmias, and mitral valve prolapse – causes blood to leak back in the heart chambers instead of moving forward
  • Osteoporosis – weak and brittle bones, which can increase the risk of bone fractures
  • Gastrointestinal disturbances such constipation, hemorrhoids, polyps
  • Absent periods in females or reduced testosterone in men
  • Kidney function problems
  • Suicide

If a person with anorexia becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. This damage may not be fully reversible, even when the anorexia is under control.

In addition to the physical and medical issues that could develop, individuals with anorexia may also experience additional mental disorders including:

  • Personality disorders
  • OCD
  • Mood disorders like anxiety and or depression
  • Substance or alcohol abuse or dependence

Diagnosing Anorexia Nervosa:

When diagnosing anorexia nervosa, a person’s doctor will run various exams and tests to eliminate other possible causes for weight loss, as well as screen for complications, before confirming the diagnosis.

Tests and exams typically include lab work, a physical exam, and a psychological self-assessment questionnaire such as the SCOFF questionnaire — to assess elements related to eating habits and feelings and thoughts related to eating and appearance.

The SCOFF questionnaire can be administered by nonprofessionals to screen for the possible presence of an eating disorder, and SCOFF stands for the following questions:

S – Do you make yourself SICK when you feel uncomfortably full?
C – Do you worry you have lost CONTROL over how much you eat?
O – Have you recently lost more than 14 lbs. in weight within the last three months?
F – Do you believe yourself to be FAT when others say you are too thin?
F – Would you say that FOOD dominates your life?

If a person answers yes to at least two of the above questions, this may indicate they have anorexia nervosa.

Additional studies. Because of the side effects of being malnourished, it could be necessary to do X-rays (and or electrocardiograms) to look for heart issues, pneumonia, and broken or fractured bone, or to determine bone density.

Body mass index (BMI) is used by the American Psychiatry Association Diagnostic and Statistical Manual Edition 5 (DSM-5) as an indicator of the level of severity of anorexia nervosa.

  • Mild: BMI of greater than 17
  • Moderate: BMI of 16 – 16.99
  • Severe: BMI of 15 – 15.99
  • Extreme: BMI of less than 15

Treatment of Anorexia Nervosa:

Treatment for anorexia nervosa may include professionals from a number of different specialties including mental health providers, dieticians, and doctors working together to form the best treatment plan. Gaining support from family often proves to be a significant contributor to the success of a treatment plan.

Hospitalization – For those at significant risk from electrolyte disorders, cardiac arrhythmias, malnutrition, dehydration, or psychiatric issues, treatment in a hospital or a psychiatric ward may be required.

Depending on the severity of the case, the doctor will determine if specialized treatment can be done in a day center or if longer-term residential treatment is required.

Chief goal – regaining weight

Treatment begins with restoring the body to the ideal weight for the person’s height and age and returning it to a nourished state. This might include a feeding tube. Specialized meal plans target daily calorie intake goals. As part of the treatment, tests can be done to best create a diet suited to the amount of energy a person’s body needs.

Talk Therapy

  • Individual therapy –Cognitive behavioral therapy (including specifically enhanced CBT) continues to demonstrate effective results in treating adults. After establishing habits that target a return to an ideal weight and healthy eating habits, CBT focuses on addressing the thoughts and beliefs which led to the condition and replacing them.
  • Family therapy –Sinceanorexic teenagers are often unable to make good decisions related to eating or about their own health, family-based therapy creates a team support structure to help with feeding and monitoring weight gains.

Medications

Medications like antidepressants may be prescribed to treat co-occurring mental disorders like anxiety or depression, but currently there are no approved medications for the direct treatment of anorexia.

Symptoms of Anorexia Nervosa & Warning Signs:

People with anorexia nervosa usually try to prevent weight gain or to induce weight loss by one or more of the following methods:

  • Try to control calorie intake by imposing severe restrictions on the food eaten and the beverages drunk
  • Vomit after eating
  • Abuse and misuse laxatives, diuretics, and/or enemas to attain or maintain an “ideal” body weight
  • Exercise excessively to burn calories

Because of measures some people take to conceal the condition, it can be a challenge to correctly identify anorexia, but some of the following are potential indicators:

  • Behavioral and emotional symptoms or signs:

    • Severely restricting food intake through dieting or fasting and may include excessive exercise
    • Bingeing and self-induced vomiting to get rid of the food and may include use of laxatives, enemas, diet aids or herbal products
    • Refusing to eat or making excuses to not eat, not swallowing food after chewing, missing meals, not being truthful about amount of food eaten
    • Won’t admit to hunger
    • Aversion to eating in public
    • Organizing food on the plate, dissecting the food, eating in sections according to a prioritized list, drastic reduction in food choices to options that are only low in fat or calories
    • Moderate to extreme obsession with food, eating according to a strict schedule
    • Afraid of putting on weight, wearing clothes in multiple layers to reduce the appearance of reduced weight, repeated verbalizing of unhappiness related to weight
    • Frequent checking in the mirror for perceived flaws, moderate to extreme obsession with checking body measurements and weight
    • Reduced to no social activity, reduced or no capacity to get pleasure from activities previously enjoyed
    • Emotionless or short tempered, depression
    • Reduced libido
    • Suicidal thoughts
  • Physical symptoms or signs

    • Looking thin, excessive weight loss
    • Extreme tiredness
    • Uncommon results from blood tests
    • Sleep issues
    • Lightheadedness, fainting
    • Menstrual period stopping
    • Visible signs of poor circulation in hands, aversion to the cold
    • Hair in notably poor condition, abnormal soft hair across the body
    • Skin discoloration
    • Visible issues with teeth and potentially on knuckles from self-forced vomiting
    • Bowel issues, including irregularity
    • Delayed growth spurt during teenage years
    • Regular dehydration and electrolyte deficiencies
    • Low blood pressure, heart arrhythmia
    • Swollen extremities
    • Brittle bones which break easily

Causes of Anorexia Nervosa:

The precise cause of anorexia nervosa is not known, but there can be a predisposition to it based on a person’s genetics, personality, and environment.

  • Biological – Certain traits like perseverance, a sensitive nature, and perfectionism, either modeled or genetic
  • Psychological – The thinking that acceptance and being liked or loved is based on appearance
  • Environmental – Not all cultures place the same values on body weight, but Western culture and media sends the message of tremendous value in being thin. This is held as being especially true by younger females and their peers.

Risk factors for Anorexia Nervosa:

Factors that can render an individual at increased risk of developing anorexia nervosa are:

  • Genetics
  • History of anorexia in immediate family
  • Female gender
  • Young age
  • Reactions from others regarding a person’s weight gain or loss
  • Stress because of daily circumstances or significant life changes
  • Being from a higher socioeconomic background
  • Professions or careers where one’s weight is a factor and weight loss is encouraged
  • Exposure to cultural portrayals of beauty in the media and film industry

Anorexia Nervosa Complications:

Anorexia nervosa has the highest rate of mortality of any psychiatric disorder, and multiple body functions can be irreversibly damaged even if the person recovers.

The complications of anorexia nervosa include:

  • Heart defects such as abnormal heart rhythms – arrhythmias, and mitral valve prolapse – causes blood to leak back in the heart chambers instead of moving forward
  • Osteoporosis – weak and brittle bones, which can increase the risk of bone fractures
  • Gastrointestinal disturbances such constipation, hemorrhoids, polyps
  • Absent periods in females or reduced testosterone in men
  • Kidney function problems
  • Suicide

If a person with anorexia becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. This damage may not be fully reversible, even when the anorexia is under control.

In addition to the physical and medical issues that could develop, individuals with anorexia may also experience additional mental disorders including:

  • Personality disorders
  • OCD
  • Mood disorders like anxiety and or depression
  • Substance or alcohol abuse or dependence

Diagnosing Anorexia Nervosa:

When diagnosing anorexia nervosa, a person’s doctor will run various exams and tests to eliminate other possible causes for weight loss, as well as screen for complications, before confirming the diagnosis.

Tests and exams typically include lab work, a physical exam, and a psychological self-assessment questionnaire such as the SCOFF questionnaire — to assess elements related to eating habits and feelings and thoughts related to eating and appearance.

The SCOFF questionnaire can be administered by nonprofessionals to screen for the possible presence of an eating disorder, and SCOFF stands for the following questions:

S – Do you make yourself SICK when you feel uncomfortably full?
C – Do you worry you have lost CONTROL over how much you eat?
O – Have you recently lost more than 14 lbs. in weight within the last three months?
F – Do you believe yourself to be FAT when others say you are too thin?
F – Would you say that FOOD dominates your life?

If a person answers yes to at least two of the above questions, this may indicate they have anorexia nervosa.

Additional studies. Because of the side effects of being malnourished, it could be necessary to do X-rays (and or electrocardiograms) to look for heart issues, pneumonia, and broken or fractured bone, or to determine bone density.

Body mass index (BMI) is used by the American Psychiatry Association Diagnostic and Statistical Manual Edition 5 (DSM-5) as an indicator of the level of severity of anorexia nervosa.

  • Mild: BMI of greater than 17
  • Moderate: BMI of 16 – 16.99
  • Severe: BMI of 15 – 15.99
  • Extreme: BMI of less than 15

Treatment of Anorexia Nervosa:

Treatment for anorexia nervosa may include professionals from a number of different specialties including mental health providers, dieticians, and doctors working together to form the best treatment plan. Gaining support from family often proves to be a significant contributor to the success of a treatment plan.

Hospitalization – For those at significant risk from electrolyte disorders, cardiac arrhythmias, malnutrition, dehydration, or psychiatric issues, treatment in a hospital or a psychiatric ward may be required.

Depending on the severity of the case, the doctor will determine if specialized treatment can be done in a day center or if longer-term residential treatment is required.

Chief goal – regaining weight

Treatment begins with restoring the body to the ideal weight for the person’s height and age and returning it to a nourished state. This might include a feeding tube. Specialized meal plans target daily calorie intake goals. As part of the treatment, tests can be done to best create a diet suited to the amount of energy a person’s body needs.

Talk Therapy

  • Individual therapy –Cognitive behavioral therapy (including specifically enhanced CBT) continues to demonstrate effective results in treating adults. After establishing habits that target a return to an ideal weight and healthy eating habits, CBT focuses on addressing the thoughts and beliefs which led to the condition and replacing them.
  • Family therapy –Sinceanorexic teenagers are often unable to make good decisions related to eating or about their own health, family-based therapy creates a team support structure to help with feeding and monitoring weight gains.

Medications

Medications like antidepressants may be prescribed to treat co-occurring mental disorders like anxiety or depression, but currently there are no approved medications for the direct treatment of anorexia.