Anorexia Nervosa

Anorexia nervosa - often called simply “anorexia” - is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss. People with anorexia have an abnormally low body weight, an intense fear of gaining weight, and a distorted perception of body weight. To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. People with anorexia may also control calorie intake by vomiting after eating, by misusing laxatives, diet aids, diuretics or enemas, or by exercising excessively.

People with anorexia generally have an abnormally low body weight. Anorexia can cause serious complications including bone weakening, increased risk of infection, dangerous heart rhythms, severe dehydration, malnutrition, seizures, thyroid gland problems, and tooth decay.

Approximately 90-95% of people with anorexia nervosa are girls and women. Anorexia nervosa typically appears in early to mid-adolescence and it is one of the most common psychiatric diagnoses in young women.

Anorexia is an unhealthy way to try to cope with emotional problems, and it can be very difficult to overcome. Treatment is available to help people with anorexia gain a better self-image and return to healthier eating habits.

The physical symptoms associated with anorexia nervosa are related to starvation and malnutrition, but anorexia also comprises many emotional and behavioral issues.

Physical signs and symptoms of anorexia include:

• Extreme weight loss (15% or more below the normal weight)
• Thin appearance
• Abnormal blood counts
• Fatigue
• Insomnia
• Dizziness or fainting
• Bluish discoloration of the fingers
• Hair that thins, breaks or falls out
• Soft, downy hair covering the body
• Absence of menstruation
• Constipation
• Dry or yellowish skin
• Intolerance of cold
• Irregular heart rhythms
• Low blood pressure
• Dehydration
• Osteoporosis or loss of bone strength
• Swelling of arms or legs
• Confused or slow thinking, along with poor memory or judgment
• Dry mouth
• Wasting away of muscle and loss of body fat

Emotional and behavioral symptoms of anorexia include:

• Preoccupation with food
• Refusal to eat
• Denial of hunger
• Fear of gaining weight
• Lying about how much food has been eaten
• Flat mood (lack of emotion)
• Social withdrawal
• Irritability
• Reduced interest in sex
• Depressed mood
• Thoughts of suicide

To severely limit the amount of food they eat, people with anorexia may:

• Cut food into small pieces or move them around the plate instead of eating
• Exercise all the time, even when the weather is bad, they are hurt, or their schedule is busy
• Go to the bathroom right after meals
• Refuse to eat around other people
• Use pills to make themselves urinate (water pills or diuretics), have a bowel movement (enemas and laxatives), or decrease their appetite (diet pills)

The exact causes of anorexia nervosa are not known. Many factors may be involved, including biological, psychological, and environmental factors. Social attitudes that promote very thin body types may also be involved.

Risk factors for anorexia include:

• Being female
• Having a relative with anorexia nervosa
• Undergoing stressful life changes or transitions
• Being worried about, or paying more attention to, body weight and shape
• Having an anxiety disorder as a child
• Having a negative self-image
• Having eating problems during infancy or early childhood
• Having certain social or cultural ideas about health and beauty
• Trying to be perfect or overly focused on rules

Anorexia often begins during the pre-teen or teen years or young adulthood. The disorder is seen mainly in Caucasian females who are high achievers in school and who have a goal-oriented family or personality. Athletes, actors, dancers and models are also at higher risk of anorexia. Coaches and parents may inadvertently raise the risk by suggesting that young athletes lose weight and maintain a certain body size or shape.

To be diagnosed with anorexia nervosa, you must meet criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. DSM-5 diagnostic criteria for anorexia include:

• Restricting food intake: eating less than needed to maintain a body weight that's at or above the minimum normal weight for your age and height
• Fear of gaining weight: intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, such as vomiting or using laxatives, even though you are underweight
• Problems with body image: denying the seriousness of having a low body weight, connecting your weight to your self-worth, or having a distorted image of your appearance or shape

Anorexia nervosa is a serious condition that can be life-threatening. Anorexia nervosa has one of the highest death rates of any mental health condition, and between 5% and 20% of individuals struggling with anorexia nervosa will die. The probabilities of death increase depending on the length and severity of the condition. Death may occur suddenly — even when someone is not severely underweight. Death may result from abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes (minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body).

Anorexia nervosa can have numerous complications, including:

• Anemia
• Heart problems, such as mitral valve prolapse, abnormal heart rhythms or heart failure
• Bone loss, increasing risk of fractures later in life
• In females, absence of a period
• In males, decreased testosterone
• Gastrointestinal problems, such as constipation, bloating or nausea
• Electrolyte abnormalities, such as low blood potassium, sodium and chloride
• Kidney 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 complications, people with anorexia also commonly have other mental disorders including:

• Depression, anxiety and other mood disorders
• Personality disorders
• Obsessive-compulsive disorders
• Alcohol and substance misuse

Support groups are available to ease the stress of anorexia nervosa for the patient and the family. If you are receiving treatment for anorexia nervosa and managing your disorder, be sure to stick to your treatment plan. Do not skip therapy sessions and try not to stray from meal plans, even if they make you uncomfortable. Talk to your doctor about appropriate vitamin and mineral supplements to make sure your body is getting all of the nutrients it needs. Do not isolate yourself from family members and friends who want to see you get healthy. Resist urges to weigh yourself or check yourself in the mirror frequently. These fuel your drive to maintain unhealthy habits.

Anorexia nervosa is a serious health condition that can be both physically and emotionally destructive. It can become chronic, debilitating, and even life-threatening, but early diagnosis and intervention improve chances for recovery.

The biggest challenge in treating anorexia nervosa is helping a person recognize the disorder. Most people with anorexia deny that they have an eating disorder. People often enter treatment only when their condition is serious.

Treatment generally involves a team approach that includes medical providers, mental health providers, and dietitians. The most effective and long-lasting treatment for anorexia is usually psychological counseling coupled with medical and nutritional care. Any treatment should be tailored to the person with anorexia and will vary according to both the severities of the disorder and the patient’s particular problems, needs, strengths, as well as the support systems available for the patient and family.

The goals of treatment for anorexia are to restore normal body weight and improve eating habits.

Treatment may include:

• Increasing social activity
• Reducing the amount of physical activity
• Using schedules for eating

Hospitalization may be needed as part of treatment if the person has lost a lot of weight or has severe and life-threatening malnutrition, if weight loss continues even with treatment, if medical complications develop or worsen, or if the person has severe depression or thinks about committing suicide.

Support groups may also be a part of treatment. In support groups, patients and families meet and share what they have been through. Ongoing therapy and nutrition education are also important to continued recovery.

Medicines such as antidepressants, antipsychotics, and mood stabilizers may be given as part of a complete treatment program to help some patients with anorexia. Although medicines may help with some of the symptoms of anorexia, no medication has been proven to decrease the desire to lose weight.