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What is Anorexia Nervosa?
Anorexia nervosa (AN) or anorexia is an eating disorder characterized by food restriction, an intense fear of gaining weight and body dysmorphia. This condition affects women more often than men and can occur at any time, but most often during the teen years.
The prevalence of anorexia has increased every 10 years since 1930 among girls aged 15-19. Data suggests that AN affects between 0.3% to 1% of all people in the United States. This condition can be fatal and has the highest death rate among any mental health disorder.
What Causes Anorexia?
Experts acknowledge that anorexia nervosa is a complex disorder and that there is likely a combination of factors that might increase a person’s incidence of developing AN.
Genetics
Studies suggest that up to 80% of the risk of developing an eating disorder is genetic. Having first degree relatives, such as biological siblings or parents with an eating disorder raises an individual’s chances of having a condition by 10 times.
Neurotransmitter imbalances
An imbalance of neurotransmitters, such as serotonin and dopamine can impact appetite and mood and impulse regulation.
Trauma
Researchers believe that individuals with anorexia may use restriction of food as a way to cope with overwhelming feelings and painful emotions. A history of physical assault or sexual assault are examples of this type of trauma.
Social pressure
The pressure to look a certain way can be especially difficult for children and adolescents. Individuals who face teasing or bullying because of the way they look or how much they weigh may be more likely to develop anorexia. In addition to peer pressure, social influences, including traditional and social media, can have a deleterious impact on body image and contribute to the development of anorexia.
Emotional health
Individuals who experience feelings of low self worth or have low self esteem may be more prone to developing anorexia. Stressors such as the need to be perfect, impulsive behaviors or relationship difficulties may also trigger the development of this eating disorder.
FAQs
Anorexia can cause a fluid volume deficit. This is due in part to limited fluid intake and may also occur as a result of the binging and purging some people with anorexia do. Repeated vomiting can cause a person to lose too much fluid which leads to dehydration and a reduced fluid volume.
Also, the use of laxatives can cause loose, watery stools contributing to fluid deficit. Individuals taking diuretics (water pills) force the body to get rid of fluid. In this case, the fluid found in a person’s blood will be removed from one’s overall circulating volume.
Circulating volume refers to the amount of blood in the body’s circulatory system. Any disruption of a person’s circulating volume can impact normal body function and may lead to decreased blood flow to organs causing dizziness, fatigue, low blood pressure, tachycardia and organ failure. In the most severe cases, fluid volume deficit can lead to hypovolemic shock and death.
Both anorexia and substance use disorder are serious mental health conditions. Both are characterized by behavior that negatively impacts one’s physical, emotional and social wellbeing.
The maladaptive behaviors may result from trauma, genetics, low self esteem and other co-occurring disorders such as depression or anxiety.
Significantly, up to 50% of individuals with eating disorders use alcohol or illicit drugs. Up to 35% of people with substance use disorders also have an eating disorder.
Both anorexia and substance use disorder require professional intervention and treatment. Both benefit from talk therapies including cognitive behavioral therapy and dialectical behavioral therapies and may require the support of medication for long term recovery success.
A study published in World Psychiatry reported that 5% of patients with anorexia will die within four years of diagnosis. While the exact reason for this statistic is unknown it is thought to be associated with severe weight loss and malnutrition that causes widespread organ damage over time, even in cases where the anorexia is considered to be well managed.
Individuals who have at least one hospitalization for anorexia were found to have an increased risk of death for up to 20 years after discharge. Furthermore, this research found that a leading cause of death for people with anorexia was suicide, even among people who have no other mental health disorder diagnosis.
Healthcare professionals use the criteria outlined in the DSM 5 for a diagnosis of anorexia. An individual with anorexia will:
- Severely restrict caloric intake leading to weight loss or failure to gain weight resulting in significantly lower body weight based on age, sex, height and stage of growth.
- Have an intense fear of gaining weight or being “fat”
- Have a distorted view of themselves and may deny how seriously restricted eating has had on their overall health.
Additionally, the use of the body mass index (BMI) can be helpful in determining the severity of the condition:
- Mild: BMI of greater than 17
- Moderate: BMI of 16-16.99
- Severe: BMI of 15-15.99
- Extreme: BMI of less than 15
Furthermore, a diagnosis of anorexia may be made upon a complete physical exam. Healthcare providers will collect a family, diet, exercise, and psychological history, discuss body image and collect information regarding the use and frequency of taking diet pills, laxatives and diuretics.
Lab and other diagnostic testing can also indicate that a person may have anorexia. These include complete blood counts (CBC), electrolyte panels, electrocardiograms, urinalysis, bone density tests, and kidney, liver and thyroid function tests.
There are two subtypes of anorexia nervosa; restrictive anorexia and binge-purge anorexia.
Restrictive anorexia occurs when a person severely limits the amount and kind of food they eat, especially avoiding carbohydrates and fats.
Binge-purge anorexia is more complex and occurs when a person greatly restricts the amount and type of food they eat. Additionally, they may also participate in episodes of binge eating large amounts of food in a short period and then purging. They may get rid of the food through self induced vomiting or by using laxatives or diuretics.
Binge-purge anorexia may appear similar to bulimia but there are some important differences in anorexia versus bulimia. As with anorexia, persons with bulimia often have a distorted body image and an intense desire to lose weight or an intense fear of gaining weight.
However, persons with bulimia often have a normal body weight, while those with binge-purge anorexia are frequently underweight. Persons with bulimia are also more likely to misuse laxatives and diuretics to avoid gaining weight after binging.
Anorexia Signs and Symptoms
Anorexia impacts both an individual’s physical and mental health. Symptoms may include:
- Changed body image
- Low body weight and appearing very thin
- Extreme fear of becoming fat
- Excessive physical activity or exercise
- Denial of hunger
- Fixation with making food
- Abnormal, obsessive or ritualized eating
- Poor nutritional status
- Fluid loss dehydration
- Stomach pain or bloating
- Constipation
- Lethargy or fatigue
- Cold intolerance
- Fine, downy body hair also called lanugo hair
- Dry or yellow appearing skin
- Brittle nails
- Thinning hair
- Poor wound healing
- Irregular or absent menstrual cycles
- Infertility
- Withdrawal from social situation
- Loss of interest in sex
- Mood changes
- Depression
How Does Anorexia Affect the Body?
Anorexia nervosa is a serious condition and has the highest mortality rate of any eating disorder.
Severe restriction of caloric intake can result in developing a number of conditions, some of which can be life threatening and may include:
- Anemia, or low red blood cell count
- Heart problems including arrhythmias, slow heart rate, heart failure and mitral valve prolapse
- Low blood pressure
- Kidney problems
- Electrolyte imbalance
- Lack of menstruation for women
- Low testosterone in men
- Bone loss
- Brain damage
- Multi organ failure
- Death
How to Help Someone with Anorexia
Treatment is essential for individuals who are suffering from anorexia. Organizations such as the National Alliance on Mental Illness (NAMI), National Eating Disorders Association (NEDA) and the National Association of Anorexia Nervosa and Associated Eating Disorders (ANAD) are good resources for individuals and families.
These organizations provide education, support and help with finding the right treatment programs to meet their needs.
Primary care providers can also help. They are often the ones to make the diagnosis and perform any medical testing to evaluate the extent that the cycle of calorie restriction has had on the overall medical condition of the individual.
The severity of an individual’s physical and mental state will dictate the level of service needed to help stabilize the condition and help get them on the road to recovery.
Some individuals will need inpatient treatment for anorexia. This may include medical stabilization and monitoring as a part of a comprehensive treatment plan.
Once an individual’s medical condition is stable, then talk therapies including cognitive behavioral therapy (CBT), acceptance and commitment therapy, dialectical behavior therapy (DBT), cognitive remediation therapy, Interpersonal psychotherapy (IPT) and psychodynamic psychotherapy may begin.
For some individuals, medication may help treat their condition including the use of antidepressants, medications such as Zyprexa to help weight gain and medications to regulate the menstrual cycle.
The use of online or virtual therapy may be helpful for individuals. It provides the flexibility and convenience that many people are looking for. This option is good for people who live in underserved communities. Research indicates that this type of treatment is just as effective as in person therapy.
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