Anorexia Nervosa

What is an Eating Disorder?

Eating disorders are serious mental illnesses involving extreme eating behavior and body image disturbances that negatively affect a person’s physical, psychological, and social well-being.

People suffering from this condition often feel they are not in control of their food intake or worry excessively about their weight.

Eating disorders come in many forms and affect men and women of all ages, races, and social classes.  Moreover, mental illnesses such as depression or anxiety often accompany eating disorders, making treatment more difficult.

There are several eating disorders, but the most well-known are anorexia nervosa, binge-eating disorder, and bulimia nervosa. Other forms of eating disorders include:

• Rumination disorder
• Avoidant Restrictive Food Intake Disorder
• Pica
• Other Specified Feeding and Eating Disorders (OSFED)

These different eating disorders all have one thing in common: a person’s relationship with food and their body.

Some people have only one episode of a short-lived eating disorder, while others have frequent bouts over many years. Other people with eating disorders also have other mental health problems, such as depression or anxiety.

Anorexia Nervosa VS Bulimia

Anorexia nervosa and bulimia nervosa are both eating disorders that can devastate a person’s well-being. Both disorders are associated with a distorted body image, an intense fear of weight gain, and a preoccupation with food, weight, and calories.

However, there are also some significant differences between the two conditions. Here is an overview:

• People with anorexia are often underweight, while those who have bulimia tend to be of normal weight or above-average body weight.
• Compared to people with bulimia who tend to binge eat and purge, anorexics restrict their food intake more often than they binge/purge.
• Because anorexia nervosa is much more serious than bulimia, it carries a greater risk for medical complications, including heart disease and kidney failure.

Anorexia Nervosa

Anorexia nervosa is a severe medical condition associated with extreme weight loss (with a body mass index (BMI) that falls below 18.5) due to self-starvation and excessive exercise.

There are two types of anorexia:

• Restricting type: In this type, the person severely limits their food intake to control or drop their weight. They usually maintain a low weight.
• Binge-eating/purging type: People with this type of anorexia regularly eat large amounts of food in a short period (binge-eating) and then try to get rid of the calories by vomiting or using laxatives or enemas (purge). They may also fast or exercise excessively to compensate for binges.

Common behaviors associated with anorexia nervosa include:

• A distorted body image; for example, seeing themselves as overweight even when they are severely underweight
• Extreme dieting to lose weight or prevent weight gain
• Excessive exercise, sometimes in the form of compulsive activity, such as running for many hours each day
• Refusing to eat certain foods (picky eating) or only eating small portions of low-calorie foods (restrictive eating)
• Abusing laxatives or diuretics
• Regularly eating in secret
• An obsession with food and a constant preoccupation with calories, fat grams, and nutrition

Bulimia Nervosa

Bulimia Nervosa is an eating disorder that involves binge eating (rapid consumption of large amounts of food) followed by compensatory behaviors such as:

• Forced vomiting
• Misuse of laxatives, diuretics, or enemas
• Fasting
• Excessive exercise

People with bulimia nervosa often go through periods of binge eating that may last up to two hours.

During these times, they may feel out of control while eating and guilty afterward because they ate so much. They may also engage in compensatory activities regularly to prevent weight gain.

Symptoms of Anorexia Nervosa

Anorexia is a serious mental illness that can devastate your physical, mental and emotional health.

If you have anorexia or are worried about a friend or family member who does, it’s important to know what to look out for. Although the signs and symptoms of anorexia can vary from person to person, many people with this condition share certain traits.

Physical Symptoms of Anorexia

People with anorexia can experience many physical problems, including:

• Excessive Weight Loss: People with anorexia often obsess about their weight and what they eat. They may weigh themselves frequently, restrict their food intake, and exercise excessively. This behavior can lead to severe weight loss (15% below average weight), which can cause problems with your health.
• Loss of Menstruation in Women: Women who suffer from anorexia may stop having their periods altogether due to insufficient nutrition resulting in low hormone levels and anemia (lack of healthy red blood cells).
• Weakness, Fatigue, and Lethargy: Anorexia nervosa causes weakness, fatigue, and lethargy because your body is not getting the nutrients it needs to function. Your body thinks it’s starving, so it slows down its metabolism to conserve energy.
• Loss of Appetite: Anorexia often causes people to have little or no appetite, and food becomes a source of anxiety rather than pleasure. If you have anorexia, you also might not feel hungry because your body thinks it needs fewer calories than it does.
• Brittle Nails, Dry Skin, and Hair Loss: Anorexia nervosa interferes with absorbing vital nutrients such as protein and fat-soluble vitamins. Lack of these nutrients leads to brittle nails, fine hair, hair loss, and dry skin.
• Constipation and Bloating: People with anorexia nervosa often have trouble digesting food properly because they don’t eat enough fiber in their diet (which helps keep things moving through their digestive system). As a result, gastrointestinal problems like constipation or bloating may occur after eating small amounts of food.
• Cold Intolerance: Anorexic people often experience low body temperature because they’re not getting enough calories to maintain a steady body temperature.
• Dizziness: Dizziness or fainting will often occur in anorexics due to dehydration. However, low blood pressure or low blood sugar levels due to malnutrition are also significant contributors.

Mental and Emotional Symptoms of Anorexia

The mental and emotional symptoms of anorexia nervosa (AN) can be as devastating and debilitating as the physical symptoms. You need to know the signs to get help for yourself or a loved one.

Some of these mental and emotional symptoms of anorexia include:

A Distorted Perception of Body Image

People with anorexia nervosa are obsessed with their body size and shape and often see themselves as overweight, even when they are dangerously thin. They may also fixate on specific areas of their bodies, such as their stomach or thighs.

Intense Fear of Gaining Weight

Anorexics desperately need to maintain their thinness, even though they know that starving themselves harms their health. They may go to extremes to control their weight—such as extreme dieting—or engage in excessive exercise.

An Obsession Over Dieting, Exercising, and Weight

People with anorexia nervosa may become obsessed over calorie counting or other aspects of dieting and weight control, such as exercise routines or calorie restriction diets. In other cases, they may engage in purging behaviors like self-induced vomiting after eating food.

Excessive Focus on Physical Appearance

People with anorexia often become obsessed with their body shape and weight, and they may try to lose weight by starving themselves or exercising excessively. They may also weigh themselves obsessively or see a fat person in the mirror whenever they look up.

Feelings of Isolation

Many people with anorexia feel alone and isolated because they cannot share their thoughts and feelings about food with others around them. They also may avoid eating in front of other people because they fear being judged or criticized.

Difficulty Concentrating

People with anorexia nervosa often have difficulty concentrating on tasks at work or school because of lacking energy from their restrictive food intake behavior. They may also have trouble completing assignments because they’re too preoccupied with food and how it makes them feel physically.

Low Self-esteem

People with anorexia often view themselves as unattractive or worthless because of their weight and body shape. These feelings can lead to depression, anxiety, and hopelessness about overcoming the illness.

Depression and Anxiety

Depression and anxiety are two of the most common mental and emotional symptoms of anorexia nervosa.

A person with anorexia nervosa may show signs of depression, such as low self-esteem, loss of interest in activities they used to enjoy, and constant fear of being fat. They may also feel anxious, worrying about their weight or body shape.

Obsessive-Compulsive Disorder (OCD)

An obsessive-compulsive disorder (OCD) is a condition in which someone has repetitive thoughts (obsessions) and behaviors (compulsions) that they feel driven to carry out. In anorexia nervosa, this might mean constantly checking to see if you’re still thin or repeatedly weighing yourself.

What Causes Anorexia?

As with all eating disorders, anorexia is not a choice but a complex psychological condition that can have devastating effects on the body.

Some people have a predisposition to the condition, while others experience an event or series of events that cause them to develop anorexia.

If you’re struggling with anorexia or know someone who is, it can help to understand what causes it so that you or your loved one can get the proper treatment.

Risk Factors for Anorexia

While there’s no single cause for anorexia nervosa, research has shown that certain risk factors make it more likely for someone to develop it or experience symptoms at some point.

People who develop anorexia may have certain risk factors in common, including:

A History of Dieting or Other Weight-Control Behaviors

Dieting can lead to maladaptive eating habits, a preoccupation with food, and weight loss that can increase your risk of developing anorexia nervosa.

People who regularly engage in extreme or unhealthy weight-control behaviors such as fasting, purging, or excessive exercise may be at increased risk for developing anorexia nervosa.

Family History of Eating Disorders

There’s a genetic component to eating disorders. If one family member has an eating disorder, there’s a greater chance that other family members will also develop one.

Age

Teens and young adults between ages 13 and 25 are most likely to develop an eating disorder. The main reason may be that young people rely heavily on peers for guidance, and peer pressure often leads them to conform to unhealthy standards about body image and food intake.

Gender

Anorexia is a serious medical condition that affects people of all ages and genders, but it’s most common in women. One primary theory is that women are more pressured to maintain a certain physical appearance than men.

Mental Disorders

Those who already suffer from depression, anxiety, or obsessive-compulsive disorder (OCD) are at higher risk for developing anorexia.

Anorexics tend to have issues with control over their emotions, thoughts, and behaviors. Having another mental illness worsens the situation and often leads them down an even darker path.

Experiencing Trauma or Abuse

Trauma or abuse can lead to feelings of pain, low self-worth, and shame, which may contribute to developing disordered eating behaviors.

A Need for Control and Perfectionism

People with anorexia are often perfectionists who strive for control over their lives. Perfectionists tend not only to see themselves as better than others but also require themselves to be perfect at all times.

Life Changes

Changes like puberty, a recent move, and losing a job or loved one can also contribute to stress and depression, leading to disordered eating habits.

Causes and Influences

Many factors can contribute to the development of anorexia. They include:

Culture

The United States has a cultural obsession with being thin and beautiful, which puts pressure on young people to look thinner than they are.

As a result, eating disorders like anorexia or bulimia nervosa can occur—as they are often related to the desire to achieve an unrealistic body image that society at large idealizes (e.g., celebrities).

Pressure From Family Members To Be Thin

Parents, siblings, and other relatives can put a lot of pressure on young people to maintain a certain weight. While this is usually well-intentioned, it can lead to some harmful practices.

In some cases, family members may encourage unhealthy weight loss practices such as diet pills or fasting—causing a young person to become obsessed with achieving and maintaining thinness and develop anorexia.

Low Self-esteem or Body Image Issues

The root of anorexia is often low self-esteem and body image issues. People with anorexia may feel like they’re not good enough or are trying to hide their imperfections by losing weight.

Peer Pressure or Bullying

Additionally, peer pressure or bullying can contribute to the development of anorexia. Children teased about their weight by their peers will often try to lose weight to fit in with their peers and avoid future bullying.

Complications of Anorexia Nervosa

Lack of proper nutrition and constant starvation can lead to various short and long-term effects. It is essential for people who suffer from anorexia to understand the potential complications involved.

Regardless of whether or not a person’s condition is mild, moderate, or severe, they must seek effective treatment immediately from a medical professional to prevent further complications.

 

Short-Term Effects

Short-term effects develop suddenly and typically resolve quickly with treatment. They include:

Hair Loss, Dry Skin, and Brittle Nails

Not getting enough nutrients can make your nails brittle and prone to breaking or splitting. You may also notice that your hair is falling out more than usual—mainly because your body isn’t getting enough protein, which it needs to grow healthy hair and nails.

Weakness, Dizziness, and Fatigue

When your body is starving, it will stop functioning at its best to conserve energy and keep itself alive—leading to problems such as weakness or dizziness when standing up quickly.

Constipation

Consuming less food can lead to constipation because your body doesn’t get enough fiber and fluids to keep things moving smoothly.

Hypothermia

Anorexia nervosa can cause your body to become cold and pale as you lose weight—because you do not consume enough calories to maintain your body temperature at normal levels.

Amenorrhea

Amenorrhea is the absence of menstruation (for three consecutive months), which can be caused by low body fat, hormone imbalances, stress, or malnutrition.

Alterations in Brain Functions

Problems with memory, concentration, and decision-making may result from anorexia nervosa—leading to difficulty returning to normal activities after treatment.

Long-Term Effects

In addition to the short-term effects, anorexia nervosa has long-term, life-threatening effects. Anorexia nervosa can cause:

Electrolyte Imbalances

Electrolyte imbalances are often the most serious complications of anorexia nervosa. Electrolytes are minerals that help regulate the body’s fluids and pH levels.

If you have an electrolyte imbalance, your body can’t keep its fluids balanced—causing you to feel dizzy, faint, or experience muscle cramps and spasms. It can also affect your heart rhythm, leading to arrhythmias (irregular heartbeat).

Kidney Failure

Kidneys work to filter out waste products from the blood and produce urine. When a person has anorexia nervosa, their body can’t get rid of these toxins properly because it’s not getting enough water and nutrients from food—this can cause kidney failure.

Low Blood Pressure

Anorexia nervosa causes low blood pressure, meaning that your heart has to work harder to keep blood flowing throughout your body. Dizziness or fainting can occur as a result if it goes too low.

Muscle Wasting

Muscles are made up of protein and water. Therefore, when you don’t eat enough food or drink enough water, it’s harder for your body to get that protein back into muscle tissue—where it’s needed for the growth and repair of injuries.

Muscle wasting will then occur, making it harder for your body to keep up with daily activities like walking up stairs or standing up straight.

Heart Problems

Anorexia can damage your heart muscle and lead to arrhythmias, irregular heartbeats, and even heart failure. A person with anorexia may have a heart rate as low as 60 beats per minute—known as bradycardia—which can be life-threatening if not treated immediately.

Osteoporosis

Osteoporosis is a condition that causes bones to become brittle and fragile due to loss of density, which can lead to fractures or broken bones.

In addition to muscle wasting, osteoporosis occurs when someone with anorexia nervosa doesn’t consume enough calories or nutrients (calcium and vitamin D) over time which are essential for strong bones.

Infertility

One of the most challenging long-term complications of anorexia nervosa is infertility.

A National Library of Medicine study revealed that 7.6% of women who visited infertility clinics had anorexia nervosa or bulimia nervosa. The reason being anorexia can cause hormonal imbalances and damage ovaries, which can lead to problems with conception.

Severe Malnutrition

Malnutrition occurs when insufficient nutrients are available for normal growth and development. People with anorexia may suffer from severe malnutrition if they do not eat enough food to maintain their low body weight.

Anorexia Nervosa Statistics

• According to the National Eating Disorders Association, the lifetime prevalence of anorexia nervosa is approximately 0.3-0.4% among young women and 0.1% among young men.
• A JAMA Psychiatry study published by the American Medical Association revealed that:
  • About 5-10% of anorexics die within the first decade after being diagnosed with the illness.
  • Among people with anorexia nervosa, 18-20% will die after 20 years.
  • Recovery is possible among anorexics, but only 30–40% completely overcome their disease.
  • Anorexia nervosa has a death rate 12 times higher than all other causes of death for women aged 15–24.
  • For many people with anorexia, the disease is fatal. About 20% of those suffering from it die prematurely due to complications, including suicide and heart problems.
• Anorexia nervosa affects roughly one out of every 200 American women, according to the South Carolina Department of Mental Health.

Diagnosis and Treatment

The first step in treating anorexia nervosa is diagnosing the condition.

The DSM-5 sets the following criteria for diagnosing anorexia nervosa:

1. Restricting caloric intake causing significantly low body weight in the context of age, sex, physical health, and developmental trajectory.
2. Extreme fear of gaining weight or becoming fat, even when underweight.
3. Distress about one’s body weight or shape, the tendency for a person’s self-evaluation to be unduly influenced by their body weight and shape, and denial of the seriousness of current low body weight.

Diagnosing Anorexia Nervosa

Diagnosis aims to provide patients with proper treatment for their condition and help them avoid serious health risks associated with malnutrition.

Physical Examination

A doctor or healthcare professional may do a physical examination to check for signs of anorexia nervosa and other medical conditions causing anorexia symptoms. The physician may examine the following to ensure they are within normal ranges.

• A person’s weight (a BMI of below 18.5 may indicate anorexia)
• Checking the heart rate with an electrocardiogram (ECG) or echocardiogram (ECHO)
• Blood pressure
• Body temperature
• Skin and nails
• Examining the abdomen
• Reflexes and muscle tone
• In postmenarcheal females, amenorrhea (the absence of at least three consecutive menstrual cycles).

Blood Tests and Other Tests

Your doctor may order blood tests to measure electrolytes and check for infections or other conditions that could be causing symptoms. These include thyroid disorders, kidney disease, and diabetes mellitus.

Psychological Evaluation

A trained psychologist or psychiatrist will either use self-assessment questionnaires or conduct a one-on-one interview to assess the severity of the condition. This procedure also lets them know whether other issues might be contributing to it (such as depression).

The psychologist or psychiatrist may also ask questions about the following:

• Family relationships
• School or work performance
• Eating habits
• Self-esteem issues
• Substance abuse
• Mental disorders

A physician will also consider other factors that may contribute to developing an eating disorder, such as family history and cultural background.

Referral to a Specialist

If your doctor suspects anorexia nervosa based on these factors, they may refer you to a mental health professional who can thoroughly evaluate your condition.

This step is crucial because it’s often difficult for patients with anorexia nervosa to recognize their symptoms—often don’t realize they’re sick until someone else points them out.

Treatment for Anorexia Nervosa

Treating anorexia involves medical treatment, nutritional counseling, and psychotherapy. The goal of treatment is to help the person with anorexia accept their body size and shape, increase their weight to a healthy level, and learn how to eat appropriately again.

Psychotherapies

Psychotherapy can help people with anorexia nervosa learn to cope with anxieties and other emotional issues that may contribute to their eating disorders. These therapies also help them gradually increase their food intake while they work through feelings about body image, weight, and eating.

These methods include:

Cognitive Behavioral Therapy (CBT)

The most common type of psychotherapy used for anorexia nervosa is CBT. CBT helps patients identify negative thought patterns and behaviors contributing to their eating disorders and teaches them how to replace these thoughts with more positive ones.

Family Therapy 

Family therapy involves family members working with the patient toward recovery by setting goals and ensuring that the patient eats enough food during meals.

Group Therapy

Group therapy is helpful because it allows individuals with similar experiences to support one another while learning new coping skills. Similarly, support groups can provide a similar structure where recovering anorexics can support one another throughout treatment.

Interpersonal Psychotherapy (IPT)

IPT is a short-term therapy that focuses on resolving issues in relationships with family members or peers that can contribute to developing or maintaining an eating disorder. It also helps people develop healthier ways of interacting with others.

Medical Care and Monitoring

Medical care and monitoring in treating anorexia nervosa entail a variety of things. The patient’s nutrition, hydration, and electrolyte levels are monitored to ensure they receive enough nutrients to support their body’s needs.

Additionally, the patient’s mental health is monitored, as well as their emotional state. The patient may also be required to attend therapy sessions with a therapist to help them cope with their eating disorder.

Nutritional Counseling

Nutritional counseling helps people with anorexia nervosa learn to eat healthy meals that will provide them with enough calories to maintain weight while still feeling sated and nourished.

Medications

Physicians or mental health professionals may prescribe medications in conjunction with psychotherapy for people with severe anorexia nervosa. These medications may include antidepressants or drugs that help reduce anxiety and stress.

How Friends and Family Members Can Help

Friends and family are often the first line of support for someone with anorexia. But it can be hard to know what to do, especially if you’re worried your loved one might have anorexia.

It’s important to remember that the person with anorexia is going through something tough and painful and may not always feel like they can ask for help.

The truth is that the best thing you can do for someone with anorexia is to love them and let them know you’re there for them. But if that’s not enough, here are some tips for helping:

Do

Here are some things that you can do to support someone with anorexia:

• Be honest and tell them if you think something is wrong so they know where they stand. For example, if they ask you how they look or how much weight they’ve lost lately, just tell them the truth so you can start working together on fixing the problem. (Remember to be gentle with them when addressing the issue).
• Encourage them to get professional help by referring them to a therapist or other health professional specializing in eating disorders.
• Offer encouragement for every step forward in treatment. It’s normal for people with anorexia to get discouraged when they don’t see immediate results from their efforts, so loved ones need to show support while working on improving.
• Help them schedule outings with others who know they have an eating disorder (this helps relieve isolation).
• Check-in with them about what they’re doing at school/work/social events to help them feel supported and less alone.

Don’t

• It’s important not to rush in and try to fix their problems right away. Instead, focus on letting them know how much their health means to you. In general, the best thing people can do is just be there for them—which means being there even when they’re not ready.
• Avoid making any comments about food or weight gain/loss. The last thing they need is another reminder of how much control food has over their life—or how little control they have over it.
• Don’t criticize their food choices or weight loss. It’s tempting to get mad when your friend or family member starts losing weight, but this will only reinforce their self-destructive behaviors and make them less likely to seek help.
• Don’t pressure them into eating more than they want to at any one time, even if you think they are hungry.

Finally, it’s okay if you’re unsure how to help your loved one—it’s normal for people who have never been through this before to feel lost. The best thing you can do is just listen and try to understand them.

Get Help for Anorexia Nervosa

Anorexia nervosa is a serious condition that can cause significant harm to your physical and mental health. Fortunately, treatment options can help you get your life back in order.

If you or a loved one is struggling with anorexia nervosa, we encourage you to seek treatment as soon as possible. To find treatment options in your area, visit SAMHSA’s Substance Abuse Treatment Facility Locator at FindTreatment.gov or call 1-800-662-HELP (4357).