What is Anorexia Nervosa (Anorexia)?
Anorexia nervosa is a type of eating disorder where individuals greatly limit their food consumption, resulting in considerably low body weight. These individuals have a strong fear of gaining weight and a warped perception of their own bodies. Additionally, they struggle with acknowledging the severity of their significantly low weight.
What Causes Anorexia Nervosa (Anorexia)?
Many professions, like modeling or acting, value thinness, which can often be hard to achieve and is enhanced with makeup and photo editing. Athletes in fields like ballet, long-distance running, or martial arts also feel the pressure to stay skinny as a way to perform better than their competitors. There’s a lot of emphasis on diet tips and weight loss advice in the media.
Groups such as growing girls often perceive thin body shapes as boosting self-confidence and associate weight loss with greater self-discipline.
Risk Factors and Frequency for Anorexia Nervosa (Anorexia)
Anorexia nervosa predominantly affects females and often begins in late adolescence or early adulthood. The likelihood of someone experiencing anorexia nervosa during their lifetime is between 0.3% to 1%, according to most studies, while some European research indicates it might be as high as 2-4%. This risk is the same across various cultures, races, and ethnicities. Several risk factors can increase the chances of developing an eating disorder. These include being overweight as a child, being female, having mood disorders, personality traits like impulsivity and perfectionism, experiencing sexual abuse, or facing weight-related pressures from family or peers.
- Anorexia nervosa commonly affects females.
- It typically starts in late adolescence or early adulthood.
- The lifetime risk of developing anorexia nervosa is 0.3% to 1% according to most studies, but some European studies suggest it could be 2% to 4%.
- No matter the culture, ethnicity, or race, the risk is the same.
- Risk factors for eating disorders can include childhood obesity, being female, mood disorders, certain personality traits like impulsivity and perfectionism, surviving sexual abuse, or facing weight-related pressures from family or peers.
Signs and Symptoms of Anorexia Nervosa (Anorexia)
People with anorexia nervosa may experience a range of symptoms related to their eating behaviors and the effects of the condition on their bodies. They might not have their period, feel cold all the time, struggle with constipation, and have swelling in their arms and legs. They may also feel tired and irritable. These individuals often restrict their food intake by counting calories or controlling portion sizes and may induce vomiting or use water pills or laxatives to lose weight. Some may also have a compulsion for long periods of intense exercise. These behaviors can lead to several health problems caused by long periods of not eating enough or purging behaviors.
- No menstruation
- Feeling cold all the time
- Constipation
- Swelling in the arms and legs
- Tiredness
- Irritability
- Calorie counting or portion control
- Self-induced vomiting
- Use of water pills or laxatives
- Long periods of intense exercise
Testing for Anorexia Nervosa (Anorexia)
If you are suspected to have anorexia, the first step in the diagnosis is a detailed medical history. This includes your earlier medical and psychological health history, any family or social events that might have contributed, and medications you’re taking, prescribed or otherwise. A physical exam will also be performed to check for any complications.
Your doctor will also order a set of basic labs to check for indicators of anorexia nervosa. These will include tests like the complete blood count, coagulation panel, complete metabolic profile, Vitamin D, testosterone for men, thyroid-stimulating hormone and urine test (pregnancy test for women and for drug use). An electrocardiogram – or EKG – might also be ordered to look for severe heart rhythm problems.
If you’re extremely underweight (Body Mass Index less than 14 kg/m), additional tests may be needed like an echocardiogram – a type of heart scan – or a CT scan of your abdomen.
People with anorexia nervosa can have various complications, including heart problems (slower heart rate, enlarged heart, low blood pressure), slowed growth or muscle wasting, skin issues like dry skin or fine hair growth, lower bone density, and constipation, among others.
The American Psychiatric Association has specific criteria for diagnosing anorexia nervosa. This doesn’t include missing your period anymore because people who still menstruate can have similar outcomes as those who don’t.
Other eating disorders that have some similarities with anorexia nervosa include Avoidant or Restrictive Food Intake Disorder, Binge Eating Disorder, Bulimia Nervosa, Pica, and others. For example, someone with anorexia nervosa could have similar symptoms to someone with ‘atypical anorexia nervosa’ who is not underweight.
Other conditions can cause weight loss and similar symptoms but are not caused by the same obsessions and fears related to food and body image as anorexia nervosa. For example, someone with depression might lose weight but the reason is different. Conditions like coeliac disease, overactive thyroid, bowel diseases, diabetes, and others can also result in weight loss.
That’s why a comprehensive medical history and thorough physical examination, as well as other lab and imaging tests, are needed for accurate diagnosis and treatment plan.
Treatment Options for Anorexia Nervosa (Anorexia)
The treatment for anorexia nervosa mainly focuses on healthy eating and psychological help. In some severe cases, patients may need to be admitted to the hospital. This typically happens if they have additional mental health conditions, are at risk of suicide, lack a support network, live too far from a daily treatment center, or have severe health problems like dehydration, slow heart rate, low blood glucose, electrolyte imbalances, or organ damage. Those who are not motivated to recover or have excessive purging behaviors might also require hospitalization.
If a patient’s weight is dangerously low or they refuse food and cannot stop excessive exercising, they may need supervised feeding or even a feeding tube.
Outpatient treatment is also a good option for less severe cases and involves intensive therapy for several hours during weekdays, or partial hospitalization for six hours a day. Family-based therapy can be particularly beneficial for younger patients in order to address the root causes and create a supportive home environment.
When someone hasn’t eaten for a long period and then starts eating again, they might develop refeeding syndrome. This causes an electrolyte imbalance in their body that can lead to heart and breathing problems. It’s crucial to monitor these patients closely for signs of this syndrome.
Medication isn’t typically the first choice of treatment. However, if a patient’s condition doesn’t improve with initial treatment, a medication named olanzapine can be used. For patients with co-existing mental health conditions like depression or anxiety, a combination of therapy and selective serotonin reuptake inhibitors (SSRIs) may be effective. If SSRIs aren’t successful, second-generation antipsychotics might be necessary. Certain antidepressants are not preferred due to their potential harmful effects on the heart, especially in malnourished patients. A medication named Bupropion is prohibited for individuals with eating disorders due to the increased risk of seizures.
What else can Anorexia Nervosa (Anorexia) be?
When experiencing certain symptoms that might seem like typical digestive troubles, it’s important to remember that there could be several possible causes to these symptoms. Here are a few conditions that could be mistaken for other digestive problems:
- Cancer: Keep in mind, that includes not just stomach or colon cancer, but also related cancers such as pancreatic cancer.
- Chronic mesenteric ischemia: A condition where there’s reduced blood flow to the intestines, which might cause stomach pain.
- Achalasia: This is a rare disorder affecting the esophagus, and it can make swallowing difficult.
- Malabsorption: This is when your digestive tract isn’t properly absorbing nutrients from food.
- Hyperthyroidism: This condition can speed up your metabolism, leading to weight loss and other symptoms.
- Irritable bowel syndrome (IBS): A common disorder that affects the large intestine and can cause symptoms like stomach pain, gas, and diarrhea.
- Celiac disease: This is an autoimmune disorder where eating gluten can damage the small intestine.
It’s important to get the correct diagnosis, as the treatment and management varies significantly for each condition. If your symptoms persist, make sure to see a healthcare provider.
What to expect with Anorexia Nervosa (Anorexia)
The outcomes for people with Anorexia Nervosa (AN) can vary greatly. About 75% of patients who are treated in outpatient settings recover within 5 years, and the same percentage experience moderately good outcomes, like weight gain. However, patients who are older, have had the disease for longer, are underweight at the end of treatment, have other mental health issues, or were treated outside a specialized clinic, are more likely to suffer a relapse. Those who partially recover often end up with a different eating disorder like bulimia or an unspecified eating disorder.
Also, AN poses more health risks than what is typical for the general population, making it one of the deadliest eating disorders. These risks include health complications, drug misuse, and suicide. Remarkably, AN patients have higher suicide rates, accounting for 25% of related deaths.
Possible Complications When Diagnosed with Anorexia Nervosa (Anorexia)
- Amenorrhea (absence of menstruation)
- Delayed puberty (late or no onset of puberty)
- Hypercarotenemia (excessive levels of carotene in the blood)
- Hypothermia (abnormally low body temperature)
- Hypoglycemia (low blood sugar levels)
- Osteoporosis (weakening of the bones)
- Failure to thrive (slow growth or development)
- Cardiomyopathy (heart muscle disease)
- Bradycardia (slow heart rate)
- Arrhythmias (irregular heart rhythms)
- Renal failure (kidneys lose function)
- Constipation (difficulty with bowel movements)
- Peripheral neuropathy (damage to the peripheral nerves)
- Pancytopenia (deficiency of all types of blood cells)
- Infertility (inability to conceive)
Preventing Anorexia Nervosa (Anorexia)
Anorexia nervosa is a mental health condition where the individual limits their food intake much more than needed to meet their body’s energy requirements. This could involve eating less, more frequent exercise, or using methods to get rid of food like laxatives or vomiting. While these individuals are severely underweight, they are often unable to acknowledge this due to a distorted perception of their own body size. As a result, they may experience health issues related to being underweight and removing eaten food from their body.
Diagnosis of this condition happens through evaluating a person’s medical history, completing a physical examination, and carrying out lab tests to rule out other potential causes of weight loss. Treatment typically includes gaining weight (sometimes required to be done in a hospital if the condition is serious), therapy to help deal with their body image issues, and care to manage the health problems caused by not getting enough nutrients.
