Charlotte, NC
Aakiriti Karki, MD
Anorexia nervosa, commonly known as anorexia, is a serious eating disorder where people lose a dangerous amount of weight for their age and height out of fear of gaining weight. They avoid eating, severely limit their food intake, go on extreme diets, exercise excessively, or resort to other unhealthy methods to shed pounds. However, anorexia goes beyond starvation in the pursuit of thinness and involves psychological and medical influences. [1]
It’s not just one of the most common illnesses among teenagers, but also the mental illness with the highest chance of death after a substance overdose. [2] The prevalence of anorexia nervosa varies across different studies, with lifetime prevalence ranging from 0.8 to 4% in females and 0.1% to 0.3% in males. [3]
Anorexia nervosa generally has two subtypes:
It is the most well-known type of anorexia nervosa, where a person severely restricts their food consumption. This restriction can take many forms, including keeping a very low calorie count, avoiding certain types of food, or eating only one meal a day. People may also follow strict rules, like eating only food of a specific color. [4]
Here, the individuals restrict their food intake as previously described and engage in periodic binge-eating episodes. They try to eliminate what they have eaten in a short period by purging activities such as vomiting or abusing laxatives or diuretics. [5]
Atypical anorexia nervosa is an eating disorder where individuals don’t fit the typical image of very low weight seen in anorexia nervosa. [6]
Anorexia nervosa causes and health risks include:
People with anorexia often have a history of being bullied for their weight, along with abuse or familial problems. It is more likely to occur when they have been in circumstances where they feel pressured to conform to a certain appearance, such as in modeling, swimming, diving, wrestling, or ballet. In one study, it was found that approximately 13.7% of women with anorexia had symptoms of post-traumatic stress disorder (PTSD), with sexual trauma being the most predominant type of trauma experienced by them. [7]
Anorexia is often linked to how people feel about their bodies and a desire to look perfect. However, their perfectionism is rooted in self-doubt. They may have tried diets or other ways to manage their weight. Impulsive behavior, especially when feeling upset, can increase the risk of binge eating or purging. [8]
If a close family member has anorexia, your risk could be ten times greater than someone without a family history of the condition. Studies have shown that genetic factors are also responsible for causing anorexia nervosa, with the estimates ranging from 28% to 74%. [9]
Women are 2 to 3 times more likely than men to have anorexia. It is more common in teens and young women in their early 20s than in other age groups. LGBT adults and adolescents have an elevated likelihood of experiencing eating disorders and disordered eating behaviors. [10]
OCD, anxiety, depression, mood disorders, and other mental health disorders can increase your chances of getting anorexia. Nearly 1 in 10 individuals with autism spectrum disorder meet the diagnostic criteria for anorexia nervosa. [11]
People with type 1 diabetes are at higher risk of developing eating disorders. Studies have shown that a significant number of people with type 1 diabetes, up to 39% of women and 15% of men, will develop an eating disorder. One common pattern is skipping insulin injections, a risky behavior known as diabulimia that has life-threatening consequences. [12]
Some of the symptoms to watch out for in anorexia nervosa are:
This is one of the most evident symptoms of anorexia nervosa. People with anorexia can have rapid and excessive weight loss, leading to being significantly underweight for one’s age and height.
The nutritional deficiency and the hormonal changes that occur in anorexia nervosa can cause you to have irregular menstruation or absent menstruation for months.
The skin of the anorexic individual is very dry, and fine, soft hair called lanugo grows on the face and body. There can be noticeable thinning of the hair and scalp.
There is a significant distortion in the perception of one’s body size and shape, seeing oneself as overweight despite being underweight.
Almost every person with anorexia denies being hungry or tries to stay away from situations where food will be served to maintain control over eating habits.
Some of the anorexics might also make use of the pills like diuretics and laxatives to get the body weight they want. [13]
Anorexia nervosa can lead to a wide range of severe health complications, affecting almost every organ system in the body. Here are the most significant complications:
People with anorexia nervosa are at high risk for cardiac complications, including sinus bradycardia, low blood pressure, and arrhythmia. [14]
Long-term consequences of anorexia include irregular or absent periods, loss of libido, and infertility, especially if under 18. In younger women and girls, menstruation may not start or may stop before menopause. It causes low testosterone levels in men.[15]
Dry skin, hair loss from the scalp, or the growth of fine, downy hair on the body can occur as long-term symptoms of anorexia. Patients can also become intolerant to colds.
A person with anorexia nervosa could have headaches, fainting, dizziness, mood swings, anxiety, poor concentration, and depression due to their preoccupation with food and calories.[16]
Anorexia can result in reduced bone density or brittle bones, known as osteopenia or osteoporosis. Excessive exercise may cause stress fractures.
Dehydration, kidney failure, constipation, diarrhea, bloating, and abdominal pain are common complications associated with anorexia.
Diagnosis of anorexia is done clinically with the help of the symptoms that are present. Suppose someone has significant weight loss that affects health and well-being, an intense fear of gaining weight or becoming fat, a distorted perception of one’s body image, a negative impact of body weight and shape on self-esteem, and a failure to recognize the serious health consequences of their weight loss. In that case, they likely have anorexia nervosa. [17]
There is no single blood test to diagnose the condition. Your doctor will use various tests, such as a complete blood count, electrolyte panel, albumin, and liver function, to examine overall health and complications associated with anorexia. Tests include an electrocardiogram (EKG) to evaluate heart health and a bone density scan for bone strength. Hormone tests for pregnancy and menstrual problems, and testosterone levels may be performed by your primary care provider.
The treatment of anorexia nervosa involves a comprehensive approach that addresses the physical, psychological, and nutritional aspects of the disorder. Here are the key components of the treatment:
Someone with severe anorexia may need to go to the hospital immediately. Hospitalization is necessary for stabilization and to treat possible complications like heart rhythm disturbances, electrolyte imbalances, dehydration, or malnutrition. People who refuse to eat may need to stay in mental health facilities. In certain cases, a tube may be inserted through the nose to provide nutrients directly despite refusal.
This involves educating individuals about their body’s nutritional needs and how much food they should eat to stay healthy based on age, size, and sex. It helps them recognize hunger cues, improve their relationship with food, address body image issues, and manage emotions. It gives them a strategy to eat more food and helps them understand that gaining weight is part of getting healthier. [18]
CBT is an integral part of treatment that helps gain weight after leaving the hospital. CBT uses techniques like establishing consistent eating habits and facing fears about certain foods. [19]
DBT is a form similar to CBT, where people learn to change their behavior by acquiring and practicing new skills. This therapy usually combines one-on-one and group sessions. For example, someone with a binge-eating disorder might learn to recognize when they feel anxious at work, which often leads to bingeing. Then, they can employ skills like mindfulness or self-soothing to manage their anxiety more healthily. [20]
FBT is an effective treatment for children and adolescents with anorexia nervosa who live with their families, spanning around a year and consisting of three stages. The first stage, re-feeding, involves families learning how to help the child eat normally again, with siblings providing important support and encouragement. The second stage, transitioning control, allows parents to guide their child to take more control over eating through trial periods. The final stage, returning to normal, focuses on the child building a healthy identity free from the eating disorder once stable eating habits are established.
While there are no medications specifically approved to treat anorexia, doctors may prescribe antidepressants like Prozac (fluoxetine), Celexa (citalopram), or Zoloft (sertraline) if symptoms don’t improve with therapy or nutritional rehabilitation. These medications can help with underlying symptoms of depression or anxiety in people with anorexia.[21]
Art therapy, such as painting and sculpture, provides a creative outlet for individuals with anorexia to express emotions. For further exploration and understanding of their feelings, they can engage in psychodrama, which offers a group setting for role-playing and dramatic presentation.
Refeeding syndrome is a serious risk for severely malnourished patients with anorexia nervosa when they start eating again. This condition can cause dangerous shifts in the body’s fluids and electrolytes, leading to heart problems, breathing issues, seizures, and even death. Symptoms such as fatigue, confusion, and difficulty breathing require immediate medical attention. Those at risk for refeeding syndrome include individuals with a very low BMI, significant recent weight loss, prolonged periods of little to no food intake, and low levels of key electrolytes like phosphorus, potassium, and magnesium. [22]
Anorexia nervosa cannot always be prevented, but there are measures to reduce the likelihood of it occurring. Eating disorder prevention programs focus on self-esteem, healthy body image, and healthy food and exercise practices. They use interactive approaches to engage individuals and involve family and friends to foster a supportive environment. The programs are based on understanding the causes that contribute to eating disorders and how to prevent them, using age-appropriate materials, and addressing cultural impacts on body image and eating behaviors.
