What is anorexia nervosa disorder?

Anorexia nervosa is a complex and potentially life-threatening eating disorder and mental illness. It affects individuals of all ages, genders, and backgrounds. This condition is characterised by an intense fear of weight gain, a distorted body image, and a severe restriction of caloric intake. Despite the physical and mental issues it causes, anorexia nervosa often goes unrecognised or misunderstood, leaving those affected to struggle in silence.

What is Anorexia Nervosa?

Anorexia nervosa is a serious eating disorder characterised by severe restriction of food intake, leading to significantly low body weight. Individuals with this condition often have an intense fear of gaining weight and a distorted body image. Despite being underweight, they view themselves as overweight. Anorexia nervosa typically develops during adolescence or early adulthood and is more common in females. It can affect people of all ages, genders, and backgrounds.

Different types of Anorexia Nervosa

There are subtypes of anorexia: the restricting type and the binge-eating/purging type. Those with the restricting type limit their food intake, while those with the binge-eating/purging type may also engage in episodes of eating large amounts of food followed by behaviours like self-induced vomiting (purging) or excessive exercise. Understanding the specific subtype can help guide the most appropriate treatment approach for each patient.

Defining Anorexia Nervosa

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides the clinical criteria for diagnosing anorexia nervosa. The key elements include:

• Restriction of energy intake relative to requirements, leading to a significantly low body weight
• Intense fear of gaining weight or becoming “fat,” even when the individual is underweight
• Disturbance in the way one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Risk Factors

Anorexia nervosa is more prevalent among females than males, typically occurring during late adolescence and early adulthood. While it can affect individuals of any age, race, ethnicity, or socioeconomic status, certain populations may be at a higher risk, such as athletes, dancers, and models who face intense pressure to maintain a lean physique.

Numerous factors can contribute to the development of anorexia nervosa, including:

Genetics

Research suggests that genetic factors play a significant role, with individuals having a first-degree relative with an eating disorder being up to 10 times more likely to develop anorexia nervosa.

Neurological factors

Individuals with anorexia nervosa often have structural and functional changes in the brain, particularly in regions involved in reward processing, emotional regulation, and decision-making. These neurological differences can contribute to the distorted body image, rigid thinking patterns, and compulsive behaviours associated with the disorder.

Psychological factors

Traits such as perfectionism, obsessive-compulsive tendencies, and low self-esteem can increase the risk of developing anorexia nervosa. Individuals with anorexia nervosa may use food restriction and weight loss as a means of coping with overwhelming emotions, gaining a sense of control, or achieving a perceived ideal body shape.

Traumatic experiences

Childhood abuse, neglect, or other traumatic events have been linked to a higher incidence of anorexia nervosa.

Sociocultural influences

The idealisation of thinness and the pressure to reach unrealistic body standards promoted by media, fashion, and social media can contribute to the development of anorexia nervosa.

Dieting

Individuals with a history of dieting, weight-related bullying, or an obsession with weight and body image are at an increased risk of developing anorexia nervosa.

Understanding these risk factors can help healthcare professionals, families, and individuals recognise the early warning signs and take proactive steps.

Symptoms

The effects of anorexia nervosa range from physical, behavioural, and psychological symptoms that can have far-reaching consequences on an individual’s overall health and well-being.

Physical symptoms

The main physical symptoms of anorexia nervosa include:

• Significant weight loss/low weight or failure to gain weight as expected
• Amenorrhea (absence of menstrual periods) in females
• Bradycardia (abnormally slow heart rate)
• Hypotension (low blood pressure)
• Hypothermia (abnormally low body temperature)
• Electrolyte imbalances, such as hypokalemia (low potassium levels)
• Gastrointestinal issues, including constipation and bloating
• Dry skin, brittle hair, and lanugo (fine, downy body hair)
• Muscle wasting and weakness
• Osteoporosis (weakening of bones)

Behavioural symptoms

Individuals with anorexia nervosa often exhibit the following behavioural symptoms:

• Restrictive eating habits including calorie counting, avoidance of certain food groups, and refusal to eat
• Excessive or compulsive exercise
• Purging behaviours, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications
• Thinking about food, calories, and body weight constantly
• Withdrawal from social activities and relationships

Psychological symptoms

The psychological symptoms of anorexia nervosa include:

• Intense fear of weight gain or becoming “fat”
• Distorted body image and a persistent belief of being overweight, even when severely underweight
• Denial of the seriousness of the condition and the need for treatment
• Perfectionistic traits
• Mood disturbances, such as depression, anxiety, and irritability
• Low self-esteem and poor body image

It’s important to note that the presence and severity of these symptoms can vary among individuals, and some may not exhibit all the classic signs of anorexia nervosa.

Diagnosis

Diagnosing anorexia nervosa requires a thorough assessment by healthcare professionals, including a thorough medical history, physical examination, and laboratory tests.

Medical assessment

This typically includes:

• A physical examination, including vital signs, height, and weight measurements
• Laboratory tests to measure electrolyte levels, organ function, and nutritional status
• Electrocardiogram (ECG) to evaluate heart health
• Bone density scan to assess for osteoporosis
• Psychological assessment to evaluate mood, cognition, and eating behaviours

Careful diagnosis and assessment are needed to ensure appropriate treatment and management of anorexia nervosa, as well as to address any underlying medical conditions that may be contributing to the individual’s symptoms such as gastrointestinal disorders (e.g., celiac disease, inflammatory bowel disease).

Treatment

The treatment of anorexia nervosa requires a comprehensive approach involving various healthcare professionals and treatment options.

Goals of treatment

The primary goals of anorexia nervosa treatment include:

• Getting the individual back to a healthy weight and normal eating habits
• Addressing the underlying psychological and emotional factors that contribute to the disorder
• Preventing relapse and promoting long-term recovery

Treatment settings

The treatment setting for anorexia nervosa may vary depending on the severity of the condition and the individual’s response to treatment:

• Individuals with severe malnutrition, medical instability, or high risk of suicide or self-harm may require inpatient treatment for intensive, round-the-clock care
• Individuals who do not require 24-hour care but need more intensive support than traditional outpatient therapy may benefit from partial hospitalisation or intensive outpatient treatment
• Individuals with less severe symptoms or who have progressed from a higher level of care may receive outpatient treatment, which typically involves a combination of individual, group or family therapy, nutritional counselling, and medical monitoring

Types of treatment

The treatment of anorexia nervosa often involves a combination of the following:

• Nutritional rehabilitation: Restoring the individual to a healthy weight through a structured meal plan. Nutritional counselling is a critical component of treatment
• Psychotherapy: Therapies, such as cognitive-behavioural therapy (CBT), family-based therapy, and dialectical behaviour therapy (DBT), address the psychological and emotional aspects of the disorder
• Medication: Antidepressants or antipsychotics may be prescribed to manage co-occurring mental health conditions, such as depression or anxiety
• Medical monitoring: Regular medical check-ups, laboratory tests, and monitoring of vital signs are essential to address the physical complications of anorexia nervosa and ensure the individual’s safety during the recovery process

Complications

Anorexia nervosa can have far-reaching and potentially life-threatening consequences if left untreated. Understanding the various complications associated with this disorder is crucial for healthcare professionals, individuals, and their loved ones.

Physical complications

The physical complications of anorexia nervosa can affect multiple organ systems, including:

• Cardiovascular: Bradycardia, hypotension, arrhythmias, and heart failure
• Gastrointestinal: Constipation, bloating, gastroparesis, and pancreatitis
• Endocrine: Amenorrhea, infertility, and osteoporosis
• Neurological: Brain atrophy, peripheral neuropathy, and seizures
• Hematological: Anemia, leukopenia, and thrombocytopenia
• Renal: Electrolyte imbalances, dehydration, and renal failure

Psychological and emotional complications

Anorexia nervosa can also have significant psychological and emotional consequences, including:

• Depression and anxiety
• Obsessive-compulsive behaviours
• Suicidal ideation and attempts
• Social withdrawal and isolation
• Impaired cognitive function and decision-making

Long-term consequences

If left untreated, anorexia nervosa can lead to severe, long-term complications and even death. The disorder has one of the highest mortality rates among mental health conditions, with up to 20% of individuals dying prematurely due to medical complications or suicide.

Recognising the potential consequences of anorexia nervosa is crucial for promoting early intervention, comprehensive treatment, and ongoing support to ensure the best possible outcomes for individuals affected by this disorder.

Recovery

Recovery for individuals with anorexia nervosa can vary, depending on factors such as the severity of the disorder, the presence of co-occurring mental health conditions, and the individual’s response to treatment.

Several factors can influence the prognosis and recovery outcomes for individuals with anorexia nervosa, including:

• Age of onset: Young people who develop anorexia nervosa tend to have a better prognosis, as early intervention can prevent the disorder from becoming engrained
• Duration of Illness: Longer durations of anorexia nervosa are associated with poorer outcomes and a higher likelihood of chronic or relapsing symptoms
• Other health problems: The presence of additional mental health conditions, such as depression, anxiety, or obsessive-compulsive disorder, can complicate the treatment and recovery process
• Treatment adherence: Individuals who actively engage in and adhere to their treatment plan, including attending therapy sessions and following nutritional recommendations, tend to have better outcomes
• Family and Social Support: Strong support from family members, friends, and the broader community can significantly contribute to an individual’s recovery and long-term well-being.

Conclusion

Anorexia nervosa is a complex eating disorder that has a significant impact on both physical and mental health. This article has explored its symptoms, causes, and treatment approaches to provide a comprehensive understanding of the condition.

Effective management of anorexia nervosa requires an approach involving various health professionals and specialist providers working together to address the needs of individuals affected by this disorder.

Sources

• Anorexia nervosa – Symptoms and causes – Mayo Clinic
• Anorexia Nervosa: What It Is, Causes, Symptoms & Treatment
• Overview – Anorexia nervosa – NHS
• Anorexia Nervosa – StatPearls – NCBI Bookshelf