Anorexia nervosa, also commonly known as anorexia, is a psychological condition and a potentially life-threatening eating disorder in which the person loses more weight than is healthy for their height and age.
Anorexia is characterized by low weight, irrational fear of gaining weight, food restriction, and a strong desire to be thin. Individuals with the condition often see themselves as overweight, even though they are underweight.
They eat specific foods and only in small amounts, they frequently check themselves for weight gain. Some others compulsively exercise or induce weight loss by using laxatives.
Although the cause of anorexia is unknown, it has been attributed to genetic and environmental factors. Certain cultures have a role in anorexia by placing importance on being thin.
Furthermore, it is a prevalent condition among those involved in activities that value thickness, such as dancing, athletics, and modeling. Anorexia is usually followed by a life-changing event, and significantly low weight is required to confirm the diagnosis.
As of 2015, anorexia was estimated to affect 2.9 million people worldwide. It is ten times more likely to occur in women than in men in developed countries. The rates are, however, unclear in developing countries.
Anorexia often begins during teenage years or early adulthood. It resulted in 600 deaths worldwide in 2013, higher than the estimated number of deaths ( about 400) in 1990.
William Gull, in 1873 first used the term ‘anorexia nervosa’ to describe the condition.
Causes and Risk Factors of Anorexia
There is no identifiable cause of anorexia nervosa. It could occur as a combination of biological, environmental, and psychological factors. These includes:
Studies have shown that people with an eating disorder may have an impaired ability to have an appetite, feel hungry, or control digestion.
This occurs as a result of an imbalance in the brain chemistry that controls these activities. Also, anorexia nervosa in an inheritable disease. People who have first degree relatives with the disorder are more likely to develop the condition.
These include hormonal changes due to puberty, existing cultural norms, and mainstream and social media. Hormonal changes during puberty are often associated with feelings of anxiety, stress, and low self-esteem.
Cases of anorexia over the decades have been associated with the increased visibility of the ideal body image propagated by the media. People working in jobs that come with the pressure to be thin (like dancers and models) are more likely to develop anorexia.
Also, people who have more than average contact with a culture that promotes weight loss can develop the disorder.
Additionally, people who partake in sports that emphasized aesthetics and low body fat have higher chances of developing anorexia nervosa. Pressure from family can also predispose one to be anorexic.
Other environmental factors of anorexia may include:
- The pressure to succeed and fear of failure
- Physical, sexual, emotional abuse
- Strained relationship with family
- Stressful life events like separation from family and bereavement
Anorexia often stems from a person’s need to control their lives. The American Family Physician describes anorexia as using “caloric intake or excessive exercise to control emotional need or pain.”
Risk factors that have been associated with anorexia nervosa include:
- Finding it difficult to handle stress
- Eating problems during early childhood or infancy
- Having a negative body image and low self-esteem
- Being susceptible to anxiety and depression
- Holding rigid ideas regarding beauty and health that are influenced by culture or society
- Being perfectionist and overly concerned about rules
- Having had a childhood anxiety disorder
- Excessive worrying, and fear or doubt about the future
- Having a high level of control over their emotions, behavior, and expression
About 33 to 50 percent of people with anorexia have mood disorders like depression and anxiety disorder like obsessive-compulsive disorder (OCD). This could be attributed to negative emotions and body image.
When a person starts losing weight, the weight loss and lack of nutrients may change the brain’s chemistry in a way that reinforces obsessive thoughts and behaviors attributed to anorexia.
This change could involve the part of the brain that controls hunger and appetite, or it could increase feelings of guilt and anxiety that become associated with eating.
According to a 2015 study, researches discovered that people living with anorexia might have gut bacteria that are different from those without the condition.
According to another survey, people with anorexia are less likely to be able to differentiate between different types of positive emotions.
Signs and Symptoms of Anorexia nervosa
There are several ways by which anorexic people lose and maintain their low weight. Some engage in compulsive exercising, while others put excessive restrictions on their diet.
Some others employ binging and purging, as seen in cases of bulimia, while others make use of laxatives, diuretics, or vomiting to get rid of food.
Symptoms of anorexia generally include:
- Severe restriction on food intake and extreme dieting
- Thinning and falling out of hair
- Dry skin
- Yellow, blotchy skin with soft fine hairs
- Amenorrhea: an abnormal absence of menstruation, or loss of 3 consecutive menstrual cycles
- Low blood pressure
Other behaviors include;
- Withdrawal and isolation from social functions, family and friend
- Infantile playing with food
- Hunger denial
- Cold feeling in the extremities
- Continued fixation on food, calorie count and recipes
- Obsession with calories and fat content of food.
A physician would require a medical history of the patient for diagnosis. The patient would be asked questions about weight loss, how they feel about their weight and body, and for women, how often they menstruate.
It can sometimes be difficult for the patient to speak truthfully about themselves; this is especially true of the person used to be obese.
The physical may carry tests to check for other underlying medical maladies with similar symptoms. These include:
- Addison’s disease
- Chronic infections
- Inflammatory bowel disease (IBS)
According to the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5), the following are the diagnostic criteria for anorexia nervosa:
- A restriction of energy intake relative to requirements leading to significantly low body weight with reference to age, sex, and physical health.
- Intense fear of becoming fat, even when underweight.
- Obessive and disturbing feelings about the way in which one’s body weight or shape is experienced.
- Excessive influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Treating anorexia would require you to realize and admit that you need help. Unfortunately, many people living with anorexia don’t believe they have a problem or are in any danger. This can make treating the condition rather difficult.
The aim of treatment is to restore normal weight and inculcate healthy eating habits. This would usually require the health of a dietician. Family members and friends are also needed to take part in the therapy with you.
The following methods can be used in the treatment of anorexia nervosa:
Therapy and Counseling
This would involve cognitive behavioral therapy, which seeks to change unhealthy thoughts and behavior with the goal of helping the patient learn how to cope with stress and intense emotions and build a healthy self-image.
Nutrition counseling would also be required to help the patient develop healthy eating habits. Family members may be needed to help the patient keep track of their eating habits and create support for family member dealing with anorexia nervosa.
Furthermore, engaging in group therapy enables the patient to interact with others who have the disorder and know that they are not alone.
This would require the use of antidepressants to deal with mental health issues common with anorexia nervosa like anxiety and depression. These drugs make the patient feel better but do not diminish the desire to be thin.
In extreme cases, the physician may require the anorexic patient to stay in the hospital for a few days in order to treat the effects of the anorexia nervosa.
The patient may be put on intravenous fluids and a feeding tube if the patient’s weight is dangerously low or if they are dehydrated.
The complications of anorexia nervosa can affect every body system. They include:
- Cardiovascular problems: Cardiovascular problems due to anorexia include low heart rate, low blood pressure, and damage to the myocardium (heart muscle).
- Gastrointestinal issues: Movement in the intestines is reduced significantly when a person is severely underweight and eating too little. This can, however, be resolved when the diet improves.
- Blood illnesses: Anorexia nervosa increases the risk of developing leukopenia, or low white blood cell count, and anemia, low red blood cell count.
- Hormonal issues: Lower levels of growth hormones may lead to delayed growth during adolescence. Normal growth resumes with a healthy diet.
- Kidney complications: Dehydration caused by anorexia nervosa can lead to highly concentrated urine and more urine production. Normal kidney processes are restored with improved weight levels.
- Bone fractures: Patients whose bones have not fully matured yet have a significantly higher risk of developing osteopenia (reduced bone tissue), and osteoporosis (loss of bone mass).