Anorexia

Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.

Signs and Symptoms

The signs and symptoms of anorexia nervosa can be broadly categorized into physical, emotional, and behavioral.

Physical Symptoms

• Extreme weight loss or not making expected developmental weight gains
• Thin appearance
• Abnormal blood counts
• Fatigue
• Insomnia
• Dizziness or fainting
• Bluish discoloration of the fingers
• Hair that thins, breaks, or falls out
• Soft, downy hair covering the body
• Absence of menstruation
• Constipation and abdominal pain
• Dry or yellowish skin
• Intolerance of cold
• Irregular heart rhythms
• Low blood pressure
• Dehydration
• Swelling of arms or legs

Emotional and Behavioral Symptoms

• Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them
• Frequently skipping meals or refusing to eat
• Denial of hunger or making excuses for not eating
• Eating only a few certain "safe" foods, usually those low in fat and calories
• Adopting rigid meal or eating rituals, such as spitting food out after chewing
• Not wanting to eat in public
• Lying about how much food has been eaten
• Fear of gaining weight that may include repeated weighing or measuring the body
• Frequent checking in the mirror for perceived flaws
• Complaining about being fat or having parts of the body that are fat
• Covering up in layers of clothing
• Flat mood (lack of emotion)
• Social withdrawal
• Irritability
• Insomnia
• Reduced interest in sex

Causes

The exact cause of anorexia nervosa is unknown. As with many diseases, it's probably a combination of biological, psychological, and environmental factors.

Biological

Although it's not yet clear which genes are involved, there may be genetic changes that make some people more vulnerable to developing anorexia. Some people may have a genetic tendency toward perfectionism, sensitivity, and perseverance — all traits associated with anorexia.

Psychological

Some emotional characteristics may contribute to anorexia. Young women may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. They may have an extreme drive for perfectionism, causing them to think they're never thin enough. And they may have high levels of anxiety and engage in restrictive eating to reduce it.

Environmental

Modern Western culture emphasizes thinness. Success and worth are often equated with being thin. Peer pressure and media images fuel this desire to be thin.

Diagnosis

The diagnosis of anorexia nervosa is based on a combination of physical signs and symptoms, as well as a psychological evaluation. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for anorexia nervosa include:

• Restriction of energy intake relative to requirements, leading to a significantly low body weight.
• Intense fear of gaining weight or becoming fat, even though 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.

Treatment

Treatment for anorexia nervosa typically involves a combination of psychological therapy, nutritional education, and medical monitoring. The primary goal of treatment is to restore a healthy weight and establish normal eating patterns.

Psychological Therapy

• Cognitive behavioral therapy (CBT) is commonly used to help individuals change their thoughts and behaviors related to food and body image.
• Family-based therapy (FBT) is often used for adolescents with anorexia. This therapy involves the family in the treatment process to help the patient eat more and gain weight.

Nutritional Education

• Dietitians can help develop meal plans that promote healthy eating habits and weight gain.
• Education about the importance of nutrition and the effects of starvation on the body is also crucial.

Medical Monitoring

• Regular monitoring of weight, vital signs, and other physical health indicators is necessary.
• In severe cases, hospitalization may be required to address malnutrition and other serious health issues.

Prognosis

The prognosis for anorexia nervosa varies. Some individuals recover after a single episode, while others may have a fluctuating pattern of weight gain and relapse. Still, others may experience a chronic course of the illness. Early diagnosis and treatment improve the chances of recovery.

See Also

• Bulimia nervosa
• Binge eating disorder
• Body dysmorphic disorder
• Mental health
• Nutrition