What is Anorexia Nervosa?

Anorexia nervosa, is an eating disorder which can be a life-threatening condition. It is characterized by the inability to maintain a normal weight as well as intense fear of gaining weight. Affected individuals also adopt extreme dietary habits to avoid weight gain. In anorexia nervosa, the way one perceives his/her own body is distorted. The severe food restriction can lead to imbalances in your body’s normal functioning.

Anorexia nervosa can be classified into two groups: restricting and binge-eating/purging type. In the restricting type, individuals severely restrict their food intake to lose weight. In the binge-eating/purging type, it consists of periods of eating followed by self-induced vomiting, excessive exercise, and laxative or diuretic abuse. These are done as a means to compensate for the food eaten.

Anorexia nervosa is most common in developed countries and is present in all socioeconomic classes. This is most likely to affect dancers, runners, models, actors, gymnasts and flight attendants as they pay particular attention to their looks due to their career choice. Anorexia nervosa is a condition that affects more women compared to men, where it is 10-20 times more common in women. Around 4% of women in the United States has the condition. More than 95% of cases are among white adolescents.

What are the causes of anorexia nervosa?

The exact cause of anorexia nervosa is unknown. However, it arises due to the contribution of various factors including social, biologic and psychological factors.

Media and the modern preoccupation with beauty standards in the Western world has also an impact on how individuals view and feel about themselves. Adolescents with poor coping mechanisms are more prone to developing the eating disorder. Genetic factors may contribute to having the disease.

What are the risk factors for anorexia nervosa?

The following factors may predispose you to having the condition:

• Being of the female sex
• Having a perfectionistic personality
• Having close family members with anorexia nervosa
• Having a poor ability to communicate negative emotions
• Having a low self esteem

What are the symptoms of anorexia nervosa?

The main symptoms present in anorexia nervosa include the following:

• Restriction of food intake resulting in an abnormally low body weight and excessive weight loss
• Excessive fear of gaining weight
• Distorted body image
• Over-emphasizing physical appearance

Some other associated features in this eating disorder include:

• Fear of certain foods perceived as having too much calories
• Withdrawing yourself from society
• Constant preoccupation with food
• Resistance to weight gain
• Avoidance of eating in public
• Denial of the main symptoms mentioned above

• Feelings of ineffectiveness
• Not eating even if they are hungry
• Attempt to hide the problem
• Poor sleep
• Decreases sexual interest
• Poor concentration
• Irritability
• Dryness of skin
• Loss or thinning of hair
• Weakness and lethargy

How is the diagnosis of anorexia nervosa made?

The diagnosis is made by first asking you a series of questions to know more about your condition. Your doctor will then proceed by examining you to look for signs of anorexia nervosa. These signs include dry skin, thin body hair, decreased size of breasts, swelling of glands found under your jaw or in front of your ears and swelling of extremities. If you have the binge-eating/purging type of anorexia nervosa, your teeth may also be damaged due to the recurrent vomiting. Your doctor will also check your vitals including your heart rate, blood pressure and temperature. Your body mass index (BMI) will also be calculated by measuring your height and weight.

Other tests may be requested to evaluate your general health or to look for any complications of anorexia nervosa. These include:

• A complete blood count (CBC)
• Blood electrolytes
• Urine analysis
• Thyroid function test
• X-rays to check for your bone density or heart problems
• Electrocardiogram (ECG) to check for any abnormalities in heart beats

A mental health profession is likely to follow you up and perform a complete psychological assessment.

How is anorexia nervosa managed?

The treatment for anorexia nervosa involves a team including a mental health professional, genera medical clinician and a dietician. People with the eating disorder and who are not medically stable should be admitted for medical treatment. Your doctor will perform a complete evaluation to decide whether you will benefit most from being hospitalized or being managed as an out-patient. The choice will depend on the severity of your condition and the presence of any coexisting medical or psychiatric problem. You are most likely to be hospitalised if you have thoughts of self-harm.

The treatment of anorexia nervosa comprises of nutritional rehabilitation and psychotherapy.  Medications are rarely needed in the treatment for anorexia nervosa. However, in certain cases, vitamin supplementation may be initiated if any deficiencies are present.

Nutritional rehabilitation

The main goal of nutritional rehabilitation is to stabilize the patient’s general condition first and reverse any complications that may be present. It involves normalisation of eating by breaking the behaviours such as self-induced vomiting and other compensatory actions. A dietician will plan a structured meal plan according to your specific needs. You will be observed while eating to make sure that you are not discarding the food. In the initial stages of treatment, exercise is usually restricted. As your condition improves, exercise is gradually introduced. Dieticians will also give you appropriate nutritional counselling so that you are able to adopt a healthy lifestyle.

Psychotherapy

This is an important part of the management of anorexia nervosa. As your medical condition improves and you start gaining weight, you are prone to feel psychologically uncomfortable. Psychotherapy comes into play to change your distorted views, thoughts and beliefs. It will enable you to normalise eating and your weight. Furthermore, psychotherapy helps to substitute negative thoughts by positive and constructive ones.

What are the complications of Anorexia nervosa?

Cardiovascular complications

The most common cause of death in people with anorexia nervosa is related to cardiac complications. 10% of people with this eating disorder die from these complications. These include severely slowed down heart rate, low blood pressure and decrease in size of the heart.

Endocrinologic complications

The most common endocrinologic complication associated with anorexia nervosa is cessation of menstrual cycles, also known as amenorrhea. Thyroid function is also affected. Severe decrease in bone mass is also a serious complication of anorexia nervosa. This is also known as osteopenia. Infertility, delayed puberty, and arrested growth are other endocrinologic complications associated with the disease.

Gastrointestinal complications

Constipation is a common complication in anorexia nervosa. Rupture of the stomach may occur during periods of excessive eating in the binge-eating/purging type.

Neurologic complications

Decrease in brain size and volume can occur in anorexia nervosa. Generalized muscular weakness can also manifest in people with the condition.

Prognosis

10-20% of people with the condition unfortunately die from it while 50% will recover completely. Among the remaining people, majority will remain thin while some will become overweight with time. If you were first diagnosed with the condition before adulthood but after 11 years old, the course of the disease is most likely to be favourable. If you were younger than 11 years or you were an adult when you were diagnosed with anorexia nervosa, it is usually associated with a poor prognosis.

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Bernstein, B., n.d. Anorexia Nervosa: Practice Essentials, Background, Pathophysiology.

Mehler, P., n.d. Anorexia Nervosa In Adults And Adolescents: Medical Complications And Their Management.

Yager, J., n.d. Eating Disorders: Overview Of Epidemiology, Clinical Features, And Diagnosis.

Steinglass, J., n.d. Anorexia Nervosa In Adults And Adolescents: Nutritional Rehabilitation (Nutritional Support).