Anorexia Nervosa

Anorexia nervosa is an eating disorder and mental health condition that makes you limit how much you eat. People with anorexia restrict food to keep their body weight as low as possible. They’re afraid to gain weight and may obsess over being thin. Anorexia can affect people of all body sizes and body types.

“Anorexia” means not wanting to eat, but the condition is much more than that. It’s a serious mental health disorder that develops from negative thoughts and feelings about eating, weight and body image. These thoughts take over your whole life. They can cause you to think, feel and act in extreme ways to avoid eating food.

Over time, anorexia can lead to malnutrition and a severely low BMI. This can have serious health consequences. Without recognition and treatment, it can be life-threatening. This is why it’s important to seek help if you’re noticing the signs of anorexia in yourself or a loved one.

Types of anorexia

There are two main types of anorexia nervosa:

• Restrictive anorexia involves severely limiting food intake. Some people exercise excessively so they don’t gain weight.
• Binge-purge anorexia involves limiting food AND episodes of binge eating and/or purging. Purging means vomiting, using laxatives or over-exercising.

Atypical anorexia is anorexia in someone who isn’t (yet) underweight. It’s usually harder to recognize.

Symptoms of anorexia nervosa

The signs and symptoms of anorexia can affect both your mind and body.

Some of the emotional and behavioral symptoms include:

• Intense focus on food, calorie counting or diets
• Frequent negative comments about body image or body size
• Exercising for long periods of time at once, especially after eating
• Complaining about being fat
• Consistently going to the bathroom right after eating
• Overusing medications like appetite suppressants, laxatives or diuretics
• Lying about how much you’ve eaten or about being hungry
• Weighing yourself often
• Becoming less social or losing interest in hobbies

Physical symptoms of anorexia include:

• Significant weight loss or not gaining weight (in kids or teens)
• Extremely thin or frail appearance
• Dry, brittle hair and nails
• Feeling cold all the time
• Fatigue or low energy
• Irregular periods or absent periods
• Brain fog or not thinking clearly
• Dizziness
• Dehydration
• Slow heart rate
• Thinning hair, losing hair or having lanugo

Anorexia causes

There’s no single cause of anorexia nervosa. Healthcare providers believe it involves many factors:

• Brain differences: Scientists notice brain differences in people with anorexia. For example, you may have different levels of serotonin and dopamine. This can affect appetite, mood and impulse control.
• Genetics and family: You’re more likely to have an eating disorder if your parents or siblings have one. Part of this may be in your genes. Part of it may also be learned behaviors.
• Peer pressure: Pressure from friends, culture, social media or your job can make you fixated on your body and appearance. Teens often feel this pressure the most. They can be very hard on themselves and each other about looks.
• Psychology: Having low self-esteem or feeling that your self-worth depends on your body weight can lead to developing an eating disorder. Factors like trauma, abuse and bullying can also contribute.

Risk factors of anorexia nervosa

Women and teen girls are most at-risk for anorexia. That doesn’t mean men or boys can’t have it, though. Other risk factors include having:

• A personal history with bullying, sexual abuse or trauma
• Careers or hobbies where appearance and weight matter (acting, dancing, wrestling, gymnastics, modeling, etc.)
• A family history of eating disorders, depression or anxiety
• A Type A or perfectionist personality

Complications of anorexia nervosa

Malnutrition (or starvation) can affect nearly every organ and tissue in your body. Severe organ damage may be irreversible, even after you’ve recovered from anorexia. Anorexia can also be devastating to your relationships and your emotional health. These effects can take time to heal, even after treatment begins.

Untreated anorexia can lead to:

• Loss of bone mass and loss of tooth enamel
• Rapid breakdown of skeletal muscle
• Kidney and liver damage
• Heart failure or cardiac arrest
• Delayed growth in children
• Infertility in adults
• Self-harm and suicidal thoughts

If you’re having suicidal thoughts, call the Suicide and Crisis Lifeline at 988. Someone will be available to talk with you anytime, day or night.

How doctors diagnose anorexia nervosa

Healthcare providers diagnose anorexia based on the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The three criteria include:

1. Self-induced calorie restriction, leading to significant weight loss or a failure to gain weight in growing children (typically, a low body weight based on age, sex, height and stage of growth)
2. Abnormal obsession with body weight and intense fear of gaining weight or being “fat”
3. A distorted self-image or being unable to see how serious the condition is

If you have signs and symptoms of anorexia, a provider will do a physical exam and take a complete medical history, including your mental health history. Then, they’ll ask you detailed questions about your eating habits, exercise routines, use of weight loss medications, and related feelings and beliefs.

Your provider might order tests to evaluate the physical effects that anorexia is causing. Tests might include:

• Bone density test
• Complete blood count (CBC)
• Electrocardiogram (EKG)
• Electrolyte panel
• Kidney function tests
• Liver function tests
• Urinalysis

How is it treated?

Treatment for anorexia nervosa is specific to the person being treated. The biggest challenge in treating someone with anorexia is helping them recognize and accept that they have a serious illness.

The goals of treatment include:

• Restore a healthy weight.
• Stop the disordered eating behaviors.
• Address underlying emotional or psychological concerns.
• Have a healthy relationship with food.

Your healthcare providers will design a custom treatment plan that involves both nutritional therapy and psychotherapy. Treatment could involve staying in a hospital or a clinic that specializes in eating disorders.

Hospitals and treatment centers

You may need to stay in a hospital if you have severe malnutrition, severe mental health issues or other serious health issues. Healthcare providers can monitor vital signs, provide nutrition through feeding tubes or give IV fluids. Hospital care also allows for close support from mental health professionals.

Some clinics or treatment centers focus on recovery from eating disorders. This can also be an option. In these settings, you stay for several days to several weeks at a time. The main goal of these programs is to offer a safe setting where you can focus on changing your thoughts, beliefs and actions related to food and body image.

Psychotherapy

Psychotherapy, or talk therapy, helps change thinking and behavior patterns associated with eating disorders. It can help you develop healthier attitudes toward food, weight and body image. It can also help you learn better techniques for dealing with negative thoughts.

Treatment could include:

• Cognitive behavioral therapy (CBT): This method focuses on addressing distorted views and attitudes about weight, shape and appearance, and making behavioral changes.
• Family therapy: Family support is very important to anorexia treatment. One specific type, called family-based therapy (FBT), is designed for teens with anorexia. The idea is that family plays a large role in the early stages of recovery.
• Dialectical behavior therapy (DBT): Specific skills you’ll learn in DBT include learning coping strategies, managing emotions and tolerating stress.
• Interpersonal psychotherapy (IPT): IPT involves reducing the stressors in your life that contribute to your eating disorder symptoms.

Nutrition therapy

There are no medications that treat anorexia. Nutrients through food are often the best “medicine.” A registered dietitian will help establish healthy eating patterns. It’s not just about beginning to eat again. It’s about meeting your body’s nutritional needs in a safe way. They can also provide education and support for someone recovering from anorexia.

Complications of treatment for anorexia

The most serious complication of treating anorexia is refeeding syndrome. This can happen when someone who is malnourished starts eating again. Your body may pull nutrients from the blood too quickly, which can cause serious complications. For this reason, refeeding should always be done under medical supervision.

How long does it take to recover from anorexia?

Recovery from anorexia is different for everyone, and some parts of your treatment may take longer than others. The important thing to remember is that healing is possible. With the right support, progress can happen, and you can overcome the disease.

When should I see my healthcare provider?

Talk to a healthcare provider if you notice signs of anorexia in yourself or someone you care for. This includes drastic weight loss, obsession with body image and changes in eating habits. Early help can make a big difference. The sooner someone gets support, the better their chances of recovery.

What is life like for someone with anorexia?

Experiences with anorexia can depend on factors like:

• How long they’ve lived with the condition
• How severe their condition is
• What kind of treatment they receive
• How well they follow their treatment plan

Anorexia gets worse the longer it goes untreated. So can the physical and mental health effects that come with it. People with anorexia may not always see that they need help. This can make getting treatment more difficult.

Without treatment, anorexia nervosa is life-threatening. It’s one of the deadliest mental health conditions, and people with anorexia are at a higher risk of dying by suicide. With the right support and treatment, recovery is possible. Long-term care and the support of loved ones can make a big difference.

There’s a risk of relapsing. So, finding a good support network is key to long-term recovery.