Anorexia nervosa is a serious, complex eating disorder with devastating physical and mental health consequences. It is caused by patients’ unrealistic perception of body weight and intense fear of becoming fat, which drives them to purposely starve themselves. However, the condition is not about food intake but a person’s unhealthy way to cope with emotional problems. The majority of patients suffer from severe depression, stress, anxiety, or are dealing with life-altering events such as the break-up of a marriage or death of a loved one.
Anybody of any age, gender, and race can develop the condition. However, it is more common in teenagers and women.
Due to their refusal to consume enough food to meet their nutritional needs, anorexics suffer from adverse effects of malnutrition, which include muscle wasting, decreased stamina, breathing difficulties, slower immune response, and fertility problems. They also have an increased risk of respiratory failure, hypothermia, and infections. If not treated promptly, the condition can lead to sudden death due to multiple organ failure or heart attack.
Just like other eating disorders, the cause of anorexia nervosa is unknown. However, specialists believe that it is the result of a combination of psychological, environmental, biological, and genetic factors, such as:
Anxiety and depression
Being emotionally restrained
Overwhelming emotional and physical stress
Phobia of being fat
Setting unrealistic goals or standards
Physical and sexual abuse
Puberty - A combination of hormonal changes, low self-esteem, and anxiety may trigger the development of an eating disorder
Societal and peer pressure - These can fuel the desire to be thin, which is often equated with being beautiful and successful in many countries
Stressful life events
Although the condition can affect anybody, some people have an increased risk of developing it. These include:
Girls and women
Those with a family history of anorexia nervosa
People who are going through difficult transition in their lives
People in the entertainment industry because there is an enormous pressure for them to always look perfect
Because anorexic people are malnourished and dealing with psychological and emotional issues, they present a wide range of symptoms. These include:
Amenorrhoea, or absent periods in women
Dangerously low body weight
Extremely thin appearance
Bluish discolouration of fingers
Dizziness or fainting
Failure to thrive in school or at work
Heart and kidney problems
Lack of emotion
Loss of interest in activities previously enjoyed
Low blood pressure
Low levels of sodium, potassium, and calcium
Low-self esteem or self-confidence
Reduced interest in sex
Swelling of arms and legs
In an attempt to continuously lose weight, people with anorexia often:
Intentionally skip meals
Lie about what they have eaten
Become obsessive in counting calorie intake
Use diuretics to rid the body of fluid
Doctors adhere to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in diagnosing anorexia nervosa. A person is diagnosed with the condition if he or she is restricting food intake, has problems with body image, and intense fear of gaining weight.
To make a diagnosis and rule out other possible causes of weight loss, the following tests and procedures are usually carried out:
A thorough physical examination to look for specific signs and symptoms, such as breathing difficulty, low blood pressure, and hair and skin abnormalities, among others.
Review of the patient’s medical history
Blood and urine tests - These are carried out to measure the level of certain hormones and check liver, thyroid, and kidney function.
Imaging tests - The doctor may also order an x-ray and other imaging tests to check for any signs of health problems affecting the musculoskeletal system and internal organs. These tests can show fractures, pneumonia, and heart irregularities, among others.
Once an anorexia nervosa diagnosis has been confirmed, treatment is initiated right away. Patients are typically managed by a multidisciplinary team of doctors composed of a mental health professional, dietitian, and paediatrician (if the patient is a child or teenager). The team will focus on normalising behaviours and eating patterns to support supervised weight gain as well as changing distorted beliefs that cause patients to restrict their eating. Depending on the severity of the condition and its complications, the patient may be treated as an outpatient or admitted to the hospital until life-threatening complications are under control.
Psychological treatment for anorexia nervosa may include:
Cognitive analytic therapy (CAT)
Cognitive behavioural therapy (CBT)
Interpersonal therapy (IPT)
Focal psychodynamic therapy (FPT)
The care plan will also involve slowly increasing the amount of food that the patient is eating. The goal is to help them gain one to three pounds per week until they achieve a healthy weight. To ensure that they are meeting their nutritional needs, vitamin and mineral supplements are also often provided. Throughout the treatment program, their hydration and vital signs are monitored.
There are currently no FDA-approved medications for the treatment of anorexia nervosa, but certain drugs are usually prescribed to treat associated psychological problems such as depression and obsessive-compulsive disorder.
Anorexia nervosa remains to be one of the most serious psychiatric conditions associated with a high mortality rate. About 6% of patients die mostly due to the medical complications of the condition including electrolyte imbalance and cardiac arrest. Despite medical intervention, it is estimated that about 20% of patients remain chronically ill and struggle to make a full recovery due to a number of factors including purging behaviours, obsessive personality disorder, and bulimia nervosa.
Misra, M., Aggarwal, A., Miller, K.K., Almazan, B.S., Worley, M., Soyka, L.A., Herzog, D.B., Klibanski, A. “Effects of Anorexia Nervosa on Clinical, Hematologic, Biochemical and Bone Density Parameters in Community-Dwelling Adolescent Girls.”
U.S. National Institute of Mental Health (NIMH), Anorexia nervosa, 2009. http://www.nimh.nih.gov/health/publications/eating-disorders/anorexia-nervosa.shtml.