Anorexia nervosa, also called anorexia, is a potentially life-threatening eating disorder that is characterized by self-starvation and excessive weight loss. The disorder is diagnosed when a person weighs at least 15% less than their normal/ideal body weight. Extreme weight loss in people with anorexia nervosa can lead to dangerous health problems and even death.
The term anorexia literally means "loss of appetite." However, this definition is misleading as people with anorexia nervosa are often hungry but refuse food anyway. People with anorexia nervosa have intense fears of becoming fat and see themselves as fat even when they are very thin. These individuals may try to correct this perceived "flaw" by strictly limiting food intake and exercising excessively in order to lose weight.
Who Gets Anorexia?
Eating disorders like anorexia are more common in females than in males, though the rates in males are increasing. The risk of developing an eating disorder is greater in actors, models, dancers, and athletes in sports where appearance and/or weight are important, such as wrestling, boxing, gymnastics, and figure skating.
People with anorexia tend to be very high achievers, performing very well in school, sports, work, and other activities. They tend to be perfectionists with obsessive, anxious, or depressive symptoms. Anorexia nervosa usually begins around the time of puberty, but it can develop at any time.
What Causes Anorexia?
The exact cause of anorexia is not known, but research suggests that a combination of certain personality traits, emotions, and thinking patterns, as well as biological and environmental factors might be responsible.
People with anorexia often use food and eating as a way to gain a sense of control when other areas of their lives are very stressful or when they feel overwhelmed. Feelings of inadequacy, low self-esteem, anxiety, anger, or loneliness also might contribute to the development of the disorder. In addition, people with eating disorders might have troubled relationships, or have a history of being teased about their size or weight. Pressure from peers and a society that equates thinness and physical appearance with beauty also can have an impact on the development of anorexia.
Eating disorders also might have physical causes. Changes in hormones that control how the body and mind maintain mood, appetite, thinking, and memory might foster eating disorders. The fact that anorexia nervosa tends to run in families also suggests that a susceptibility to the disorder might partially be hereditary.
What Are the Symptoms of Anorexia?
The symptoms of anorexia often include the following:
- Rapid weight loss over several weeks or months
- Continuing to diet/limited eating even when thin or when weight is very low
- Having an unusual interest in food, calories, nutrition, or cooking
- Intense fear of gaining weight
- Strange eating habits or routines, such as eating in secret
- Feeling fat, even if underweight
- Inability to realistically assess one's own body weight
- Striving for perfection and being very self-critical
- Undue influence of body weight or shape on self-esteem
- Depression, anxiety, or irritability
- Infrequent or irregular, or even missed menstrual periods in females
- Laxative, diuretic, or diet pill use
- Frequent illness
- Wearing loose clothing to hide weight loss
- Compulsive exercising
- Feeling worthless or hopeless
- Social withdrawal
- Physical symptoms that develop over time, including: low tolerance of cold weather, brittle hair and nails, dry or yellowing skin, anemia, constipation, swollen joints, tooth decay, and a new growth of thin hair over the body
Untreated, anorexia nervosa can lead to:
- Damaged organs, especially the heart, brain, and kidneys
- Drop in blood pressure, pulse, and breathing rates
- Loss of hair
- Irregular heart beat
- Thinning of bones (osteoporosis)
- Fluid-electrolyte imbalance
- Death from starvation or suicide
How Is Anorexia Diagnosed?
Identifying anorexia can be challenging. Secrecy, shame, and denial are characteristics of the disorder. As a result, the illness can go undetected for long periods of time.
If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical exam. Although there are no lab tests to specifically diagnose anorexia, the doctor might use various diagnostic tests, such as blood tests, to rule out physical illness as the cause of the weight loss, as well as to evaluate the effects of the weight loss on the body's organs.
If no physical illness is found, the person might be referred to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists may use specially designed interview and assessment tools to evaluate a person for an eating disorder.
What Is the Treatment for Anorexia?
Emergency or not, treatment of anorexia is challenging because most people with the disorder deny they have a problem -- or are so terrified of becoming overweight that they may oppose efforts to help them gain a normal weight. Like all eating disorders, anorexia requires a comprehensive treatment plan that is adjusted to meet the needs of each patient.
Goals of treatment include restoring the person to a healthy weight, treating emotional issues such as low self-esteem, correcting distorted thinking patterns, and developing long-term behavioral changes. Treatment most often involves a combination of the following treatment methods:
- Psychotherapy: This is a type of individual counseling that focuses on changing the thinking (cognitive therapy) and behavior (behavioral therapy) of a person with an eating disorder. Treatment includes practical techniques for developing healthy attitudes toward food and weight, as well as approaches for changing the way the person responds to difficult situations.
- Medication: Certain antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs) might be used to help control anxiety and depression associated with an eating disorder. Some antidepressants may also help with sleep and stimulate appetite. Other types of medications also might be offered to help control anxiety and/or distorted attitudes toward eating and body image.
- Nutrition counseling: This strategy is designed to teach a healthy approach to food and weight, to help restore normal eating patterns, and to teach the importance of nutrition and following a balanced diet.
- Group and/or family therapy: Family support is very important to treatment success. It is important that family members understand the eating disorder and recognize its signs and symptoms. People with eating disorders might benefit from group therapy, where they can find support, and openly discuss their feelings and concerns with others who share common experiences and problems.
- Hospitalization: As mentioned above, hospitalization might be needed to treat severe weight loss that has resulted in malnutrition and other serious mental or physical health complications, such as heart disorders, serious depression, and risk of suicide. In some cases, the patient may need to be fed through a feeding tube or through an IV.
What Is the Outlook for People With Anorexia?
Anorexia, like other eating disorders, gets worse the longer it is left untreated. The sooner the disorder is diagnosed and treated, the better the outcome. Anorexia can be treated, allowing the person to return to a healthy weight; although, many people with anorexia deny they have a problem and refuse treatment.
Although treatment is possible, the risk of relapse is high. Recovery from anorexia usually requires long-term treatment as well as a strong commitment by the individual. Support of family members and other loved ones can help ensure that the person receives the needed treatment.
Can Anorexia Be Prevented?
Although it might not be possible to prevent all cases of anorexia, it is helpful to begin treatment in people as soon as they begin to have symptoms. In addition, teaching and encouraging healthy eating habits and realistic attitudes about food and body image also might be helpful in preventing the development or worsening of eating disorders.
When Should I Seek Help for Anorexia?
If you suspect that you or someone you know has anorexia or another eating disorder, seek help immediately. Eating disorders can become increasingly dangerous the longer they go untreated. In severe cases, the effects on the body caused by eating disorders can be fatal.