Anorexia Nervosa

Anorexia Nervosa is an eating disorder manifested when a person refuses to eat an adequate amount of food or is unable to maintain the minimal weight for a person's body mass index (BMI). Individuals with anorexia often have a distorted body image (seeing themselves as fat or bulky in certain areas) and have an intense fear of gaining weight or becoming fat. Therefore, restricting the intake of food serves the function of maintaining their desired weight or appearance. Alternatively they may engage purging behaviors (using laxatives, exercising excessively) to lose weight.

In the United States, an estimated 0.9 percent of females and 0.3 percent of males suffer from anorexia nervosa in their lifetime with an increase in the age group of 15- to 19-year-old girls, based on national epidemiology surveys.

Definition

Anorexia nervosa is one of the three major types of feeding and eating disorders; the other categories are bulimia nervosa and binge eating disorder. Anorexia nervosa is characterized by a person's refusal to stay at the minimum body weight considered normal for the person's age and height. It may emerge as a restricting type disorder or a binge-eating/purging type disorder.

Other symptoms of the disorder include distorted body image and an intense fear of weight gain. Inadequate eating or excessive exercising results in severe weight loss. Engaging in purging behaviors after eating or bingeing on food may also lead to a reduction in weight. 

Eating disorders frequently develop during adolescence or early adulthood, but some reports indicate their onset can occur during childhood or later in adulthood. 

People with anorexia see themselves as overweight and have an intense fear of gaining weight or becoming fat. Their perception often contradicts reality, as some continue to restrict even though they are dangerously thin. The process of restricting becomes a preoccupation and is often obsessive in nature. Individuals may spend a lot of time thinking about their body, or foods, and ways to restrict and lose weight. They may develop unusual eating habits such as avoiding what they perceive as high caloric food and meals, picking out a few foods and eating only these in small quantities, or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight and many engage in other techniques to control their weight, such as intense and compulsive exercise or abuse of laxatives, enemas, and diuretics. Girls with anorexia often experience a delayed onset of their first menstrual period or amenorrhea (absence of menstrual periods).

Eating disorders frequently co-occur with other psychiatric disorders, such as depression, substance abuse, anxiety disorders, and borderline personality disorder. In addition, people who suffer from eating disorders can experience a wide range of physical health complications, such as loss of bone mineral density, anemia, including serious heart conditions and kidney failure, that may lead to death. Recognition of eating disorders as real and treatable diseases, therefore, is critically important.

Symptoms

 Symptoms of anorexia nervosa include:

  • Refusal to maintain body weight at or above a minimally normal weight for one's age and height
  • Intense fear of gaining weight or becoming fat, even though one is underweight
  • Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of low body weight

A person has Restricting Type Anorexia Nervosa when the primary method of weight loss involves dieting, fasting and excessive exercising and not engaging in any bingeing or purging behaviors for at least a three-month period. 

A person has Binge-eating/Purging type Anorexia Nervosa when the person has engaged in episodes of bingeing or purging behavior (self-induced vomiting, misuse of laxatives, diuretics or enemas). 

Causes

Anorexia Nervosa and other eating disorders are commonly found in cultures and settings where "being thin" is seen as desirable. These include post-industrialized, high income countries where fashion trends, sales campaigns, and media presentation often present thinness as a desirable or typical trait. Some activities and professions such as modeling, horse-racing, and athletics may promote a goal of being leaner (than required for health) in order to do well.

The onset or beginning of an eating disorder can also be associated with a stressful life event. For young adults, this may involve leaving home for college. For older women, similar life transitions—such as returning to work after raising a family, finding a new job, divorce or separation, can precipitate symptoms of an eating disorder.

Temperamental factors such as perfectionism and obsessional traits in childhood are also associated with eating disorders.

Due to the increased prevalence of Anorexia among first-degree relatives of those with the disorder, as well as in identical twins (relative to fraternal twins), biology and heredity seem to play an important role in developing risk for the disorder.

Studies on the basic biology of appetite control and its alteration by prolonged overeating or starvation have uncovered enormous complexity; in time, their findings may lead to new pharmacologic treatments for eating disorders. Scientists suspect that multiple genes may interact with environmental and other factors to increase the risk of developing these illnesses.

Treatments

If left untreated, anorexia may lead to osteoporosis, cardiac problems, infertility, depression, relationship difficulties, suicide, and even death from medical complications.

Counseling and therapy coupled with medical attention to health and nutritional needs are an important aspect of treatment. Because of their complexity, eating disorders require a comprehensive treatment plan involving medical care and monitoring, psychosocial interventions, nutritional counseling, and, when appropriate, medication management. The sooner the disorder is identified and diagnosed, the better the chances for treatment and successful outcomes.

Treatment of anorexia involves three main goals:

  1. Restoring weight lost to severe dieting and purging
  2. Treating psychological disturbances associated with body image issues
  3. Achieving either long-term remission and rehabilitation or full recovery.

Psychotherapy

Therapy can be meaningful and necessary to uncover factors promoting fears about eating and gaining weight as well to help an individual work through issues related to body image, self-esteem, control, and perfectionism. Cognitive Behavioral Therapy (CBT) is considered an effective form of therapy for eating disorders. It is time-limited and focused in nature, helping an individual to see the links between their thoughts, beliefs, and behaviors. An aspect of CBT also involves focusing to increase the repertoire of certain behaviors and building a tolerance for the discomfort and distress surrounding food. This helps to normalize eating patterns and engage in behaviors that support gaining healthy weight. CBT can shed light on our dysfunctional thought patterns and negative attitudes and beliefs about food and eating that promote body shame and poor esteem. 

Family therapy is also considered to be an effective way to treat anorexia nervosa as well as other eating disorders. The "Maudsley Method" is a form of family therapy where parents are integrated as active agents playing a positive role in their child’s recovery journey. Developed at the Maudsley Hospital in London in 1985, the approach emphasizes parents to be calm, supportive and consistent in the feeding of the child or adolescent with eating disordered behavior.

Medications

The role of medications is limited in the role of treating eating disorders, however antidepressants or other psychiatric medications can help treat other co-existing disorders that may also occur, such as depression or anxiety.

When a person's eating disorder is severe enough with physical problems that are life threatening or causing severe psychological or behavioral problems, inpatient and/or residential treatment may be recommended.

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References

  • American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders.
  • American Psychiatric Association Work Group on Eating Disorders (APAWG). Practice guideline for the treatment of patients with eating disorders (revision). American Journal of Psychiatry, 2000; 157(1 Suppl): 1-39.
  • Becker AE, Grinspoon SK, Klibanski A, Herzog DB. Eating disorders. New England Journal of Medicine.
  • American Journal of Psychiatry , 1999; 340(14): 1092-8.
  • National Institutes of Health, National Library of Medicine, MedlinePlus, 2006. http://www.nlm.nih.gov/medlineplus/ency/article/000362.htm
  • The National Institute of Mental Health
  • Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-V)

Last reviewed 04/25/2017