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. Individuals with anorexia often have a distorted body image. Those with anorexia view themselves as fat or bulky in certain areas and have an intense fear of gaining weight or becoming fat. The process of restricting becomes a preoccupation and is often obsessive in nature. They may avoid 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 engage in 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).
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.
Anorexia nervosa is one of the three major types of feeding and eating disorders; the other categories are bulimia nervosa and binge eating disorder. 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, heart conditions, and kidney failure, which can, in some cases, lead to death.
The DSM-5 classifies symptoms of anorexia nervosa as follows:
- 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, 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 individual has engaged in episodes of bingeing or purging behavior, such as self-induced vomiting, misuse of laxatives, diuretics, or enemas.
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 often present thinness as a desirable or typical trait. Some activities and professions such as modeling or athletics may promote a goal of being leaner (than required for health) in order to do well.
The onset 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, or separation and divorce—can precipitate symptoms of an eating disorder.
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.
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:
- Restoring weight lost to severe dieting and purging
- Treating psychological disturbances associated with body image issues
- Achieving either long-term remission and rehabilitation or full recovery
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. CBT also involves increasing 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 that parents be calm, supportive, and consistent in the feeding of the child or adolescent with eating disordered behavior.
The role of medications in treating eating disorders is limited. However, antidepressants or other psychiatric medications can help treat co-existing disorders that may also occur, such as depression or anxiety.
When a person's eating disorder is severe enough to be life threatening or cause severe psychological or behavioral problems, inpatient or residential treatment may be recommended.