Anorexia Nervosa is characterized by a distorted body image (e.g., thinking you are “fat” despite being underweight) and excessive dieting that leads to significant weight loss. A person with anorexia nervosa is generally afraid of gaining any weight and engages in behaviors that prevent weight gain. In the restricting subtype, a person will limit the amount of food they eat each day in order to maintain a weight that is below normal. In the binge-purge subtype, a person may also have recurrent episodes of binge eating and/or purging through self-induced vomiting, exercise, or pills (such as diet pills, laxatives, or diuretics).
Anorexia Nervosa is diagnosed based on the appearance of three main symptoms, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5):
- Restricting food intake (relative to personal need) resulting in a significantly low body weight (for an individual, based on age, sex, developmental trajectory) or, in children, a failure to reach expected growth benchmarks
- Intense fear of gaining weight or becoming fat or behavior that interferes with weight gain (despite a significantly low weight)
- Disturbance in how one’s body weight or shape is experienced, significant influence placed on weight or shape in self-evaluation, or lack of recognition of the severity of current low body weight
People with anorexia nervosa often show other symptoms such as:
- Ritualistic behaviors around food and eating (cutting things into small pieces, chewing a certain number of times, etc.)
- Perfectionistic, all-or-nothing thinking
- Social isolation
- Difficulty concentrating, thinking, or making decisions
- Depression and/or anxiety
- Physical symptoms, such as cold intolerance, anemia, low blood pressure, low heart rate, and fine, downy hair covering the body (lanugo)
Who is at risk for anorexia nervosa?
There is no single cause of eating disorders, including anorexia nervosa. Eating disorders are often the result of a combination of biological, sociocultural, and environmental factors.
- Biological risk factors include genetics and family history. Over the past decade, research has shown that a person with a first-degree relative (parent, sibling, or child) with anorexia is seven to ten times more likely to develop the disease themselves.
- Sociocultural risk factors include the culture a person was raised in. While eating disorders occur in all parts of the world, they are more common in societies where there is a cultural emphasis on being thin and/or fit as the beauty ideal. Living in a society where food is commonly labeled as “good” or “bad” and media messages perpetuate the fear of food and fat may also contribute to the development of anorexia.
- Environmental risk factors include how a person was raised and their experiences as a person. It is not uncommon for those suffering from eating disorders to have also suffered some type of bullying, abuse, or neglect in their past. Additionally, some activities (such as dance, running, wrestling, and gymnastics) that place an emphasis on body shape or size put participants at an increased risk for developing anorexia.
Despite stereotypes often portrayed in the media, anorexia affects people from all ages, races, social classes, genders, and cultural backgrounds. While most sufferers will develop anorexia in their teens and young adulthood, cases are now being diagnosed in boys and girls as young as six and men and women in middle-age and beyond. Don’t let the belief that only certain groups of people struggle with eating disorders prevent you from seeking help.
How is Anorexia Nervosa Treated?
Because of the physical and mental complications of the disorder, anorexia is best treated by a multidisciplinary team, including a medical doctor, psychiatrist, registered dietitian, and therapist. Depending on a person’s specific needs, other specialists, such as internists or endocrinologists, may play a role in the treatment of anorexia.
A primary concern in the treatment of anorexia is stabilizing the person’s nutrition. After prolonged periods of starvation, a person’s body may have difficulty adjusting to regular and adequate nutrition, putting the person at risk for medical complications. Careful monitoring by a doctor and dietitian is vital during the refeeding process.
In addition to nutrition, it is essential for a person suffering from anorexia to understand the factors that lead to his/her eating disorder and what factors contribute to its maintenance.