What is anorexia nervosa?
Anorexia nervosa (AN) is an eating disorder that can lead to devastating physical, psychological, and social consequences if left unaddressed.
Anorexia nervosa is characterized by an intrusive preoccupation about body size and shape, leading to the patient not adequately nourishing themselves. It is essential to understand that anorexia nervosa can happen at any body size due to anorexia nervosa being centered around self-starvation, regardless of body weight.
Diagnosing anorexia nervosa
Early diagnosis and treatment of anorexia nervosa is essential to preventing permanent health damage and accelerating the recovery process. In fact, with proper treatment many can make a full recovery from AN.
Before settling on a treatment option, a medical provider with specialized training in eating disorders, and AN, will complete a thorough examination of the patient. After establishing a diagnosis, the provider will then suggest appropriate treatments based on the patient’s needs.
Medical professionals use the following indicators to make a diagnostic determination:
Preoccupation with body size
While not every patient with anorexia nervosa is underweight at the time of diagnosis, most present with low body weight and are undernourished. Regardless of weight, however, the common thread is an altered perception of body weight. (3)
Behavioral patterns, such as eating habits, exercise frequency, and intensity, and the use of laxatives and diuretics indicate disordered eating.
A thorough medical history and physical examination of patients with suspected eating disorders can reveal malnutrition and other related health conditions. In addition to a visual inspection of hair, skin, nails, knuckles, and teeth, providers also assess vital signs like blood pressure, pulse, temperature, and respiration rate. People with anorexia nervosa often have a low heart rate and low blood pressure, in addition to muscle loss.
Blood tests provide other valuable insights about the health status of patients who engage in restrictive eating behaviors. Low blood counts often indicate inadequate nutrition, compromised immune function, and impaired metabolism. They can also detect related medical conditions, such as dehydration and vitamin deficiencies. In people with anorexia nervosa, low sodium, potassium, creatinine, and urea are common.
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Signs & symptoms of anorexia nervosa
Eating disorders can be elusive, and the subtle nuances between the different types of eating disorders can also make them difficult to diagnose. Identifying the signs and symptoms of anorexia nervosa is therefore a critical part of getting a proper diagnosis. Prompt treatment can prevent permanent organ damage and help people with anorexia nervosa recover fully.
Here are a few warnings signs that could reveal anorexia nervosa:
- Wearing baggy clothing to disguise your thinness
- Avoiding eating in front of people
- Declining social gatherings that include food
- Expressing feelings of guilt after eating
- Obsessing about weight
- Having body image issues, including fear of gaining weight
Effects of anorexia nervosa
In the short term, the effects of anorexia nervosa are more subtle. Anorexia nervosa causes electrolyte imbalances and blood pressure changes that lead to fatigue and interfere with day-to-day activities.
Many people who engage in disordered eating also experience gastrointestinal distress:
- Abdominal pain
The long-term effects of anorexia nervosa are more devastating. The restriction of calories and lack of nourishment impacts every organ system. Irreversible effects can include osteoporosis and infertility.
Out of all the eating disorders, people with anorexia nervosa are most likely to die by suicide, with studies showing 20-40% of AN patients take their own lives. (15)
Over time, anorexia nervosa interferes with the body’s ability to function correctly, leaving the immune system vulnerable. (1)
Here are some other negative long-term health consequences associated with anorexia nervosa:
- Loss of bone density (osteoporosis)
- Loss of muscle (cachexia)
- Thin or brittle hair
- Growth of fine hair (lanugo)
- Severe constipation
- Irregular or absent menstrual cycles in women (amenorrhea)
- Low blood pressure
- Irregular heart rhythms and permanent heart damage
- High sensitivity to cold temperatures
- Reduced immune function
- Cognitive impairment
- Death, if untreated
The effects of disordered eating also take a toll on a person’s emotional well-being, which can lead to strained relationships and poor social support.
In most cases, anorexia nervosa does not occur independently. Over half of those diagnosed with AN also have at least one other co-occurring DSM-IV disorder. (10) Other related disorders that commonly occur alongside AN include:
- Body dysmorphic disorder
- Major Depression
- Obsessive Compulsive Disorder
- Post-Traumatic Stress Disorder
- Substance use disorder
- Impulse control disorder
- Bulimia nervosa
Treatment of anorexia nervosa
Anorexia nervosa is a life-threatening disorder, yet only one-third of those who suffer from the condition seek treatment. (10)
These are some common reasons patients resist treatment:
- Fear of gaining weight
- Fear of leaving home for treatment
- Fear of being in a residential setting
- Social stigmas and fear of judgment
- Not realizing treatment is necessary
Overcoming resistance to anorexia nervosa treatment is vital, since early intervention reduces both the condition’s short- and long-term effects.
Treatment of anorexia nervosa may include the following:
- Cognitive Behavioral Therapy (CBT): CBT is a common form of psychotherapy that helps patients with anorexia nervosa connect their thoughts with their behaviors. This type of therapy focuses on identifying triggers and changing the corresponding responses.
- Intensive Outpatient (IOP): Treatment for AN includes attending a treatment clinic a few days per week. IOP is best for people who have a strong support system at home, and will benefit from some structure at a clinic or hospital in their care and treatment.
- Partial Hospitalization (PHP): PHP is for people with AN who require a high degree of supervision. During their treatment, people with AN will stay for 4-7 days per week in a clinic or hospital setting, and must display the ability to continue treatment at home without 24-hour supervision.
- Residential Treatment: This type of treatment is generally received at a clinic or treatment center, and is required for AN patients who are experiencing co-occurring mental health disorders. Residential treatment includes 24-hour monitoring, and is recommended for those who lack a supportive home environment.
- Inpatient Hospitalization: This level of treatment is required for anyone who is having suicidal ideation, or severe depression, that prevent them from attending lower levels of care, such as PHP or IOP.
- Group Therapy: This is a powerful modality of treatment that allows patients to form deep connections with other members of the group. Attending group therapy in addition to other forms of treatment will greatly help in healing from anorexia nervosa.
Additional psychological therapies for anorexia nervosa include:
- Interpersonal Psychotherapy
- Dialectical Behavioral Therapy
- Family Therapy
- Emotion Focused Therapy
- Internal Family System Therapy
- Acceptance and Commitment Therapy
- Nutrition Therapy
Within Health's treatment options for those struggling with anorexia nervosa depend on the severity of the condition and the overall health of the individual seeking treatment. Still, the most important thing to understand is that eating disorders are treatable.
Therapies for anorexia nervosa
The most effective treatments for disordered eating are individualized, considering the patient’s unique medical needs, behaviors, barriers, and challenges.
Interdisciplinary teams consist of healthcare professionals with specialized knowledge in the treatment of eating disorders. A comprehensive clinical care team should include (at minimum):
- A physician
- A mental health professional
- A registered dietitian/nutritionist
In addition to the core medical team, family and friends also play a vital role in the recovery process. By offering additional support and encouragement throughout the treatment process, patients achieve better outcomes.
Medications for anorexia nervosa
Currently, there is no FDA-approved medication specifically targeted to treat anorexia. (11) However, some medications may be prescribed to treat related psychological conditions.
Understanding anorexia nervosa
Without a clear understanding of eating disorders such as anorexia nervosa, people often make over-generalizations that lead to inaccurate assumptions and judgments. For example, anorexia nervosa is not a lifestyle choice – it is a complex medical psychological condition that requires professional treatment.
There is a common misconception that anorexia nervosa only affects women when it actually affects people across all genders. Anorexia nervosa does not discriminate and affects all gender identities, sexualities, races, ages, and ethnicities.
One in three people diagnosed with an eating disorder identifies as male. (4) Likewise, anorexia nervosa also occurs in sexual and gender minority populations. (13)
Living with anorexia nervosa
For those who live with the condition, anorexia nervosa influences every aspect of their life. From food choices to social interactions, every decision is based on how it will affect a person’s weight and body image. The preoccupation with food and weight can lead to feelings of isolation, which take a toll on mental health. With treatment, however, people with anorexia nervosa can make a full recovery.
People who are navigating the challenging landscape of anorexia need a great deal of support, medical care and psychological care. Coping with anorexia nervosa requires a team of medical professionals like those at Within Health. Our team has specialized knowledge in the physical, emotional, and social aspects of the condition.
Equipped with effective coping strategies and treatment, a full recovery from anorexia nervosa is possible.
History of anorexia nervosa
- Self-induced starvation was first recorded in the Middle Ages, when some religions viewed extreme fasting as a sign of beauty and reverence. (5)
- In 1689, Dr. Richard Morton recorded the first notes about “nervous consumption,” a term he used to describe patients with poor appetite and weight loss. (6)
- In 1873, the term “anorexia nervosa” was first used to describe the condition. (7)
- In 1952, anorexia nervosa was officially listed in the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Anorexia nervosa in pop culture
Over the past 50 years, there has been a spike in cases of eating disorders in younger populations.8 Some health experts believe this is due to the constant societal messaging that thinness is something to be celebrated.
In recent years eating disorders have increased substantially in adolescents during the pandemic. The National Eating Disorder Association (NEDA) has experienced a 40% increase in helpline calls, while hospitals estimate intake for patients with eating disorders is also up 25%. (13)
In some industries, such as fashion and entertainment, expectations around weight are unrealistic. As many as 62% of fashion models have been encouraged to lose weight at some point in their careers. (9)
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How to help someone with anorexia nervosa
Early treatment is critical if you or someone you know is experiencing signs of anorexia nervosa. The first step in the recovery process is to find a trusted health care provider who can guide you through the treatment process.
Within Health offers compassionate, highly-personalized treatment programs for people with eating disorders. Call our admissions team today to learn how we heal anorexia nervosa.