Acute anorexia vs. anorexia nervosa
Anorexia nervosa is one of the most well-studied eating disorders. It involves extreme restrictions around food intake, driven by an intense fear of gaining weight and distorted thoughts about one's body shape and weight.
Acute anorexia, sometimes also called severe anorexia or extreme anorexia, is not a separate condition but instead describes a particularly severe case of AN.
There's no official definition of severe anorexia nervosa, but most analyses use body mass index (BMI) or body weight as a guide to determine when someone reaches this level. Some common designations of acute anorexia are a BMI under 15 or patients who are less than 65% of their ideal body weight.2
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Signs and symptoms of severe anorexia
Extreme anorexia is a more severe presentation of AN, so many of the signs and symptoms are shared. Some common warning signs include:6
- A preoccupation with food, eating, calories, nutrition, or dieting
- A fixation on appearance, especially concerning body shape or weight, in themselves and others
- Strange rituals around food or eating, i.e., not letting foods touch each other on the plate or eating foods in a specific order
- Avoiding situations or events that involve food
- Depression, anxiety, irritability, and/or mood swings
- Frequently checking oneself in the mirror or avoiding mirrors
- Complaining about being or feeling "fat"
- Wearing loose or baggy clothes to hide the shape of one's body
Eventually, people with AN start struggling with several physical complications, as well, due to the malnutrition that develops with extreme food restriction. This can result in:6
- Low blood pressure
- Arrhythmia or irregular heartbeat
- Dry or yellowish skin
- Absence of menstruation
- Extreme cold intolerance
- Constipation
- Soft, downy hair (lanugo) growing on the body and face
- Dizziness or fainting
In cases of acute anorexia nervosa, these behaviors and physical concerns will likely be even more extreme due to the additional complications of a dangerously low body weight. Someone who has reached this point may also be less likely to admit they need help or more deeply involved in maintaining their disordered eating patterns.
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Complications of extreme anorexia
While severe anorexia has many of the same health impacts as AN, with the ability to affect nearly every organ, the resulting complications are often more severe or life-threatening in the case of extreme anorexia.
Heart complications
Anorexia nervosa can have many detrimental effects on heart health. In fact, cardiovascular complications are considered the leading cause of AN's high mortality rate.
7 And extreme anorexia can have an even bigger impact on this organ system.
Some of the most common and serious impacts include:
- Heart rhythm complications: Anorexia nervosa is frequently associated with bradycardia, or a slowed heart rate, and associated issues that can commonly lead to cardiac arrest.7
- Structural damage: Low body weight, malnutrition, and other issues associated with severe anorexia can damage the structure of the heart, most frequently causing the organ—as well as the volume of blood it can handle—to shrink.7
- Sudden death: This is a life-threatening condition when the heart suddenly stops beating. The condition is closely tied to anorexia nervosa.8
Gastrointestinal complications
Studies have found that anorexia nervosa can impact every part of the gastrointestinal (GI) tract, both while someone is directly struggling with the condition and while they're in recovery.5
Malnutrition is responsible for many of these issues, as well as the complications that come from refeeding. Some people with AN, including certain types of acute anorexia, also utilize purging behaviors to help them control weight, which can also lead to GI issues.
The most common complication is slowed emptying of the stomach and intestines, which can cause constipation, bloating, pain, and discomfort, among other symptoms.5
Bone and muscle complications
Bones and muscles have trouble developing and staying healthy without the proper nutrients. And acute anorexia can wreak havoc on nutritional intake.
Low bone mineral density was found to be almost a universal symptom of AN in one study, impacting nearly 90% of participants.2 The issue presented as osteoporosis, or clinically low levels of bone mineral density, in 43% of patients.2
In the same study, patients with severe anorexia were also found to have low levels of bone marrow (serous fat atrophy). Aside from being linked to additional health concerns, low bone marrow levels were connected to the duration of illness in patients with extreme anorexia.2
Treatment for acute anorexia
Unfortunately, in many cases, extreme anorexia leads to life-threatening complications. Many patients at this stage of illness are admitted to inpatient hospitalization, the highest level of care for eating disorders, where they can receive 24-hour medical treatment and monitoring.
The main priority of inpatient hospitalization is helping a patient become medically stable again, which means addressing issues that impact vital signs and extreme states of mind, such as suicidality.
Refeeding syndrome
Patients with acute anorexia risk developing what is called refeeding syndrome if they try to start eating again suddenly. It is essential to begin eating again inside of a hospital setting because this process can be particularly sensitive, as it triggers changes in hormonal, metabolic, and electrolyte levels, which can become deadly.4 This is why it's especially important for patients with severe anorexia to receive appropriate medical care.
Once someone is medically stable and past the early refeeding stages, they can continue treatment at residential facilities or through a partial hospitalization program. These levels of care still emphasize the physical needs of a person in recovery from acute AN, but they also incorporate mental health treatment that's necessary for long-term recovery.
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The experts at Within Health understand the complexity of eating disorders, including severe anorexia. Within Health offers evidence-based treatment personalized to each individual's unique case. Call our team today to see how you can start on the road to recovery.
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Recovering from acute anorexia
Getting out of immediate danger is the primary goal of severe anorexia treatment, but the next step of the journey has longer-term outlooks.
Each person's road to recovery is different but typically includes a combination of psychotherapy and nutritional counseling. Some patients may also require medication, whether to treat aspects of their eating disorder or commonly co-occurring mental health conditions like anxiety and depression. And others may find help in additional forms of care, like eating disorder support groups.
