Anorexia means a loss of appetite or the inability to eat, and it can be a symptom of various diseases. When a person has anorexia nervosa, they intentionally restrict their food as part of a serious and potentially life threatening mental health disorder.This often involves emotional challenges, an unrealistic body image, and an exaggerated fear of gaining weight.
Anorexia nervosa often appears during a person’s teenage years or early adulthood, but it can sometimes begin in the preteen years or later in life.
People often think of anorexia nervosa in connection with people who are female, but it can affect people of any sex or gender. Statistics show that females with anorexia outnumber males with the disorder at a ratio of 10 to 1.The effects of the disorder are more likely to be life threatening among males than among females. The reason for this is that males often receive a later diagnosis due to the mistaken belief that it does not affect them.
The physical signs and symptoms of anorexia nervosa are related to starvation. Anorexia also includes emotional and behavioral issues involving an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat.
▪︎ Physical symptoms
Physical signs and symptoms of anorexia may include:
• Extreme weight loss or not making expected developmental weight gains
• Thin appearance
• Abnormal blood counts
• Dizziness or fainting
• Bluish discoloration of the fingers
• Hair that thins, breaks or falls out
• Soft, downy hair covering the body
• Absence of menstruation
• Constipation and abdominal pain
• Dry or yellowish skin
• Intolerance of cold
• Irregular heart rhythms
• Low blood pressure
• Swelling of arms or legs
• Eroded teeth and calluses on the knuckles from induced vomiting
▪︎ Emotional and behavioral symptoms
Emotional and Behavioral symptoms of anorexia may include attempts to lose weight by –
• Severely restricting food intake through dieting or fasting
• Exercising excessively
• Bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products
• Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them
• Frequently skipping meals or refusing to eat
• Denial of hunger or making excuses for not eating
• Eating only a few certain “safe” foods, usually those low in fat and calories
• Adopting rigid meal or eating rituals, such as spitting food out after chewing
• Not wanting to eat in public
• Lying about how much food has been eaten
• Fear of gaining weight that may include repeated weighing or measuring the body
• Frequent checking in the mirror for perceived flaws
• Complaining about being fat or having parts of the body that are fat
• Covering up in layers of clothing
• Flat mood (lack of emotion)
• Social withdrawal
• Reduced interest in sex
Factors that may be involved in developing anorexia include:
Research suggests that approximately 50% to 80% of the risk of developing an eating disorder is genetic. People with first-degree relatives (siblings or parents) with an eating disorder are 10 times more likely to develop an eating disorder, which suggests a genetic link. Changes in brain chemistry may also play a role, such as neurotransmitters, such as serotonin and dopamine, which can affect appetite, mood and impulse control.
Many experts believe that eating disorders, including anorexia, are caused by people attempting to cope with overwhelming feelings and painful emotions by controlling food. Physical abuse or sexual assault, for example, can contribute to some people developing an eating disorder.
• Environment and culture
Cultures that idealize a particular body type — usually “thin” bodies — can place unnecessary pressure on people to achieve unrealistic body standards. Popular culture and images in media and advertising often link thinness to popularity, success, beauty and happiness.
• Peer pressure
Particularly for children and adolescents, peer pressure can be a very powerful force. Experiencing teasing, bullying or ridiculing because of appearance or weight can contribute to the development of anorexia.
• Emotional health
Perfectionism, impulsive behavior and difficult relationships can all play a role in lowering a person’s self-esteem and perceived self-worth. This can make them vulnerable to developing anorexia.
Risk Factors –
Several factors can increase a person’s risk for developing anorexia nervosa, including –
• Past criticism about their eating habits, weight, or body shape
• A history of teasing or bullying, especially about weight or body shape
• A sense of pressure from society or their profession to be slim
• Low self-esteem
• Having a personality that tends toward obsession or perfectionism
• Sexual abuse
• A history of dieting
• Pressure to fit in with cultural norms that are not their own
• Historical trauma, such as racism
• A close relative has had a similar disorder
• There is a family history of depression or other mental health issues
• They have type 1 diabetes
Anorexia can have numerous complications. At its most severe, it can be fatal. Death may occur suddenly — even when someone is not severely underweight. This may result from abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body.
Other complications of anorexia include:
• Heart problems, such as mitral valve prolapse, abnormal heart rhythms or heart failure
• Bone loss (osteoporosis), increasing the risk of fractures
• Loss of muscle
• In females, absence of a period
• In males, decreased testosterone
• Gastrointestinal problems, such as constipation, bloating or nausea
• Electrolyte abnormalities, such as low blood potassium, sodium and chloride
• Kidney problems
If a person with anorexia becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. This damage may not be fully reversible, even when the anorexia is under control.
In addition to the host of physical complications, people with anorexia also commonly have other mental health disorders as well. They may include:
• Depression, anxiety and other mood disorders
• Personality disorders
• Obsessive-compulsive disorders
• Alcohol and substance misuse
• Self-injury, suicidal thoughts or suicide attempts
A healthcare provider can diagnose a person with anorexia based on the criteria for anorexia nervosa listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Diagnostic guidelines in the DSM-5 also allow healthcare providers to determine if a person is in partial remission (recovery) or full remission as well as to specify the current severity of the condition based on body mass index (BMI).
The provider or a mental health professional will likely ask questions about the following topics:
• Dietary history (attitudes about food, dietary restriction).
• Exercise history.
• Psychological history.
• Body image (this includes behaviors such as how often you weigh yourself).
• Bingeing and purging frequency and elimination habits (use of diet pills, laxatives and supplements).
• Family history of eating disorders.
• Menstrual status (if your periods are regular or irregular).
• Medication history.
• Prior treatment.
Tests to rule out weight-loss causing illness or to assess anorexia side effects may include:
• Complete blood count to assess overall health.
• An electrolyte blood panel to check for dehydration and your blood’s acid-base balance.
• Albumin blood test to check for liver health and nutrient deficiency.
• Electrocardiogram (EKG) to check heart health.
• Urinalysis to check for a wide range of conditions.
• Bone density test to check for weak bones (osteoporosis).
• Kidney function tests.
• Liver function tests.
• Thyroid function tests.
• Vitamin D levels.
• A pregnancy test in people assigned female at birth who are of childbearing age.
• Hormone tests if evidence of menstrual problems in people assigned female at birth (to rule out other causes) and measuring testosterone in people assigned male at birth.
One of the biggest obstacles in the treatment of anorexia nervosa is realizing that you need help. Many with anorexia nervosa don’t believe they have a problem. That can make treatment difficult.
The main goal of treatment is to restore your body to a normal weight and establish normal eating habits. A dietitian will help you learn how to eat properly. It might also be recommended that your family take part in therapy with you. For many people, anorexia nervosa is a lifelong challenge.
You and your family must work hard to overcome anorexia nervosa. Individual, family, and group therapies are often an integral part of treatment.
▪︎ Individual Therapy
A form of therapy called cognitive behavioral therapy is often used to treat anorexia nervosa. CBT helps change unhealthy thoughts and behaviors. Its goal is to help you learn to cope with strong emotions and build healthy self-esteem.
▪︎ Family Therapy
Family therapy gets family members involved in keeping you on track with your healthy eating and lifestyle. Family therapy also helps resolve conflicts within the family. It can help create support for the family member learning to cope with anorexia nervosa.
▪︎ Group Therapy
Group therapy allows people with anorexia nervosa to interact with others who have the same disorder. But it can sometimes lead to competition to be the thinnest. To avoid that, it’s important that you attend group therapy that is led by a qualified medical professional.
While there is no medication at this time that is proven to treat anorexia nervosa, antidepressants may be prescribed to deal with the anxiety and depression common in those with anorexia. These may make you feel better. But antidepressants do not diminish the desire to lose weight.
Depending on the severity of your weight loss, your primary care provider may want to keep you in the hospital for a few days to treat the effects of your anorexia nervosa. You may be put on a feeding tube and intravenous fluids if your weight is too low or if you’re dehydrated. If you continue to refuse to eat or exhibit psychiatric issues, your primary care provider may have you admitted into the hospital for intensive treatment.
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