What Is Anorexia Nervosa?

Anorexia nervosa is more than just a struggle with body image or a mere desire to lose weight. It is a complex eating disorder that encompasses aspects of physical, emotional, and psychological nature. Awareness of anorexia nervosa can be just what an affected person needs to truly feel understood and supported.

Anorexia nervosa is an eating disorder characterised by an intense fear of gaining weight. It can be characterised as a distorted perception of one's body shape and size. Individuals with anorexia nervosa often have an obsessive desire to be thin, leading them to restrict their food intake significantly, engage in excessive exercise, and adopt unhealthy weight loss methods.

This disorder goes beyond a simple desire to look a certain way. It involves deep-seated emotional and psychological factors that contribute to a relentless pursuit of thinness despite the detrimental impact on physical health. The term "nervosa" in anorexia nervosa refers to the psychological aspects of the disorder. 

Treating anorexia nervosa requires a multidisciplinary approach involving medical professionals, therapists, and nutritionists. The journey towards recovery is complex and challenging, but with the right support system, professional guidance, and a commitment to healing, individuals can regain a healthy relationship with food, their bodies, and themselves.

In this article, we will explore the origins, symptoms, and various challenges faced by those living with this condition. We will also explore the profound impact it can have on individuals and their relationships with their close ones. We will also cover some fundamental therapeutic approaches that aim to help people with anorexia nervosa.

The goal here is not to delve into complicated medical jargon but rather to provide a comprehensive overview combined with understanding and compassion. Please refer to the FAQ for the key questions when dwelling on this condition.

Overview

Causes of anorexia nervosa

Doctors and researchers are not yet sure about a concrete reason for this disease. You are more likely to suffer from anorexia or any other eating disorder when you are or have been exposed to the following conditions in the past:¹

• Someone in your family has a history of eating disorders, depression, or addictions to alcohol/drugs
• In the past, you have been criticised for your dietary habits or body/ weight shamed
• You have low self-esteem
• You suffer from anxiety, depression, or excessive behaviours
• You are a perfectionist
• You excessively compare your body to standards presented in the media, for example, bodies of models, influencers, athletes
• You have experienced sexual abuse

Signs and symptoms of anorexia nervosa 

The most common symptom of anorexia is losing lots of weight, as well as keeping your body weight deliberately lower, outside of healthy weight brackets for your height and age.

People who face anorexia tend to also suffer from mental health problems, such as depression and anxiety. You can distinguish behavioural and physical symptoms.²

Behavioural signs and symptoms of anorexia include:

• Skipping meals, eating very little or avoiding eating foods you consider fattening
• Lying about what and when you’ve eaten
• Lying about how much you weigh
• Taking appetite suppressants to make you not feel hungry, for example diet pills
• Excercising excessively
• Making yourself sick, using laxatives or diuretics to help you poo or pee to get rid of the food you’ve eaten
• Panicking about putting on weight
• Having peculiar rituals around food and meals
• Seeing only positives about extreme weight loss
• Believing that you are fat when you are of healthy weight or even underweight
• Denying the seriousness of your weight loss

Physical signs and symptoms may include:

• Adults: Unusually low BMI (Body Mass Index)
• For people under 18 years old: Your weight is lower than expected, considering your height and age
• For people who can have periods: Your periods have stopped, and it is not connected to menopause, or have not started your periods (in younger people)
• Feeling bloated, constipated, and having stomach issues
• Headaches
• Trouble sleeping/ insomnia
• Feeling cold, dizzy, extremely tired
• Your hands and feet are extremely cold to touch
• Brittle hair, prone to falling out
• Dry skin
• Fine, downy hair growing on the body, similar to peach fuzz or little hairs that newborns have in their first weeks;
• Reduced sex drive/libido

If you worry that someone from your close circle of family/or friends is suffering from anorexia, these are the main symptoms to be mindful of:

• Dramatic weight loss
• Lying about when or how much they have eaten or how much they weigh
• They avoid eating in the presence of others
• Playing with food, cutting food into small pieces or eating very slowly to disguise how much they are actually eating
• Wearing loose or baggy clothes to disguise how thin they are.

It is important to note that in children with anorexia, puberty might be delayed, and thus, the growth spurt connected to it might come later, too. Children and teenagers with anorexia might be smaller than their peers.

Management and treatment for anorexia nervosa

In general, the treatment for anorexia nervosa combines a form of therapy and controlled weight gain. The sooner you decide to start treatment, the better to avoid possible health complications, especially when you have already lost a lot of weight.³

There is a variety of treatments available, depending on your needs and background. The treatment for anorexia differs slightly for adults and people under 18 years old. 

The following therapies are recommended and supported by the NHS, with the sessions typically varying between 20-40 weeks (can be longer, depending on your needs) to make sure you are getting better and getting the support you need.

Treatment for adults:

1. Cognitive Behavioural Therapy
2. Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
3. Specialist supportive clinical management (SSCM)
4. Focal psychodynamic therapy

No matter which one you decide to follow, you will be offered advice on your eating and food habits. You will most possibly receive some vitamins and minerals to supplement the crucial nutrients your body needs to function. 

Diagnosis 

Diagnosis consists of taking measurements of your height and weight. Your GP calculates your BMI, as well as they will measure your pulse and heart pressure, temperature, and ability to breathe. Further examination of bodily organs is conducted to look for signs of eating disorders and to rule out potential other diagnoses that can lead to excessive weight loss, such as inflammatory bowel disease, hyperthyroidism, or Addison disease.⁴

Additionally, the doctors take a psychiatric assessment, including your psychiatric, family, social, and developmental history. Special attention is paid to assessing safety issues, such as suicidality and self-harm.

Risk factors

There are several risk factors that can make you fall ill with anorexia nervosa.⁴ 

Biological factors

From a biological perspective, there are some genetic aspects that can make you more susceptible. For example, if any of your parents had suffered from this disease in their lifetime, you have a 50% - 74% chance of developing anorexia nervosa.

Similarly, if you are a twin to someone with anorexia, you are more likely to fall ill as well. 

You should be cautious if you suffer from hormonal imbalance, for example, when your levels of cortisol and leptin levels are outside of the norms.

Psychological factors

You are more likely to fall ill if you characterise yourself with perfectionism, obsessionality, inflexibility, and neuroticism.

You have a higher chance of developing the symptoms if you have low self-esteem, low emotional awareness, and poor stress tolerance.

People with existing personality disorders are more likely to have anorexia, for example, obsessive-compulsive personality disorder and avoidant personality disorder.

You are more likely to suffer from anorexia if you have been already diagnosed with other mental illnesses, such as depression or anxiety.

Social factors

It is difficult not to mention external factors such as influences from society, starting from the immediate family circle. Observing strict dietary habits performed by parents during childhood or having parents who have been diagnosed with medical issues such as diabetes, obesity, or heart problems. This might trigger excessive dieting in adolescence, followed by a higher risk of falling with anorexia. 

One study showed that adolescents who put themselves on overly restrictive diets have an 18 times higher chance of developing anorexia nervosa.⁵ 

Importantly, variables such as peer pressure and going through stressful situations (for example, being bullied, life changes, abuse) can also trigger anorexia.

The expectations set by society and unattainable beauty and thinness standards are other culprits outlined by experts. This issue is widely documented in Western society, where anorexia is mainly found in Caucasian women. However, it can affect anyone, no matter the race.

Complications⁴

There are many medical complications connected with anorexia. They all stem from the imbalance between energy intake and expenditure. Your body goes into a power saving mode, as it does not have enough energetic supply to perform basic functions, starting from shutting off less vital bodily functions up to more severe and potentially life-threatening complications. 

The most significant medical complications include: 

• Extremely slow heart rate (less than 50 beats per minute)
• Hypokalemia (Low potassium levels) leading to heart problems
• Low oestrogen levels lead to bone fractures and bone-breaking
• Refeeding syndrome - during recovery, if a patient eats too much too quickly, it can lead to numbness, dizziness, coma, seizures, and potentially death.

FAQs

How can I prevent anorexia nervosa?

To prevent developing anorexia, it is important to work on your thinking patterns and eating behaviours. Upkeeping a positive body image, mindful eating, maintaining a healthy diet and lifestyle, and restricting social media influences should be a baseline of anorexia prevention. 

How common is anorexia nervosa?

Anorexia nervosa is relatively uncommon. One study estimates that 8 out of 100,000 people suffer from this illness, with the main group being young girls.⁶ 

When should I see a doctor?

If you notice three or more symptoms mentioned in this article and you suspect you might have anorexia, you should arrange an appointment with your GP to discuss your concerns. 

The most important symptom you should watch out for is your relationship with food and your body - if you notice unhealthy thinking patterns and behaviours, hypervigilance around food, and negative body image, you should seek medical advice.

Similarly, if you notice someone who exhibits anorexia symptoms, it is important to discuss getting help, but it must be done in a sensitive, empathetic way. Typically, people with anorexia might resist admitting to having this issue due to the nature of the disease, stigma, shame, and guilt. It is nevertheless important to discuss it and show your support.

Summary

Anorexia nervosa is a complex eating disorder that goes beyond a desire to lose weight. It involves physical, emotional, and psychological factors and can affect anyone regardless of age or gender. People with anorexia have an intense fear of gaining weight and a distorted perception of their body shape and size. They engage in restrictive eating, excessive exercise, and unhealthy weight loss methods.

The article emphasises the need for awareness and understanding of anorexia nervosa to support affected individuals. It discusses the origins, symptoms, and challenges faced by those living with the condition. Treatment for anorexia typically involves a multidisciplinary approach, including therapy and controlled weight gain.The article also highlights the importance of early diagnosis, as well as risk factors and potential complications associated with anorexia nervosa. 

It provides FAQs addressing prevention, prevalence, and when to seek medical help for both individuals with anorexia and those concerned about someone they know.