What is Anorexia Nervosa?

People with anorexia nervosa starve themselves, subsisting on little or no food for an extended time, yet they remain convinced that they need to lose weight. As a result, their body weight is significantly below the average body weight of their age and height. 

People who seek treatment for anorexia often come with the fear of gaining weight or looking fat. They have a distorted self-image of their bodies, often believing that they are disgustingly fat and need to lose weight despite being low weight. 

People suffering from anorexia usually severely restrict their food intake to avoid or maintain weight loss. They may limit their calorie intake by vomiting after eating or misusing medication, diet supplements, diuretics, or enemas.

 Weight loss causes people with anorexia to be chronically tired, yet they drive themselves to exercise excessively. No matter how much weight is lost, the person is still afraid of gaining weight.

People with anorexia nervosa often develop elaborate rituals around food. 

Restricting Type

They refuse to eat. People with anorexia engage in excessive exercising to prevent weight gain. They eat very little food and lose weight through self-starvation or excessive exercise. Restricting individuals consume insufficient calories to support bodily functions and everyday activities.

Binge/Purge Type 

They periodically eat or have purging behaviors. They eat food, and they do self-induced vomiting to limit their calories. Binge type is different from bulimia nervosa in that people are typical with average weight or even overweight. 

However, anorexia nervosa isn’t about food or even body weight, it serves as a coping mechanism for other issues such as depression or low self-esteem. The obsession stems from the belief that if you could look better, everything wrong in your life would disappear, including stress, feelings of loneliness, and the fear of bullying. 

According to research, adolescents with asthma, diabetes, and other chronic illnesses are four times more likely to develop this eating disorder.

Warning Signs of Anorexia Nervosa

Behavioral & Emotional Changes 

•  Behavior and attitudes generally indicate that weight loss, dieting, and food control are top priorities.
• They appear to be uncomfortable eating in public.
• Obsession with weight, food, calories, carbs, fat grams, and dieting
• Significant weight loss
• Constipation, abdominal pain, cold intolerance, lethargy, and an excess of energy
• Claims not to be hungry
• Becomes more isolated or withdraws from usual friends 
• Refuses or is unable to maintain a body weight appropriate for their age, height, and build 
• Is terrified of gaining weight or becoming “fat,” despite being underweight
• Has a strong desire for control
• Has minimal initiative and emotional expression
• Difficulty in concentrating

Physical Changes 

• Other non-specific gastrointestinal complaints include stomach cramps (constipation, acid reflux, etc.)
• Menstrual irregularities include amenorrhea, irregular periods, or having a period while using hormonal contraception (not having proper periods)
• Dizziness
• Hyperventilating
• Constantly feeling cold
• Sleep difficulties
• Nails that are dry and brittle
• Swelling in the proximity of the salivary glands
• Enamel erosion, cavities, tooth sensitivity, and other dental issues.
• Hair loss on the scalp, as well as dry and brittle hair 
• Vomiting causes tooth decay or discoloration.
• Muscle fatigue
• Nails become dry and brittle
• Swelling in the vicinity of the salivary glands
• Enamel erosion, cavities, tooth sensitivity, and other dental issues. 
• Hair loss on the scalp, as well as dry and brittle hair 
• Vomiting causes tooth decay or discoloration.
• Muscle fatigue
• Irregular heartbeat
• Low blood pressure.
• Dehydration
• Arm and leg swelling

Prevalence 

About 1% of the population worldwide suffers from anorexia, and, in Australia, 3% to 4% of adolescent and adult women fulfill the diagnostic criteria for anorexia nervosa. According to the National Eating Disorder Collaboration, about one million Australians live with anorexia nervosa, about 4% of the total population. 

Furthermore, Community-based studies in the United States and Europe find that the lifetime prevalence of anorexia nervosa is 0.9 percent in adult women and 0.3 percent in adolescent girls. The rate among males is 0.3 percent in U.S studies.

Gender Differences 

Anorexia affects girls and women more than boys and men. It is also more common in young women and girls than in older women. Girls typically develop anorexia at the age of 16 or 17. Teenage girls aged 13 to 19 and young women in their early twenties are the most vulnerable.

Diagnosis 

A healthcare provider can diagnose anorexia nervosa using the criteria listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for anorexia nervosa.

DSM-5 also suggests using a body mass (BMI) of 18.5 kg/m2 as the lower limit of average body weight. The severity of anorexia nervosa will be mild if BMI is 17 kg/m2, moderate if BMI is 16-16.99 kg/m2, and severe if BMI is 15-15.99 kg/m2. However, the severity level is not only based on BMI but diagnosed based on symptoms and level of disability. 

Take away

There is no sure way to avoid anorexia nervosa. Primary care physicians (pediatricians, family physicians, and internists) may be in a suitable position to detect early signs of anorexia and prevent the illness from progressing. During routine medical appointments, for example, they can inquire about eating habits and satisfaction with one’s appearance.

If you notice a family member or friend has low self-esteem, strict dieting habits, or dissatisfaction with appearance, consider talking to them about it. Although you may not be able to prevent the development of an eating disorder, you can discuss healthier behaviors or treatment options.