Anorexia Nervosa

Anorexia nervosa is a dangerous mental health disorder characterized by an abnormally low body weight, an intense fear of gaining weight, and a distorted view of body weight. People struggling with anorexia will do almost anything to avoid gaining weight, including starving themselves. When people with anorexia look in a mirror, they do not see an accurate reflection. They believe they are fat, even when they are dangerously thin.¹

People with anorexia restrict the amount and types of food they eat and regulate calories closely. They maintain an intense fear of gaining weight and will employ any number of tactics to achieve weight loss.¹ To control calories, they might vomit after eating or exercise excessively, or misuse laxatives, diet pills, diuretics, and enemas. They might even binge and purge like people with bulimia nervosa.

Anorexia is a disorder that focuses on food, but it is about so much more. Researchers believe that anorexia is a way to manage emotional problems by gaining control over the body. People with anorexia often equate their self-worth with thinness.¹

Doctors diagnose anorexia nervosa in people of all ages and genders, but 90 to 95% of sufferers are girls and women.² Anorexia is most common among teens; research suggests that as many as 3 in 100 teenage girls are struggling with anorexia.¹ It is one of the most common psychiatric disorders in young women, and one of the most dangerous.

Anorexia nervosa is one of the most fatal mental health disorders in the United States.² As many as 5% to 18% of people with anorexia die from the disease, and about half of these deaths are the result of malnutrition, while the other half are from suicide.³

How Does It Develop?

No one knows exactly what causes anorexia, but researchers believe that it is a complex combination of several issues, including psychological, biological, environmental, and social factors.³ Studies show that roughly one in five people with anorexia have a relative with an eating disorder,¹ yet it is unclear whether this suggests a genetic component or a shared set of family values prioritizing thinness.³

People develop eating disorders for many reasons:^1,4

• Those at highest risk are young women in their teens.
• Certain temperaments and personality types can increase the risk of developing anorexia.
• People who tend to be perfectionistic, obsessive, anxious, and avoidant are at higher risk.
• Some people with anorexia believe they need to be perfect if they want love and respect.
• Others have an intense fear of humiliation and ridicule.
• Mental health issues—including depression, obsessive-compulsive disorder (OCD), and anxiety—are all common in people with anorexia.
• For some people, a triggering event can raise the risk of developing anorexia.
• A history of trauma, such as sexual abuse or the death of a parent, increases the risk of developing an eating disorder.
• A transitional event, like changing schools, moving, or ending a romantic relationship, can also cause stress and trigger anorexia.

Other high-risk groups are athletes and those in the performing arts, including dancers, actors, and models. Pressure from coaches and parents can—even when it is unintentional—contribute to the problem. Many anorexia sufferers enjoy the positive reinforcement they get when they lose weight the first time, so they continue to restrict food to garner more praise and acknowledgment.⁴

Finally, there is environmental and social pressure. In mainstream American culture, thinness is the ideal.⁴ It is easy for young women to infer from movies, magazines, and social media that thinness leads to popularity and love. Media is everywhere so it is impossible to avoid the messages it sends about beauty. Parents can help combat this risk factor by demonstrating healthy eating habits and teaching their kids that all bodies are beautiful.

Signs and Symptoms

The primary sign of anorexia nervosa is extreme weight loss.

The physical signs and symptoms of anorexia all relate to starvation, while the psychological signs relate to the distorted perception of body weight.

People with anorexia believe they are fat. To lose weight they might drastically reduce their food intake through dieting or fasting. They often exercise compulsively to burn calories, which can begin to look like an exercise addiction. People with anorexia might also make themselves vomit to get rid of calories, or use laxatives, diuretics, diet aids, or enemas. They may even binge and purge in a way that resembles the primary symptom of bulimia nervosa.⁴

Anorexia nervosa and bulimia nervosa are both characterized by a distorted body image and abnormal eating behaviors, but they are different disorders. Among people diagnosed with anorexia, there are 2 subtypes: those who restrict food intake and those who binge and purge.³ What differentiates anorexia from bulimia is body weight. Clinicians will provide an anorexia diagnosis if the patient has a low body mass index (BMI). They will diagnose bulimia if the patient has a normal or above-normal BMI.³

Physical symptoms of anorexia nervosa include:^1,4

• Extreme weight loss.
• Hair thinning, breaking, or falling out.
• Dry, yellowish skin.
• Brittle nails.
• Absence of menstruation.
• Dizziness or fainting.
• Bluish discoloration of the fingers.
• Cold or swollen hands and feet.
• Bloated or upset stomach.
• Downy, soft hair covering the body (lanugo).
• “Chipmunk-like cheeks” (parotid gland enlargement).
• Fatigue.
• Insomnia.
• Intolerance to cold.
• Constipation.
• Dehydration.
• Low blood pressure.
• Abnormal heart rhythms.
• Osteoporosis.
• Swelling of the arms or legs.

Mental health and behavioral health signs of anorexia include:^1,4

• Distorted self-perception (believing they are overweight when they are thin).
• Fear of gaining weight.
• Refusing to eat.
• Refusing to acknowledge the seriousness of the illness.
• Denial of hunger.
• Preoccupation with food.
• Obsessive-compulsive behavior.
• Depression.
• Exercise addiction.
• Lying about how much food has been eaten.
• Social withdrawal.
• Irritability.
• Thoughts of suicide.
• Flat mood (lack of emotion).
• Reduced interest in sex.
• Inability to remember things.

Warning signs of anorexia:^1,4

• Skipping meals or making excuses not to eat.
• Constantly weighing themselves.
• Eating only a few types of food.
• Refusing to eat in public.
• Ritually cutting food into tiny pieces.
• Compulsive exercising.
• Planning and preparing elaborate meals for others but not eating.

Complications and Side Effects

Anorexia can cause severe, even devastating, complications, including death if left untreated.Anorexia can cause severe, even devastating, complications, including death if left untreated. Death can result from the physical complications of starvation and malnutrition. It can happen suddenly, even if someone does not appear to be starving to death. Death often results from an irregular heart rhythm (arrhythmia) or an electrolyte imbalance.⁴

Electrolytes are minerals in the human body that have an electric charge. They are responsible for maintaining the healthy blood and cellular chemistry needed for muscle function and other processes. People get electrolytes like sodium, calcium, potassium, and magnesium through the foods they eat. When people with anorexia practice self-starvation, they can develop a dangerous electrolyte imbalance. Because electrolytes influence fluid balance throughout the body, an imbalance can cause severe dehydration and even kidney failure.⁴

When the body does not have the essential nutrients it needs to function, it begins to slow down all its processes in an attempt to conserve energy. As the heartbeat slows and blood pressure levels lower, the risk of heart failure increases.² The more severely malnourished someone with anorexia is, the more dangerous it can be. Every organ in the body, including the brain, can be damaged. This damage might not be completely reversible, even when someone gets treatment.⁴

Other complications can include:^2,4

• Reduction of bone density (osteoporosis), which causes brittle bones and raises fracture risk.
• Muscle loss and weakness.
• Severe dehydration, which can result in kidney failure.
• Fainting, fatigue, and overall weakness.
• Dry hair and skin.
• Hair loss.
• Growth of a downy layer of hair all over the body.
• In females, the absence of a period.
• In males, decreased testosterone levels.

In addition to the physical complications, people with anorexia can develop several psychological disorders. Around half of all anorexia-related deaths are from suicide.³ Developing co-occurring mental disorders can only increase the risk of death by suicide. Other disorders common in people with anorexia include:⁴

• Depression.
• Anxiety.
• Obsessive-compulsive disorders (OCD).
• Alcohol and substance abuse disorders.

Treatment Options

The best treatment programs for anorexia nervosa take a combined approach that includes psychotherapy, family therapy, medicine, and nutritional counseling. It is important that you are as invested as possible in your own treatment plan even though this can be difficult, since many people with anorexia deny the seriousness of their problem. Learning about your treatment options helps.

• Hospitalization: In many cases patients are suffering from severe malnutrition. If they have reached a dangerously low BMI and are unwilling to eat, they may need emergency medical treatment. Doctors will monitor vitals, look for medical complications, and medically stabilize them.
• Inpatient Residential Treatment: This provides an alternative to full hospitalization, but has the benefit of medical supervision. Patients live at the facility and receive 24/7 medical care, psychotherapy, and nutritional support. This works well for patients who are medically stable but psychiatrically impaired and not ready for, or responding to, outpatient treatment.
• Outpatient Treatment: There are many different types of outpatient anorexia treatment programs, ranging from intensive full-time outpatient programs to weekly therapy in a private office environment. This works well for patients who no longer require daily medical monitoring and need to work on their behavioral health by developing a healthy relationship with food.
• Luxury Treatment Programs: These are residential inpatient programs or intensive outpatient programs that offer high-end amenities in addition to conventional treatment. Amenities can include upscale lodging, swimming pools, spas, massage, yoga, acupuncture, and other alternative treatments.
• Executive Treatment Programs: These are inpatient residential and intensive outpatient programs designed for working adults. They may offer flexible work/life schedules to allow professionals time for recovery.
• 12-Step Programs: People with anorexia and their families organize these peer-to-peer support groups to support one another’s recovery. They follow the same 12-step recovery protocol as Alcoholics Anonymous.