What You Need to Know about Anorexia Nervosa Treatment and Symptoms

Anorexia nervosa (AN) is an eating disorder that has a huge impact on both those who experience it and their loved ones. It’s a serious condition that impacts on all areas of life. While anorexia nervosa is more commonly seen in females, males are also affected by the condition. In both males and females, anorexia nervosa tends to begin during a person’s teenage years.

Defining Anorexia Nervosa

The DSM, Fifth Edition (DSM-5) (APA, 2013) categorizes anorexia nervosa as an eating disorder that has a specific set of diagnostic criteria.

These include:

  • Restricting the amount of food consumed.
  • Notably low body weight as a result of food restriction (which can include not making expected weight gains appropriate for the person’s age).
  • Extreme fears about weight gain.
  • Using laxatives, exercise, and vomiting (in addition to food restriction) to avoid weight gain.
  • Distorted perceptions in thinking, including not recognizing the seriousness of their condition, distortion in how they see their body and weight, and distorted views of ‘ideal’ weight.

Types of Anorexia Nervosa

There are two types of anorexia – the “restricting type” and the “binge-eating/purging type.” Although commonly thought of as symptomatic of bulimia nervosa (BN), binge-eating/purging that results in the significantly low body weight is classified as anorexia nervosa. Bulimia nervosa doesn’t result in the same body weight reduction.

It is possible to have all the symptoms of anorexia nervosa except the low body weight, in which case a person may be diagnosed instead with other specified eating disorder.

When a person is diagnosed with anorexia nervosa, they may also meet the diagnostic criteria for other co-occurring mental health conditions. For example, depressive disorders commonly are diagnosed in people with anorexia. Other co-occurring conditions include anxiety disorders and bipolar disorder.

People who are diagnosed with the restricting type anorexia nervosa may also experience symptoms of obsessive-compulsive disorder, too. Those with the binge-eating/purging type are more likely to have co-occurring substance abuse problems.

Complications Associated with Anorexia Nervosa

Anorexia can cause serious physical complications, and even be deadly. Therefore, it’s critical to seek the right kind of treatment as soon as possible. Some of the complications can include:

  • Heart problems such as bradycardia
  • Hypothermia
  • Reduction in density of bone minerals
  • Blood pressure issues
  • Problems with other organs

In women, it’s common to experience amenorrhea, which is when periods stop. Pre-pubescent girls may find that starting their periods does not happen until they have recovered from the low body weight of anorexia nervosa. Women and girls also tend to develop a kind of fine, downy body hair that is known as lanugo.

If someone with anorexia nervosa regularly engages in purging, there are more complications to consider. These include:

  • Electrolyte imbalances and other lab test abnormalities
  • Teeth erosion due to stomach acid
  • Enlargement of salivary glands
  • Problems with bowel movements due to laxative use

Risk Factors

One of the most commonly asked questions about anorexia is regarding the reasons why someone develops the condition. Unfortunately, answering this question is rarely, if ever, simple, because there are a number of contributing factors.

There is no single cause for anorexia nervosa developing. Instead, it’s usually a combination of risk factors that result in someone experiencing anorexia.

1. Cultural and Environmental Factors

There’s no avoiding social media and the internet, and this means that there’s no way of avoiding the influence that these things have on our body image. A horrifying fact is that one can find websites and various social media profiles that actually promote anorexia. Known as “pro-ana”, these sites give out tips to help increase “success” in anorexia behavior.

While anorexia nervosa is diagnosed in many different cultures, there are certain types of cultures that have higher rates than others. Usually, these are “post-industrialized, high-income countries” (APA, 2013).

However, since not all people in these cultures develop anorexia nervosa, there’s some question about how much of an impact culture alone has and different hypotheses to explain the whole phenomenon have been suggested.

Researchers have shown that there’s a connection between a culture’s perceived “ideal” body size and the overall level of dissatisfaction with one’s body (NEDA, 2018), as well as a connection between anorexia nervosa and cultures that put a lot of focus on being thin (APA, 2013).

Living in cultures in which activities associated with being thin (such as modeling and gymnastics) are heavily promoted tends to result in a greater risk for developing anorexia nervosa. These types of activities include. In these cultures, people may experience bullying that can contribute to developing anorexia later.

2. Experience of Trauma and Other Significant Stressors

Another risk factor for the development of anorexia nervosa is a person’s experience of traumatic events. Research has demonstrated a link between emotional, physical and sexual abuse and eating disorders (Kong & Bernstein, 2009; Brewerton, 2007).

In addition to events commonly regarded as trauma, significant life stressors (such as moving home or the loss of a loved one through death or divorce) can also be a risk factor for anorexia nervosa developing (APA, 2013).

3. Psychological Factors

Certain types of temperamental and emotional traits are commonly seen in people who go on to develop eating disorders like anorexia nervosa. For example, perfectionism is particularly common in people with the restricting form of anorexia (Fairburn & Brownell, 2002).

Obsessive-compulsive traits can also increase the risk of anorexia. Obsessively planning meals, for example, and constantly obsessing about food makes a person more likely to later develop the symptoms of anorexia (APA, 2013).

Those with poor self-esteem or difficulties managing and/or expressing emotions may be at a greater risk of developing anorexia, too (APA, 2013; Gual, P., et al, 2002; Peck & Lightsey, 2008).

4. Genetic Predispositions

If someone has an immediate family member with anorexia, then they have a greater risk of developing the condition themselves (APA, 2013). The specific reason for this is, as yet, unknown.

Researchers have, however, made the suggestion that anorexia nervosa may be linked to a genetic predisposition. They hypothesize that when someone also has other risk factors, then the genetic predisposition can be triggered. Some studies have shown brain abnormalities in people with anorexia – but it’s not clear whether this is a result or a cause of the condition.

5. Family Dynamics

It’s been demonstrated that certain kinds of family dynamics can be linked to anorexia nervosa (Tozza, Sullivan, Fear, McKenzie, & Bulik, 2003). Examples of these types of dynamics include over-emphasis on appearance, chaotic family situations, and either unbending or fuzzy boundaries.

The Academy for Eating Disorders (2010) refutes the notion that any family situation is the only cause of the development of anorexia nervosa, however. Rather, the authors claim that: “family factors can play a role in the genesis and maintenance of eating disorders, current knowledge refutes that idea that they are either the exclusive or even primary mechanism that underlie risk” (Le Grange, Lock, Loeb, & Nicholls, 2010).

It is most important, therefore, not to automatically blame a family for a person’s eating disorder. Instead, it’s vital to examine how the whole family is impacted by the eating disorder – as well as whether the family dynamics in any way maintain the disordered eating. Involving the family in treatment can have a big impact on recovery – particularly in the case of children and teenagers (LaGrange & Eisler, 2009).

6. Dieting

A history of dieting can be a risk factor for the later development of anorexia (Fairburn & Brownell, 2002). Additionally, an illness that results in reducing food intake and the associated weight loss, can be contributory factors.

While risk factors can, to some extent, explain the development of an eating disorder, they aren’t necessarily causal. Not all people who are at risk will subsequently develop anorexia nervosa.

Suicide Risks

People who have a diagnosis of anorexia nervosa are at an increased risk of attempting suicide (APA, 2013). In fact, some research has shown that suicide is one of the most common causes of death in anorexia patients (Birmingham, Su, Hlysky, Goldner and Gao, 2005).

Because of this, it’s important to conduct a suicide risk assessment. If someone is experiencing suicidal thinking, getting professional help is essential. If the person is actively suicidal, you should immediately dial 9-1-1.

Anorexia Nervosa Treatment Options

Because of the serious effects on a person’s life brought on by anorexia nervosa, getting the right kind of help is crucial. This means seeking support from professionals experienced in diagnosing and treating anorexia and other eating disorders.

Most treatment options for anorexia nervosa include multiple professionals. These may include doctors, dietitians, therapists, and psychiatrists. The type of treatment will depend on how severe the condition is. A treatment plan will be discussed during initial evaluations and reevaluated as treatment progresses.

Less severe cases of anorexia can be treated in outpatient settings. There is also the option for intensive outpatient treatment. More severe cases are likely to require some level of hospitalization, such as partial hospitalization programs (PHP), specialized residential programs, and inpatient hospitalization programs. The type of treatment most appropriate depends on a number of factors, which include patient safety, co-morbid medical conditions, and the severity of the behavior.

Therapy is an important part of anorexia nervosa treatment. Specifically, therapies such as dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT), and acceptance and commitment therapy (ACT) are recommended for people with anorexia.

Other useful therapies include eye movement desensitization and reprocessing (EMDR – particularly useful for patients who have experienced trauma) and psychodynamic therapy. Family therapy may be offered to help not just the person with anorexia, but their loved ones, too.

Starting treatment for anorexia can seem like a daunting process. It’s important that you remember that not only are there professionals ready to help you, but also that recovery is achievable. Beginning the path towards recovery starts with getting an evaluation from an eating disorder specialist.

“Weigh-In”, Courtesy of I Yunmai, Unsplash.com, CC0 License; “Grief and Shame”, Courtesy of Anthony Tran, Unsplash.com, CC0 License; “Forgotten Twilight Flower”, Courtesy of Sharon McCutcheon, Unsplash.com, CC0 License; “Forest Road”, Courtesy of John Towner, Unsplash.com, CC0 License

3 Reasons for Teen Eating Disorders

In many societies around the world, there are teens who are obsessed with their appearance. They are constantly searching for newer, more effective products to whiten their teeth, straighten their hair, or give them a flawless complexion.

A big portion of their conversations with one another revolves around looking good or catching the eye of someone they like, causing them to compare themselves against each other or even against those seen on the big and small screens.

Because of these, it is no small wonder why teen eating disorders are more prevalent now than ever before. In homes and schools, teenagers are either starving themselves or binge-eating and then throwing it all up. Such disorders, however, are very dangerous to the health which is why it is such a worrisome problem to parents and guardians.

Three Reasons for Teen Eating Disorders

Though there are may be many reasons why adolescents deal with teen eating disorders today, the following are most probably the top three:

1. There is too much societal focus on personal appearance

Shallow as it may seem to some, many teenagers develop eating disorders because they want to fit in with society’s standards of beauty, believing that anything less makes them substandard. Media now really bombards people with images of fitness, claiming such bodies to be the benchmark for healthy living.

This is then reinforced by people around – in social media posts, discussions amongst friends, and even preferences by people (such as their crushes!) around them, further cementing these wrong notions of “beauty” in the minds of the young.

Initially, it may begin with internal questions like “Why don’t I look like the other girls?” or “Am I buff enough to attract the girl I like?” But later on, this internal talk becomes even more negative in nature until they finally decide to do something about their weight.

2. Someone said they were not beautiful 

Words are very powerful. As stated in Proverbs 12:18, “The words of the reckless pierce like swords, but the tongue of the wise brings healing.”

For some teenagers, it was not necessarily media that brought their eating disorder about, but the careless words of someone around them – be they a close family member or friend, or a complete stranger. Teens are still developing their self-identity which often makes them very fragile inside. As they are still not fully aware of who they truly are, spoken words can help build them up or shatter their idea of themselves.

Sadly, not all words may have been spoken because of spite or harsh criticism. It could have been stated matter-of-fact, such as “I think you are too big for that dress now” or “I think you look rounder than usual.” Though no harm was meant, the teen may have wrongly internalized the observation, further breaking down their confidence.

3. There is a lack of positive reinforcement in their life

The teenage years are a topsy-turvy time. At this time, bodily changes, the craving for acceptance from peers, and the new responsibilities and pressures from parents and school can really cause a teen to crumble inside. This is why positive reinforcement is necessary, most especially from parents and those closest to them.

Unfortunately, with the busy lives that many parents have today, such reinforcement is lacking. Many teens grow up believing that they are not loved or they are not “good enough.” This causes some to try and control a portion of their life – their eating habits – to become what the world expects them to be.

How to Help Others Overcome Teen Eating Disorders

An eating disorder is a serious condition indeed; thankfully, there are three things that can be done to help them.

1. Love them

Eating disorders develop because the teen no longer loves themself; thus, love is what they need, particularly from those closest to them. This, however, will require much sensitivity and patience from the loved one as the teen will undergo many trials, big and small, during this trying time. But it is imperative that there is someone there to contradict the teen’s critical inner voice and show them that they are truly loved.

2. Educate them

Sometimes even if a teen feels loved, they may still be obsessed with becoming slim. In this case, it is important to educate them on how to lose weight in a safe way. Teach them about the correct eating habits, the need for rest, and commitment to regular exercise so that they can achieve their desired look without resorting to throwing up their food or starving themselves. When done successfully, it may become a permanent part of their lifestyle, helping them even when they are much older.

Educating them also includes redefining what “healthy” looks like and teaching them what “beautiful” really is. They must be informed that a skeletal physique is not healthy, which is why they should NOT strive to be what the supermodel TV shows portray. But more importantly, they need to know about true beauty – that if they are beautiful inside, then they are truly beautiful despite the many curves or lack of them.

3. Be careful with your language

For parents and guardians, careful guidance continues well beyond the elementary years. Sometimes, though, people forget, uttering the wrong words like “big boned,” “chubby,” or “fat” that cause a teen to lose confidence.

It may seem like an additional burden to always watch what one says around a teen; but if the bigger picture is taken into account, then the sacrifice will be well worth it.

Seek Help through Christian Counseling

Your beauty should not come from outward adornment, such as elaborate hairstyles and the wearing of gold jewelry or fine clothes. Rather, it should be that of your inner self, the unfading beauty of a gentle and quiet spirit, which is of great worth in God’s sight. 1 Peter 3:3-4

In some situations, a teen’s eating disorder may be too much for parents or guardians to handle, despite attempts to change the teen’s mindset about how they look. When this occurs, professional help should be sought out before other complications (e.g. failing health, depression, substance abuse) set in. Sometimes teens choose to listen to a neutral party’s advice rather than the same sound advice from parents, which is why therapy is often quite useful for teens.

In Christian counseling, the latest counseling methods will be used to help the teen overcome their weight obsession issues. They will also be taught and encouraged to opt for the healthier methods of staying healthy.

But more importantly, the Christian counselor will help connect the teen to our Lord Jesus Christ, through prayer and meditation on His Word, so that they can view their life circumstance through His eyes. When the teen is able to see how much they are loved by God and how beautiful they are in God’s perspective, then it becomes easier to break the eating disorder’s hold on them.

God wants everyone to know that they are beautiful and loved by Him. If your teenager is dealing with an eating disorder, seek help soon so that they may know about His perfect love.

“Makeover”, Courtesy of Andrei Lazarev, Unsplash.com, CC0 License; “Reflection,” courtesy of Ali Marel, unsplash.com, CC0 License; “Contemplation”, Courtesy of Strecosa, Pixabay.com, CC0 License; “Altered Conscious”, Courtesy of Alex Perez, Unsplash.com, CC0 License

What is the Most Effective Treatment for Eating Disorders?

For many people, it is difficult to imagine how others suffer from eating disorders. The idea of throwing up a delicious meal or trying to maintain an almost skeletal-like frame seems absurd to them.

Yet for those who do suffer from such disorders, it is a very serious reality that it is not about food or about entering the modeling world, rather it is about problems with control. This article will discuss this issue since many truly suffer from this, often in secret, and need help.

Causes Behind the Problem

The primary cause for most stems from control. Some feel that they lack control in certain areas of their life. The root causes of such are psychological such as low self-esteem, perfectionism, or difficulties controlling the emotions. Since they are not able to overcome these, they instead try to consciously control something else like their food intake.

For others, the control problem comes from elements in their environment such as peer pressure, bullying, family concerns or abuse. The world around them is chaotic and problematic so they try to establish some sense of control by controlling how they eat.

To a lesser extent, the disorder may manifest in reaction to stress at work or in the classroom, especially in the case of binge eating where people may seek their comfort food when they feel bombarded with problems.

Additionally, biological problems may also cause eating disorders to develop. Abnormal levels of body chemicals connected to sleep, stress, appetite or mood may also cause a person to overeat or undereat.

Unfortunately, eating disorders often run in the family. If a parent has an issue with overeating or undereating, it is oftentimes passed on to the children since they usually model what they see.

So Just How Bad is it?

According to the Washington State Department of Health (www.doh.wa.gov Mental Health-Eating Disorders, August 27, 2016):

“Approximately 1% of adolescent girls in the United States develop anorexia nervosa and 2-5% of adolescent girls develop bulimia. Anorexia is the third most common chronic illness among adolescents in the United States. The prevalence of eating disorders in males is much smaller than females but an estimated 19-30% of anorexia cases diagnosed in older adolescents are male.”

For the adult population in the US, eating disorders affect one million males and ten million females across the country. Moreover, four out of ten people know of someone who has experienced an eating disorder or they have personally undergone such a struggle themselves.

The following are the estimates of eating disorders over men and women’s lifetimes.

For men … For women …

● 0.3% will battle anorexia ● 0.9% will deal with anorexia

● 0.5% will deal with bulimia ● 5% will struggle against bulimia

● 0.2% will struggle with binge eating ● 5% will battle binge eating

(National Institute of Mental Health, nimh.nih.gov, Eating Disorders, August 27, 2016).

Perhaps for those who are not plagued by this, the statistics are meaningless. But for those affected by them, whether personally or because of people they know, the numbers are disturbing.

These Disorders are an Addiction

When people think of the word “addiction”, shopping, sex, drugs, or alcohol abuse come readily to mind. But eating disorders are also an addiction.

Binge eating can easily be identified as an addiction as sufferers may crave food in times of stress the same way a person may crave alcohol or cigarettes when stressed. Yet one’s obsession with having a particular body size is also an addiction since sufferers do what they do (e.g. vomiting up food or undereating) to achieve their goal.

Treatment for Eating Disorders

Just like the other addictions out there, it is very difficult to overcome an eating disorder alone. Treatment for eating disorders is necessary, lest something even worse (e.g. health complications, other addictions, severe depression, or suicide) happens to the sufferer.

Usually a team of specialists – counselor, dietician, and psychiatrist (if medication is involved) – is needed to overcome the problem. Individual and family counseling are highly encouraged to help both the sufferer and their family deal with the issue.

The sufferer must face the root cause of their addiction in order to overcome it. However, family members must also acknowledge their own feelings (e.g. shame, guilt, anger, regret) about having a loved one who is suffering from this, and they must learn what they need to do to help in the recovery.

Group counseling with other sufferers helps the person realize that they are not the only one battling such disorders. Insights are often gained in these groups leading to faster recovery.

Many times this support may be done on an outpatient basis via regular appointments with counselors and the medical team. In extreme cases, however, inpatient care at a facility may be needed with such care lasting anywhere from a few months up to a year.

Other Helpful Activities

In addition to the professional support, there are other things that may be done to speed up recovery.

1) Meditation or yoga may help relax the mind and body.

2) Exercise, which should be at least 30 minutes a day, three times a week, keeps the body healthy and may take the thoughts off of binge eating. Just be careful that the sufferer does not overdo it as excessive exercise may be connected to obsession over bodyweight.

3) Proper diet, as instructed by the dieticians, can get the body back on track.

4) Appointments with a specialist for connected disorders will help overcome problems like anxiety, alcohol or drug addictions, depression or other issues.

5) Hobbies like reading, art projects, music and other creative activities can refocus the mind on something positive to help boost self-esteem and self-love.

6) Helping others at this time of healing can also boost recovery. Most people usually feel more thankful for life and their blessings when they are able to assist others in need.

Prayer and Bible Reading

A very important activity to help overcome eating disorders is to spend time in prayer and Bible reading. Prayer allows us to communicate and connect with God. When this is done, a person feels less alone and less helpless, knowing that God the Almighty is there. It is only God who truly sees how beautiful and special we all are so it is His love that we should all seek.

But prayer must be paired with knowing more about God through His Word. It is difficult to trust someone we do not know so it is important to know more about God by meditating on Scripture. Aside from bringing us closer to Him, God’s Word will inspire sufferers in their struggle against their eating disorders.

The following, for example, are some Bible verses specifically for such disorders:

Don’t you know that your body is a temple that belongs to the Holy Spirit? The Holy Spirit, whom you received from God, lives in you. You don’t belong to yourselves. You were bought for a price. So bring glory to God in the way you use your body. – 1 Corinthians 6:19-20

Charm is deceptive and beauty is fleeting, but a woman who fears the Lord will be praised. – Proverbs 31:30

The Lord is near all who call out to Him, all who call out to Him with integrity. – Psalm 145:18

Do not be anxious about anything, but in everything by prayers and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus. Philippians 4:6-7

Seek Christian Counseling

While counselors are available in many institutes, a Christian counselor is able to integrate treatment for eating disorders with Scripture and prayer. In this way, both the sufferer and their family are able to seek God together to gain spiritual peace and wisdom to surmount the eating disorder at hand. Furthermore, even after the disorder has been overcome, the benefit of knowing God more intimately helps in whatever happens afterward.

If you or a loved one is suffering from an eating disorder, seek help soon before things worsen. Remember, God always has the best in mind for us.

The only temptations that you have are the same temptations that all people have. But you can trust God. He will not let you be tempted more than you can bear. But when you are tempted, God will also give you a way to escape that temptation. Then you will be able to endure it. – 1 Corinthians 10:13

“Moody,” courtesy of PublicDomainPictures, pixabay.com, CC0 Public Domain License; “Reflection”, courtesy of Ali Marel, unsplash.com, CC0 License; “Friends”, Courtesy of Brooke Cagle, Unsplash.com; CC0 License; “Pray”, courtesy of Patrick Fore, unsplash.com, CC0 Public Domain License