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.
- 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
- 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
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).
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.
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.
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