Anorexia nervosa

Anorexia nervosa patient

Anorexia nervosa (also called anorexia) is a very serious psychological condition where people severely restrict the amount of food (self-starvation) they eat which causes excessive weight loss and extreme thinness, sometimes to fatal levels. It is considered both an eating disorder and a metabolic condition.

Anorexia nervosa can affect anyone, regardless of their age, gender, race, or background, although it mostly affects adolescent girls and women.

What causes anorexia nervosa?

The main cause of anorexia nervosa is psychological. A person with anorexia nervosa has a distorted body image and equates thinness to self-worth, meaning the thinner they are, the more they think they are valued, so they can never be thin enough. This distorted sense of self can make a person seriously unwell.

Other factors may also play a role, such as genetics (risk increases if a close family member also has anorexia), or the presence of other mood disorders, such as obsessive-compulsive disorder, anxiety, or depression, or personality traits, such as perfectionism or sensitivity.

People who participate, work or study in industries that emphasize a lean physique are at particularly high risk.

What are the symptoms of anorexia nervosa?

Symptoms can depend on the level of self-starvation and current body weight but may include:

  • Extreme thinness
  • Fear of gaining weight
  • Flat mood without emotion
  • Frequent references or complaints about weight gain
  • Insecurity about appearance
  • Intense exercise regimens
  • Irritability
  • Low sex drive
  • Lying about eating habits
  • Obsessive thoughts and behaviors regarding weight gain
  • Refusal to eat in public
  • Skipping meals
  • Tiredness, fatigue, or dizziness
  • Wearing numerous layers of clothing to disguise the thinness
  • Withdrawal from social activities.

The person's efforts to control their body weight, shape, and size become ultimately all-consuming. This behavior can contribute to a feeling of control, especially in people who feel like they don’t have control over other aspects of their life.

Eventually, their low body weight causes significant effects, such as:

  • Abnormal blood counts (low red blood cells, white blood cells, and platelets)
  • An abnormally slow heart rate
  • Anxiety and depression, suicidal thoughts
  • A bluish color on the fingertips
  • Body-wide downy hair growth
  • Bone loss, causing osteoporosis or osteopenia
  • Deficiency disorders, such as scurvy
  • Dehydration
  • Dry hair and hair loss
  • Dry skin that may look yellowish
  • Increased risk of heart failure
  • Irregular periods
  • Loss of muscle tone
  • Low blood pressure
  • Low testosterone levels in men.

How is anorexia nervosa diagnosed?

Your doctor may suspect anorexia nervosa based on your weight loss. They will ask you about your eating and weight loss history and perform some tests to determine any other causes and the extent of the impact this weight loss has on your body. If anorexia nervosa is diagnosed, then it is important to seek help from someone with the appropriate education, training, and experience to treat your specific condition.

You can also seek help yourself if you are unable to get it from someone in your immediate support circle from the National Eating Disorders Association helpline toll-free at 1-800-931-2237.

Some people's symptoms may not match all the criteria necessary for a diagnosis of anorexia nervosa and they may be diagnosed with atypical anorexia nervosa or another form of other specified feeding or eating disorder (OSFED). Both these conditions can develop into anorexia nervosa and prompt treatment should be sought.

How is anorexia nervosa treated?

Treatment involves a combination of psychotherapy, medical treatment, and nutrition counseling. Treatments may include:

  • Cognitive-behavioral therapy
  • Coping strategies
  • Medication for depression or anxiety
  • A meal plan provided by a nutritionist or dietician
  • Relaxation techniques, meditation, yoga, mindfulness instruction, yoga or other therapies.

Some people may require admission into a hospital, clinic or an eating disorders treatment center for intensive treatment initially if their body weight is at life-threatening levels.