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Anorexia nervosa: Starving yourself can be risky

What is anorexia nervosa?

Anorexia nervosa is an eating disorder characterised by lower body weights, extreme fear of weight gains and a distorted notion of body weight. It is commonly known as anorexia. Anorexia is the leading reason behind weight loss in younger women.

Individuals suffering from anorexia are very dogmatic about their weight and their body shape, and take punishing efforts to manage them. Such steps take a toll on their routine activities. Restricting food is the key practice used here to lose weight. Self-induced vomiting and use of laxatives, medicines for weight loss are other practices followed by such anorexic individuals to purge the food as in bulimic individuals. They are obsessed with frequent body checking like measuring, weighing and gazing in the mirror to assure themselves that they are thin.

Anorexia nervosa is the leading psychiatric disorder in terms of the highest number of mortalities reported. Females account for approximately 90% of the anorexic patients. Anorexia is prevalent in about 0.3% of the younger women. In teenage girls, its onset is reported in 15 years of age.

People suffering from anorexia habitually connect thinness with their self-esteem. Anorexia is more about emotional issues than food alone.

anorexia

Causes and risk factors

Causes

The precise causes of anorexia are still not known. Anorexia like other diverse disorders is thought to be a mix of psychological, biological and environmental factors.

  • Psychological: Anorexia could also result from few emotional factors as well. Some younger women may show signs of extreme obsessiveness about their weight and shape, making them fast despite being hungry and follow strict diets. The presence of anxiety and restrictions on food intake could lead to anorexia.
  • Biological: Anorexia can result due to genetic factors as well. Genetics usually has a bigger role, especially if there are family histories of mood disorders, obesity and eating disorders.
  • Environmental: Often in the society, one’s worth is equated with thinness. The pressure from the peer groups plays a major role in one wishing to be thin, especially in teenage girls.

Symptoms and signs

The symptoms and signs of anorexia include the signs and symptoms of starvation, the behavioural and emotional aspects of extreme fears of weight gains and the distorted view of one’s body shape and weight.

Thus the physical symptoms and signs may be:

  • Severe loss of weight
  • Thin look
  • Atypical blood counts
  • Insomnia
  • Dizziness
  • Insomnia
  • Fatigue
  • Thinning of hair
  • No periods
  • Constipation
  • Yellow or drier skin
  • Osteoporosis
  • Arm or leg swellings
  • Intolerance of cold
  • Uneven heart rhythm
  • Dehydration
  • Low blood pressure

Behavioural signs and symptoms of anorexia can be:

  • Extreme food restriction by fasting or dieting
  • Excessive exercising
  • Vomiting and purging to rid the food by use of enemas, laxatives, herbal medicines, etc.
  • Not eating
  • Fear of weight gain
  • Irritation
  • Depression
  • Suicidal ideations
  • Obsessive behaviour

anorexia

Diagnosis

An individual is diagnosed to be anorexic, based on the suspicion of friends or family members and the evaluation of a doctor.

To diagnose anorexia, your doctor may suggest:

  • Physical examination: It involves measurement of weight and height, heart rate, blood pressure and temperature.
  • Blood tests: Complete blood count and tests for monitoring kidney, liver and thyroid functions.
  • Urine analysis: A urinalysis could be done.
  • Mental health evaluation for anxiety and depression.
  • X-rays to detect the weakening of bones.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for anorexia nervosa diagnosis include:

  • Restriction of food intake
  • Fear of weight gain
  • Issues related to body image

Treatment and prevention

Treatment

Anorexia treatment involves medical therapy under the guidance of dieticians and mental health specialists.  Nutritional education and concurrent therapy are vital for sustained improvement of this disorder.
Severe cases of anorexia might require hospitalisation. Usual treatment for non-fatal cases of anorexia includes:

  • Ideal weight restoration: The key aim of the treatment is the restoration of an appropriate body weight. Dietician and your psychologist may assist you to attain a healthier body weight. Family members will be helpful in encouraging one adopt a healthy diet and develop good eating habits.
  • Therapy: Individual and family-based therapies could be beneficial. For teens, family-based therapy is preferred to enable them to develop good eating habits.

No medicines have been approved yet for the treatment of anorexia. However, the treatment includes that of depression and anxiety.

Prevention

There are no sure shot ways for preventing anorexia.

In case you notice any of your friends or family members with extreme habits of dieting and low self-regard, make sure to discuss anorexia with them. One may be able to instil healthy eating habits and discuss options of treatment available for anorexia.

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Complications

Severe cases of anorexia are fatal in nature requiring immediate emergency hospitalisation.

Severe weight loss can lead to

  • Electrolyte imbalances
  • Starvation
  • Dehydration

Anorexia could be much difficult to treat if left untreated for long.

Next steps

See your doctor if you suspect disorders like anorexia. In case you suspect others of having anorexia, motivate and talk to them to seek help immediately. The sooner one seeks help, closer will they be on the way to recovering from this disorder.

Red Flags

Often individuals with anorexia hide their physical issues, eating habits and their skinniness.

If you think that one of your friend or family members is anorexic, be on the look out for the following likely red flags:

  • Giving excuses to avoid eating
  • Skipping meals frequently
  • Frequent checks of weight and body measurement
  • Selective eating especially low calorie and foods low in fat
  • Avoiding eating in public
  • Knuckles with calluses and signs of teeth erosion by induced vomiting

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References

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  • Anorexia nervosa, BMJ. 2007 Apr 28; 334(7599): 894–898.
  • Anorexia nervosa. National Alliance on Mental Illness. http://www.nami.org
  • Anorexia nervosa. The Merck Manual. http://www.merckmanuals.com/professional/psychiatric_disorders/eating_disorders/anorexia_nervosa.html
  • Diagnostic and Statistical Manual of Mental Disorders DSM-5: American Psychiatric Association; 2013. http://www.psychiatryonline.org
  • Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Curr Opin Psychiatry. 2006 Jul; 19(4):389-94.
  • WHO. International statistical classification of diseases and related health problems, 10th revision Geneva: WHO, 1992

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