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Anorexia Nervosa: Know More About Its Symptoms and Causes

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  • Anorexia nervosa or anorexia, is an eating disorder that arises when people eat significantly less than normal because they’re afraid of gaining weight
  • Women and teens are more likely to be diagnosed with anorexia, but it can affect people of all genders, ages and races
  • Anorexia can manifest through physical, emotional and behavioral symptoms. If the condition isn’t addressed quickly, this can negatively impact your health and raise your risk for life-threatening consequences

Mental health issues can manifest in other ways aside from extreme feelings of sadness (depression)1 or nervousness (anxiety).2 Such is the case for eating disorders like anorexia nervosa (or simply anorexia), which may be classified as one of a range of “bio-psycho-social diseases.”3

Anyone, no matter what age, gender, body weight or ethnicity, may develop anorexia.4 If you think you’re suffering from anorexia, it’s important to act on this eating disorder immediately, since it’s both a dietary and psychological issue.5 Not seeking treatment for anorexia may put you at risk for severe repercussions, some of which may be fatal.

What Is Anorexia?

Anorexia is an eating disorder that can cause you to have very low body weight (15% less than the ideal amount)6 and look very thin and malnourished.7 If you have anorexia, you may fear weight gain, and employ extreme measures to control weight or lose some pounds, such as the following:8

Restricting food consumption

Working out excessively

Regulating calorie intake by trying to vomit after eating, or wrongly using laxatives, diet aids, diuretics or enemas

Anorexia can be divided into two types:9,10

Restrictive or restrictor type anorexia — It’s characterized by implementing drastic restrictions on the quantity and type of foods you eat.

Binge-purge or purging type anorexia — This occurs when you binge eat (consume large quantities of food within a short time), and then try to induce vomiting or purging, use laxatives, fast or exercise to expel what you’ve eaten.11

Who’s Likely To Be Affected With Anorexia?

This eating disorder can affect around 0.6% of adults throughout their lives, with females more likely to be diagnosed with anorexia compared to males. Anorexia statistics from the National Institute of Mental Health (NIMH) highlight that this eating disorder is seen in 0.9% of women and in 0.3% of men.12

Anorexia usually begins during puberty, sometimes as young as 10 years old,13 although the lifetime prevalence of adolescent eating disorders of any age ranges from as young as 13 to 18 years old.14 Teenagers are considered an at-risk group because they experience many bodily changes during puberty, may be pressured to achieve an “ideal figure” and are extremely sensitive to remarks regarding their appearance.15

Anorexia can also appear among those who play sports or do activities that place great emphasis on your body shape and size. According to Johns Hopkins, models, ballet dancers or bodybuilders, wrestlers, figure skaters, gymnasts, cheerleaders and jockeys can struggle with anorexia.16

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What Causes Anorexia? Here Are 5 Possible Factors

Anorexia nervosa’s causes aren’t exactly known, although you may want to consider these five potential factors:

Societal influences — Peer pressure can cause you to think that looking very thin or losing weight will make you successful and become accepted by society.17 The media can also play a role in causing anorexia, through campaigns of fashion labels and other brands that equate being beautiful with being thin, even if it’s unhealthy.18

Genetics — Some genes19,20 or genetic changes may affect your anorexia risk. It’s also possible to have this eating disorder if you have a first-degree relative (parent, sibling or child) who struggled with it before, or if you have genetic tendencies linked to anorexia-related behaviors (more on this to come later).21

Psychological causes — Eating disorders like anorexia are common in someone with low self-esteem, or who feel helpless or who are uncomfortable with their appearance.22 If you have anorexia, you may exhibit these behaviors:23

Obsessive-compulsive personality traits — They may prompt you to avoid food despite feeling hungry or follow very strict diets.

Extreme perfectionism — It can distort your perception of your body and make you think you’re not thin enough.

High anxiety levels — If you’re feeling very anxious, you may restrict food intake to curb your feelings.

Life events —  Stressful or traumatic life changes like these may increase your anorexia risk:24,25

Moving to a new school or home

Being fired from a job or starting a new job

Family or relationship problems

Previous cases of bullying

Physical, emotional or other types of abuse

Increased pressure to succeed

Death or illness

Increased dieting and starvation — Purposely starving yourself can cause reduced appetite, amplified anxiety, thinking rigidity and mood changes, which can be a precursor to eating disorders. Extreme dieting and starvation can also trigger negative effects to your brain, by affecting its function, promoting harmful eating habits and making it challenging to revert to usual eating habits.26

The Warning Signs of Anorexia Can Be Classified Into 3 Types

There are multiple anorexia symptoms you need to be aware of, and they can be classified into the following categories:27,28

Physical — Extreme weight loss, very thin appearance, dizziness or lightheadedness, alopecia or hair loss, fatigue, having low blood pressure levels, dehydration, infertility, insomnia, irregular heart rhythms, lack of menstruation, low body temperature (hypothermia), dry skin and swollen hands, arms, legs and feet can be symptoms of anorexia.

Behavioral — Significant reduction of food intake via fasting or dieting, obsession with consuming very small amounts of low-fat and low-calorie foods, excessive exercise, tendencies to skip meals and binge on foods, attempts to induce self-vomiting, refusal to eat or admit they’re hungry, fear of gaining weight or being fat, constant inspection of their body in the mirror, complaints about being fat or having fatty body parts and avoiding eating in public are all warning signs that someone may have an eating disorder.

Emotional — Mood changes, irritability, depression,29 withdrawal from social functions and lessened interest in sex can signal an eating disorder when coupled with weight loss or refusal to eat.

Spotting signs of anorexia may be tricky, especially if you’re trying to identify them in other people. Anorexic individuals can hide their unhealthy eating habits or cover up their figure. Common symptoms of anorexia such as low body weight and extreme thinness also may not be obvious to others, because perception of such aspects of physical health can vary from person to person.30

What’s the Difference Between Anorexia and Bulimia?

Another eating disorder that may be mentioned in the same vein as anorexia would be bulimia. Also called bulimia nervosa, those with this eating disorder usually are closer to a normal weight rather than being extremely thin. Bulimia is characterized by frequent periods of binge eating or consuming high-calorie foods quickly within a short timeframe (at least two hours). Binge eating can either be spontaneous or planned, uncontrollable and difficult to stop once it begins.

According to Medical News Today, you may feel bloated, guilty, unattractive and ashamed after eating too much food, and be afraid of weight gain. If you have bulimia, you may resort to the following behaviors to counteract the unhealthy eating habits, curb these negative thoughts and prevent weight gain:31

  • Self-induced vomiting
  • Over-exercising
  • Intake of amphetamines or other illegal drugs
  • Fasting or dieting
  • Abusing diuretics, enemas, emetics, laxatives or diet pills

Just like anorexia, bulimia can trigger behavioral and physical symptoms,32,33 and may initially appear during your teenage years. It develops more often among young women (although men are also vulnerable to it)34 and can result in life-threatening effects if not tackled immediately35

Although bingeing behaviors also appear in people with anorexia, remember the main differences between these eating disorders. If you’re dealing with anorexia, you’ll focus more on avoiding eating so you won’t pack on the pounds. However, if you have bulimia, you eat more food than what you can handle, and then perform measures afterward that’ll prevent weight gain.

What Are Treatment Options for Anorexia?

Once you notice signs of anorexia, seek medical attention right away because your condition can worsen the longer it remains unaddressed. According to Mayo Clinic, there are various tests that can check for anorexia:36

Physical exam — Aside from determining your height and weight, your doctor can also check your heart rate, blood pressure levels and temperature, and inspect your skin, nails, heart, lungs and abdomen.

Lab tests — While your doctor can recommend a urinalysis, a complete blood count (CBC) and more-specialized blood tests may be more advisable. They can help determine your body's electrolytes and protein content, and see if your liver, kidneys and thyroids are working properly.

X-rays — X-rays may be needed if your doctor wants to look for stress fractures, broken bones, pneumonia or heart problems, or just wants to examine your bone density.

Electrocardiogram — If your doctor suspects that you have heart problems caused by anorexia, you may need to undergo this test.

Psychological tests — Your doctor may ask you to complete assessment questionnaires and discuss your current eating habits and feelings. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association can help determine if you have anorexia or not.

Results of these exams not only are helpful in finalizing an anorexia diagnosis, but also ensure that you’re not suffering from another disease. They also help your doctor to look for and monitor complications.37 Some cases of anorexia can be so severe that you may be hospitalized and given nourishment via an IV or a feeding tube. Hospitalization is urgently needed if these health issues occur:38,39

  • Severe weight loss that resulted in malnutrition, heart disorders and mental health problems such as depression and an increased risk for self-harm or suicide
  • Being underweight or still undergoing weight loss
  • Increased risk for self-harm or suicide

Your age, health status, medical history and symptoms play a role in determining the anorexia treatment method that’ll work best for you.40 A healthy recovery from anorexia is possible if you quickly take steps to treat it, with the help of doctors, mental health professionals and dietitians. They can provide insights on how you may lessen anorexia’s impact on your body and promote speedy and continuous recovery.41

Refrain From Using Conventional Medicines to Address Anorexia

If you have anorexia, you may be prescribed antidepressants, antipsychotics or mood stabilizers42 to alleviate mental health issues linked to this eating disorder.43,44 However, these drugs may not work in curbing an unhealthy obsession with weight loss.45

Some research has shown that antidepressants, especially high doses taken for longer periods of time, are connected to Type 2 diabetes, as the drugs negatively affect glucose control.46 Researchers also discovered a fairly small margin of difference between the effects of antidepressants and placebos toward people with various severities of depression, thereby suggesting that this class of drugs isn’t effective in addressing this health issue.47,48

Does Anorexia Lead to Side Effects?

If you reject the idea that you’re suffering from a disorder and don’t seek professional help, anorexia can worsen and result in side effects. Some of the dangerous side effects of anorexia include:49,50,51

  • Cardiovascular problems such as irregular heartbeats, mitral valve prolapse or heart failure
  • Electrolyte level imbalances (low blood potassium, sodium and chloride)
  • Lower blood pressure levels
  • Anemia or weakened immune system
  • Muscle loss
  • Kidney or bowel problems
  • Increased fracture risk due to osteoporosis or bone loss
  • Reduced testosterone levels in men
  • Irregular menstruation
  • Nerve and brain issues that may impede concentration and memory and result in seizures

Mayo Clinic warns that anorexia can also affect your mental health, and having this eating disorder may increase the probability of:52

  • Suicidal thoughts or suicide attempts
  • Self-harm53
  • Obsessive-compulsive disorder
  • Depression
  • Anxiety
  • Personality disorders
  • Alcohol and substance abuse

Malnutrition is another major side effect of anorexia. While proper eating habits can help address this issue,54 in some cases the damage can’t be undone. Severe malnutrition caused by anorexia can trigger detrimental effects to your brain, heart and kidneys.55 It can also be life-threatening and lead to death because of the following reasons:56

  • Electrolyte imbalances57
  • Cardiovascular problems (mainly bradycardia, hypotension, arrhythmias, repolarization abnormalities or sudden death)
  • Hypoglycemia (very low blood sugar levels) that can lead to sudden death
  • Suicide58
  • Gastric problems
  • Severe hypophosphatemia that may result in muscle weakness and bulbar muscle dysfunction

Despite initial anorexia treatment, there’s also a high risk for relapse. To prevent this, you should fully commit to your treatment plan and seek help from a support group and your loved ones.59

How to Recover From Anorexia

Undergoing therapy, whether done one-on-one, with family members or with a group, is recommended if you have anorexia. This can assist you in learning about the disorder and proactive ways of coping with it. If you have mental health problems that have developed because of anorexia, therapy may be greatly helpful in addressing them too.60 NHS-UK suggests that the following types of therapy may be recommended if you have anorexia:61

  • Cognitive behavioral therapy (CBT)
  • Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
  • Specialist supportive clinical management (SSCM)
  • Focal psychodynamic therapy
  • Family therapy
  • Adolescent-focused psychotherapy
  • Diet advice

As mentioned, support groups for people living with anorexia may help with recovery, since it can allow you to discuss your experiences and problems with others who have this eating disorder.

If You’re Recovering From Anorexia, Take Note of These Diet Strategies

Addressing your diet is important if you’re recovering from anorexia, as you will need to replenish nutrients and regain lost weight. Your body needs energy to achieve these goals, however. How much of it you’ll need depends on your recorded body weight before you had anorexia and your physiological status when you started treatment.

You can then ask a dietitian or naturopath trained in diet issues for help in determining your ideal recovery meal plan. Factors like your medical and family history should be considered too.

The book “Case Studies in Physiology and Nutrition” recommends a lactose-free diet containing 1,200 calories, including 3 grams of sodium. Instead of three large meals, you should be consuming six or more small meals within one day. The overall diet should be gradually increased by at least 300 calories three times a week.

Although a low-fat diet may be recommended in some instances, your doctor will need to look at your genetic background and health status before being diagnosed with anorexia to determine whether a low-fat diet is appropriate.

Be aware that it can be challenging at first to regain lost weight. This is because intentionally starving yourself for long periods of time can result in cell loss, especially those found in your gastrointestinal tract, and lead to weakened gut absorptive capacity and malabsorption.63

Refrain from bingeing on foods if you’re still recovering to lower your risk for refeeding syndrome. This health issue, which usually arises among anorexics or people who fasted or starved for so long,64 is characterized by imbalances in your body’s electrolyte and fluid levels that occur when sugar or glucose is reintroduced your system.

When you starve yourself, your body will need to get its energy from fat and proteins instead of insulin-produced carbohydrates. This causes a shift, resulting in decreased vitamin and electrolyte levels. Once you’re starting to recover from anorexia and you try to consume glucose, this may then cause your body to create more insulin, reduce electrolyte levels again and trigger some of these devastating health problems:65,66

  • Hypokalemia (extremely low potassium levels)67
  • Hypomagnesemia (extremely low magnesium levels)68
  • Hypophosphatemia (phosphorus deficiency)
  • Issues linked to your heart, lung, kidney, blood or muscles

Tips to Prevent Anorexia

Research still hasn’t fully determined why anorexia occurs or how to ultimately stop it.69 However, anorexia prevention can begin at home, and involve simple and helpful actions. The following tips from WebMD can be vital, especially if you live with young women and teens who have a high anorexia risk:70,71,72

  • Promote healthy eating habits.
  • Teach realistic attitudes and perceptions toward body image.
  • Try to increase self-esteem, particularly by highlighting that personality is more important than physical attributes.
  • Explain the possible drawbacks of dieting.
  • Try to instill the notion that extreme thinness isn't better or ideal.
  • Encourage honesty regarding personal feelings.

By Developing Healthy Eating Habits and Self-Confidence, You Can Avoid Anorexia

Taking steps toward maintaining a healthy weight and toning your body in the process is commendable. However, remember there are ways for you to achieve these goals without affecting your well-being and increasing your risk for additional health problems.

Anorexia is a very serious disorder that can be linked to an obsession with unrealistic body standards. It can cause many physical, mental and emotional health problems. While anorexia can be addressed through participating in therapy sessions and following a healthy diet, there are instances when treatment can be too late and result in life-threatening effects.

There are ways to avoid anorexia before its indicators appear. Debunking the notion that extreme and unhealthy thinness is “beautiful,” while promoting healthy eating habits and boosting self-esteem levels are impactful ways to prevent anorexia and its adverse effects.

Frequently Asked Questions (FAQ) About Anorexia

Q: What are the different types of anorexia?

A: There are two types of anorexia: restrictive or restrictor type anorexia and binge-purge or purging type anorexia.73,74

Q: What is purging type anorexia?

A: Purging type anorexia is when you eat excessive amounts of food within a short span of time (also known as binge eating), and attempt to compensate for it by triggering vomiting or purging, taking laxatives, fasting or exercising.75

Q: How do I know if I have anorexia?

A: Anorexia symptoms can be physical, behavioral or emotional in nature. Arguably, the most common symptoms of anorexia would be extreme thinness and drastic weight loss.76,77

Q: Is anorexia a mental illness?

A: Anorexia can be considered a mental health issue because it may be influenced by psychological factors78 and result in mental health problems in the long run.79,80

Q: How is anorexia diagnosed?

A: Physical exams, lab tests, X-rays or psychological assessments are some of the ways your doctor can diagnose anorexia.81

Q: How long does anorexia last on average?

A: A case of anorexia typically lasts for an average of six years.82

Q: Can you die from anorexia?

A: Yes. You can die unexpectedly if your anorexia is very severe, as it can cause electrolyte imbalances,83 cardiovascular complications, gastric problems84 and even increase your risk for suicide.85

Q: How do you help someone diagnosed with anorexia?

A: If you know someone diagnosed with anorexia, you can help them recover by learning more about how the disorder can affect them, making time to listen to their concerns, boosting their self-esteem levels, including them in your plans for activities and convincing them to seek professional medical treatment.86,87

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