Anorexia Nervosa

Defintions
Signs and Symptoms
Physical/Medical Complications 

Definition

Anorexia nervosa is an eating disorder characterized by the restriction of food intake which can result in low body weight or significant weight loss, an intense fear of gaining weight, and distorted body image. When someone experiences symptoms of anorexia nervosa but does not meet the low weight requirement, they are diagnosed with atypical anorexia nervosa. Despite common misconceptions and stereotypes, a serious eating disorder can exist at any weight and seeking professional treatment right away is recommended. These are psychological disorders that can’t be diagnosed based on what someone looks like or weight alone.

It is common for people struggling with anorexia nervosa to not recognize the seriousness of their condition. Our culture normalizes and encourages many eating disorder behaviors making it even more difficult to see the seriousness of their condition. Being undernourished can also play a role in this. When a body does not have the nutrients it needs in order to function on a daily basis, it begins to feel a great amount of stress. Many begin to feel depressed, irritable, anxious, hopeless and moody as a result. These are all symptoms of malnutrition. An estimated 10 to 20% of people with anorexia will eventually die from complications related to it, giving anorexia nervosa the highest mortality rate of any psychiatric illness. There has been a lot of research into anorexia in the last thirty years and because of this treatment has been seeing much more positive results.

Signs and Symptoms

The following are some symptoms that might be noted. However, it is important to understand that eating disorders are complex and unique to each person. They might not exhibit all symptoms.

  • Weight loss is often but not always noted
  • Becoming withdrawn
  • Exercising excessively
  • Feeling coldanorexia nervosa
  • Muscular weakness
  • Preoccupation with food, calories, macros/points, recipes
  • Excuses for not eating meals (ie. ate earlier, not feeling well)
  • Unusual eating habits (ie. cutting food into tiny pieces, picking at food)
  • Noticeable discomfort around food
  • Complaining of being “too fat”
  • Cooking for others, but not eating themselves
  • Restricting food choices to only diet foods
  • Guilt or shame about eating
  • Depression, irritability, mood swings
  • Evidence of vomiting, laxative abuse, diet pills or diuretics to control weight
  • Irregular menstruation
  • Amenorrhea (loss of menstruation) is sometimes but not always present
  • Wearing baggy clothes
  • Frequently checking weight on a scale
  • Fainting spells and dizziness
  • Difficulty eating in public
  • Very secretive about eating patterns
  • Pale complexion (almost a pasty look)

Physical/Medical Complications

  • Fatigue and lack of energy
  • Amenorrhea (loss of menstruation)
  • Skin problemsanorexia in men
  • Dizziness and headaches
  • Dehydration
  • Shortness of breath
  • Irregular heartbeats
  • Cold hands and feet
  • Bloating
  • Constipation
  • Hair loss
  • Stomach pains
  • Decreased metabolic rate
  • Edema (water retention)
  • Lanugo (fine downy hair)
  • Loss of bone mass
  • Kidney and liver damage
  • Electrolyte imbalances
  • Osteoporosis
  • Insomnia
  • Anemias
  • Infertility
  • Depression
  • Cathartic colon (caused by laxative abuse)
  • Low potassium (most common cause of nocturnal cardiac arrest)
  • Cardiac arrest and death

Causes

There is no specific cause of eating disorders. It is most likely a combination of biological, social, and psychological factors that contribute. More recently, epigenetics (a scientific field of study that looks at the interaction between environment and genes that influence a person) has led researchers to understand that anorexia is a brain-based disorder. Studies with twins have also shown that it is the genetic component that is significantly influential in anorexia development and expression, more so than the environmental factors that siblings may share.

Dieting can be a risk factor for developing an eating disorder. 1 in 3 people who go on a diet develop pathological dieting (disordered eating), and from this number 1 in 4 develop an eating disorder. It’s important to understand that eating disorders aren’t usually as much about the food or body as it seems, they often develop during difficult life transitions and experiences. Trauma, loss, getting married, divorced, and having children are common times when eating disorders emerge. Some personality traits may also put some at risk like perfectionism, persistence, impulsivity (purging type), agreeableness, and harm avoidance.

Treatment

If you or someone you love is struggling with anorexia nervosa, it’s best to take a treatment team approach with the following professionals who specialize in eating disorders: licensed therapist, registered dietitian, medical doctor, and possibly a psychiatrist. It may be helpful to also get involved in an outpatient eating disorder treatment group or professionally run support group to connect with others in the recovery process. Here is more on treating eating disorders.

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Additional Reading:

Higher-Weight (Atypical) Anorexia Nervosa

A Mom’s Perspective: Having a Child with an Eating Disorder

Refeeding Syndrome – What refeeding syndrome is, who is at risk, prevention.

Family-Based Treatment For Adolescent Anorexia Nervosa

Young Adults With Anorexia: Not Too Old For Family Therapy

Working Through the Weight Restoration Phase of Anorexia Nervosa

Anorexia Recovery for Orthodox Jews: Kosher Dietary Strategies

Navigating Eating Disorder Treatment

Anxiety Depression and Anorexia Symptoms – Information on the link between anxiety, depression, and anorexia. Other psychological symptoms, treatment information.

Autism And Anorexia – There are many similarities between anorexia and autism, and many researchers believe they are related.

Girls With Anorexia – Additional information on how anorexia affects girls. Treatment information and resources.

Male Anorexia – Additional information on how anorexia affects men. Treatment information and resources.

Causes Of Anorexia – Causes and warning signs of anorexia. Facts, statistics, and treatment information.

References:

Twin Studies of Eating Disorders- International Journal of Eating Disorders

Genetic factors in Anorexia Nervosa- National Institutes of Health

Surviving an Eating Disorder: Perspectives and Strategies for Family and Friends by Michelle Siegel, Ph.D., Judith Brisman, Ph.D., and Margot Weinshel, Ph.D. – Harper & Row Publishers, NY, 1988

Walking A Thin Line by Pam Vredevelt and Joyce Whitman – Mullnomah Press, Oregon 1985

Eating Disorders Handout – Sudbury General Hospital Eating Disorders Clinic (information for handout obtained from NEDIC)

Shisslak, C.M., Crago, M., & Estes, L.S. (1995). The spectrum of eating disturbances. International Journal of Eating Disorders, 18 (3), 209-219.

Updated 11/2019 by Molly Bahr
Written By: Colleen Thompson