Many people ask, what is anorexia? Anorexia nervosa is a psychiatric illness characterized by maintaining a low body weight, caloric restriction, and body dissatisfaction. Often times, people suffering from anorexia experience a distorted body image, seeing themselves as overweight even when they are significantly underweight. Anorexia nervosa can also be accompanied by binge eating and purging.
Anorexia nervosa affects an estimated 5-20% of American women. Men also suffer from anorexia. However, the prevalence rates vary as many men remain undiagnosed or do not seek help due to stigma. Men experience many of the same symptoms as women, but in addition to a drive for thinness, they often experience pressure for a muscular and lean body.
There are many theories and much misunderstanding regarding the causes of anorexia nervosa such as the desire for control, family dysfunction, stubbornness or a conscious choice, that have been disputed by scientific research. Anorexia nervosa is not a function of will, rather it is a biologically based illness influenced by the environment. Anorexia nervosa is a brain disorder. There are genetic predispositions that make some people more vulnerable to developing anorexia nervosa. These tendencies can include perfectionism and interpersonal sensitivity. Contrary to what may be expected, individuals with a predisposition to anorexia nervosa who are also experiencing high levels of anxiety feel calmer when restricting food.
Depression, anxiety, social isolation and perfectionism commonly co-occur with anorexia.
Medical Consequences of Anorexia Nervosa
Anorexia nervosa is associated with severe health consequences related to malnutrition. Health effects can include dry skin, hair loss, difficulty regulating temperature, slow heart rate and blood pressure, muscle weakness, loss of bone density and severe dehydration that can lead to kidney failure. Women can experience a loss of menses and infertility. Men may experience a loss of sexual desire and impotency.
Anorexia nervosa has the highest mortality rate of any psychiatric illness—between 5-20%. The causes of death associated with anorexia nervosa are medical consequences associated with malnutrition and suicide. The mortality rate is higher amongst individuals concurrently experiencing anorexia nervosa and a substance use disorder.
Warning Signs of Anorexia Nervosa
- Sudden unexplained weight loss
- Food rituals (eating only specific foods, taking small bites, cutting food in small pieces)
- Social isolation (including avoidance of social situations with food)
- Extreme anxiety about weight gain
- Body dissatisfaction
- Denial of hunger
- Preoccupation with food, calories, collecting recipes and cooking
- Checking body parts, frequent weighing
What is Anorexia Treatment and Recovery?
People with anorexia nervosa may deny they are ill. They often experience difficulty seeing their behaviors as problematic. This experience is known as anosognosia. Although it can look like denial, this phenomenon is a function of the brain being unable to determine the extent of the illness. Often, malnutrition contributes to this distorted perception. This can be a significant barrier to accessing treatment. Additional barriers include a lack of access to specialized care, difficulties with insurance reimbursement, misunderstanding, misdiagnosis and stigma.
It is important to seek treatment from qualified treatment specialists. A shorter duration of illness is associated with improved outcome.
Although recovery from anorexia nervosa can be difficult, it is entirely possible.
Treatment is most effective when approached from a multidisciplinary team specializing in eating disorders. The team typically consists of a therapist, medical doctor, registered dietitian, and possibly a psychiatrist. The initial focus in treating anorexia nervosa is on refeeding as weight restoration is a crucial component of treatment for anorexia nervosa. Food is medicine. Weight restoration not only repairs physical damage, but can also improve faulty thought patterns caused by malnutrition. Improved psychological functioning increases the likelihood of recovery. The process of refeeding for weight restoration must be supervised by a medical professional or registered dietitian to avoid refeeding syndrome (severe physical complications) associated with nutrient intake occurring too rapidly.
Goals of treatment for anorexia nervosa often include weight gain and resumption of healthy eating, reduction of other symptoms associated with the eating disorder, and assisting the sufferer in returning to healthy functioning in all aspects of their life. There are several treatment modalities available for people suffering from anorexia nervosa. Family-based treatment can be effective for adolescents. In adults, Cognitive Behavioral Therapy (CBT) may reduce the risk of relapse after weight has been restored.
Online Resources and Treatment Information
About The Author
Dr. Kristine Vazzano is a clinical Psychologist that specializes in eating disorders. Her private practice is located in Bloomfield Hills, Michigan. You can learn more about Dr. Vazzano by visiting her website www.mindfullness.com
Recommended Books on Anorexia Nervosa
Arnold, C. (2013). Decoding Anorexia. New York, NY: Taylor & Francis.
Lock, J., LeGrange, D. (2015). Help Your Teenager Beat An Eating Disorder. New York: NY: The Guilford Press.
Accurso, E.C., Ciao, A. C., Fitzsimmons-Craft, E.E., Lock, J.D. & Le Grange D. (2014). Is weight gain really a catalyst for broader recovery? The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa. Behaviour Research and Therapy 56, 1-6.
Written – 2015