Anorexia Nervosa

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Anorexia nervosa, or more commonly referred to as just “anorexia” (a term which refers to self-starvation and lack of appetite), is an eating disorder in which a person experiences extreme weight loss, an intense fear of gaining weight, severely distorted body image and perception of weight. 

BMI or body mass index is a tool that is used to assess the body weight relative to someone’s height, and is used by treatment providers to judge the appropriateness of the body weight of a person suffering from anorexia nervosa, or any other eating disorder. Other parameters which can be assessed are eating patterns, personality traits, exercising patterns, etc. which can help in the diagnosis of anorexia nervosa. People with anorexia nervosa go to extreme extents to lose weight to achieve a particular kind of body shape and body weight. This tends to interfere with their daily functioning, and rapidly affects their physical as well as psychological health directly. Anorexia symptoms include extreme efforts to lose weight and reduce calorie intake such as severely restricting the amount of food eaten, or inducing vomiting by abusing laxatives, diuretics, enemas, etc. They also work out severely in order to lose weight. Anorexia is less about body weight, food, and working out. It is in fact more of an intensely unhealthy way to cope with one’s emotional problems. People with anorexia have a severely contorted image of the self. They tend to equate being thin with self worth. 

Anorexia nervosa is in fact the most lethal psychiatric disorder. However, with proper treatment, as patients gain insight and develop a better sense of self, recovery is enabled and they return to healthier habits and routines.

Types of Anorexia Nervosa

The two most common types of anorexia nervosa are:

• Binge/Purge Type: Those with binge/purge type anorexia purge after eating their meals, as they feel guilty and ashamed of eating anything that they want to restrict or anything that isn’t known to be “healthy” and alleviates their fear of gaining weight. The purge behaviour that is used to compensate for eating involves exercising excessively and abusing laxatives, diuretics, enemas, etc. 
• Restrictive Type: People with restrictive type anorexia try to restrict food amounts, calories, and high fat or high sugar foods. They eat very less in terms of calories, macro and micro nutrients, portion size and/or the number of meals taken in a day. The amount they eat is too less for anyone who would want to remain fit and healthy. This is a form of self-starvation under the guise of appearing self-disciplined. 

Signs and Symptoms of Anorexia Nervosa 

There are physical, behavioural, and emotional symptoms of anorexia nervosa. All these symptoms are interlinked and, while it may be difficult to notice the early signs of anorexia as some may not appear as extremely thin as people with anorexia can get, even though they may be experiencing all three dimensions of symptoms severely. People with this disorder also try to hide their symptoms under the guise of “fitness,” and they try to not show their extreme behaviour in public. People with anorexia often tend to have their meals privately, and hide their laxatives and diuretics. The symptoms of anorexia are discussed more in depth below:

Physical Symptoms

The physical signs and anorexia symptoms are largely related to starvation. They are as follows: 

• Extreme loss of weight and not making expected weight gain related to development
• Very thin appearance
• Intense fatigue, dizziness, or fainting
• Severe loss of muscle mass
• Hypotension
• Hypothermia (low body temperature, cold hands and feet)
• Upset stomach, bloating, constipation
• Dry and scaly skin
• Lanugo, i.e fine downy hair growing on the body and increased facial hair
• Insomnia
• Infertility
• Loss of bone density or osteoporosis
• Abnormal heart rhythm
• Alopecia/hair loss
• Dehydration
• Eroded teeth, calluses on knuckles
• Yellowish skin
• Absence of or disturbance in menstruation cycle
• Bluish discoloration of fingernails

Emotional and Behavioural Symptoms

• Severely reducing food intake and fasting in order to reduce calorie intake
• Overly worried about calorie intake, preoccupation with food, cooking elaborate meals for others and not eating them
• Excessive exercising
• Bingeing and self-induced vomiting by abusing diuretics, laxatives, enemas, diet aids, herbal products
• Not eating in public
• Spitting food out after chewing
• Social withdrawal and irritability
• Flat affect (lack of emotion)
• Reduced sex drive
• Wearing many layers of clothes
• Frequently checking mirror 
• Complaining about perceived flaws of the body, like saying some specific parts of their body are too fat, etc. 
• Skipping meals, refusing to eat
• Repeated weighing and measuring of the body, fear of gaining weight
• Lying about their food intake (saying they have eaten more than what they actually have)
• Denying hunger and making excuses for skipping meals and not eating

Diagnosis of Anorexia Nervosa 

Early diagnosis of anorexia  increases the chances of quicker recovery and prompt treatment. The patient will have to be taken to a physician, who may ask them about their weight loss and for females, about their menstruation cycle. It can take a lot of time to confirm a diagnosis if the patient was overweight or obese earlier. 

Then, the physician may perform some medical exams (including imaging scans, blood tests, electrocardiogram [ECG]) in order to rule out the following conditions that could be the underlying cause of the symptoms: 

• Inflammatory bowel disease
• Diabetes
• Addison’s disease
• Chronic infections 
• Immunity related problems such as immunodeficiency 
• Malabsorption of nutrients
• Cancer
• Hyperthyroidism

Then, a psychiatrist may assess the patient on the diagnostic criteria for anorexia nervosa as given by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This includes restricting food intake to the extent that leads to very low body weight relative to age, sex, height, and health, an intense fear of gaining weight even when being underweight, and a distorted perception of one’s own body. 

Treatments of Anorexia Nervosa

Anorexia treatment involves psychotherapy, nutrition counselling, medication, and the aid of dieticians. The first goal of the treatment could be helping the client gain in fitness and health and making them realize that the way they perceive their body and food is not only a problem; it is terribly unhealthy and can be lethal.

A proper action plan is made for the treatment of anorexia nervosa which also addresses the client’s distorted thinking patterns, and assists them in making behavioural changes in order to live a better, healthier life. Psychotherapy for anorexia often involves cognitive behavioural therapy to help target the distorted thinking patterns and the unhealthy behaviours. During the course of the anorexia treatment, the patients learn the value of a balanced diet. Medication is used to reduce the emotional symptoms and help reach the ideal weight. 

The treatment of anorexia is generally long term, as relapse can be possible at any given moment. Social support from close friends and family plays an important role in the recovery process.