Anorexia Nervosa – Symptoms, Causes, Risk factors and Treatments

What is Anorexia Nervosa? 

Anorexia nervosa is a psychological condition that negatively affects the body, the mind and society. It is characterised by body dissatisfaction and an obsession with the fear of gaining weight.

Anorexia nervosa is an eating disorder. Anorexics restrict their caloric intake, have negative body perceptions, and experience severe weight gain anxiety.

A person may have a very low weight as a result of the limitation in calorie intake, which can rapidly lead to severe weight loss. Most cases of Anorexia nervosa in women typically begin in adolescence.

Even when they are severely underweight, individuals with anorexia nervosa may perceive themselves as huge or heavy. They adhere to strict diets and even engage in strenuous, excessive exercise routines out of fear of gaining weight.

Types of Anorexia Nervosa 

There are two basic types of Anorexia.

Restricting type 

People with a restricting type of anorexia nervosa will severely limit the amount and type of food they eat.

These individuals show characteristics like calorie tracking, restricting particular foods (like carbohydrates), skipping meals and adhering to compulsive restrictions like only eating foods of a specific colour.

Too much exercise may go along with these behaviours. The person loses weight by eating less, fasting, taking diet pills or exercising more than necessary. 

Some people simply consume what they need to stay alive. In the restricting type, there are no recurrent binge eating or purging episodes.

Purging type 

In an effort to lose weight, a person engages in binge eating or purging. Purging anorexia occurs when a person binge eats and purges the consumed food, whereas bulimia nervosa is when an individual repeatedly indulges in binge eating.

Even while someone with binge-eating or purging anorexia can maintain a healthy or average weight, they are typically underweight. 

The amount of food consumed by those who suffer from this type of Anorexia is severely restricted. This is accompanied by binge eating followed by purging.

Binge eating is when a person eats a lot of food and feels out of control. Following this binge eating, the person compensates by abusing laxatives, diuretics or enemas or by vomiting the food out.

Causes of Anorexia Nervosa 

Biological factors

Individuals who have a family history of eating disorders, depression, or substance abuse are more likely to be affected, suggesting that there may be a genetic link between Anorexia and these conditions. 

Compared to people without a family history, those who have a close relative with Anorexia have a tenfold increased risk of developing the disorder.

It may also be a feature that is developed due to environmental factors, such as having negative body image beliefs similar to other family members.

Anorexia nervosa is assumed to be related to the hormonal and neurological changes that occur throughout puberty, and its prevalence is highest at this time. Anorexia is known to be especially triggered by stress, anxiety and low self-esteem.

Psychological factors

Psychological features include a high degree of perfectionism or obsessive-compulsive personality traits, a sense of having little control over one’s life and low self-esteem, depression and anxiety, and an inability to cope with stress.

Perfectionism

Perfectionism describes a personality type in which a person strives for perfection, places a high value on acceptance, and may be very hard on themselves. 

High levels of perfectionism can be observed in anorexics, like possessing strict regulations about eating and food. They also have extremely high standards and expectations for themselves.

Low self-directedness

Self-directedness is the capacity to change one’s behaviours to achieve desired goals. Reduced degrees of self-directedness are common among anorexics. 

As a temporary solution to their present body image issue, an anorexic in treatment most often choose to skip a meal. This serves to perpetuate the condition.

Sociocultural 

Sociocultural settings, including social networks, media influence and cultural standards pertaining to appearance and eating, are important for the development of Anorexia nervosa.

The pressure to follow dieting can put some people at higher risk. These behaviours include those that promote unrealistic beauty standards that prioritise having a particular look.

Studies have shown that social pressures to attain the thin beauty ideal can raise body dissatisfaction and weight worries, which may eventually contribute to Anorexia nervosa. 

The urge to regulate weight is high when people are constantly exposed to media pictures of models who are painfully thin. According to recent studies, eating disorders are becoming more prevalent in minority groups and non-Western civilisations.

Anorexia nervosa can more likely develop in specific situations. Running, dancing, wrestling, gymnastics, being a member of a sorority, or working in an industry that places a high value on looks and image (such as modelling or acting) can add to the pressure to maintain a certain weight or appearance, causing Anorexia.

Risk factors for Anorexia Nervosa 

Women 

Women are more likely to get eating disorders like Anorexia. Social pressures are a major factor when it comes to negative perceptions of appearance. This may help to explain why eating disorders affect women more frequently than men, as women are typically more vulnerable to these influences.

Peer pressure 

By observing their peers and friends, adolescents grow to feel dissatisfied with their bodies. This unhappiness triggers behaviours like anorexic symptoms and dieting behaviour. If peer pressure persists, these symptoms may subsequently turn into an eating disorder like Anorexia nervosa.

Family Influences 

When children feel that they are falling short of their parent’s expectations of them, they may turn to something that seems easier to manage and at which they may be more effective, such as food restriction or weight loss. This helps them live up to their family’s expectations.

Chemical imbalance in the brain

Some women are more prone to eating disorders and anxiety problems due to chemical imbalances in their brains.

Research shows that anorexics have higher levels of dopamine in their brains. Dopamine is a molecule that affects reward, reinforcement, weight, eating habits and reinforcement. 

Symptoms of Anorexia Nervosa 

Withdrawal from social situations 

Individuals with Anorexia Nervosa choose to avoid social gatherings to prevent encounters and interactions with other people. There may also be several other reasons, including anxiety, fear, humiliation, vulnerability, the possibility of rejection, and more.

Dramatic weight loss 

People with Anorexia Nervosa restrict their food intake severely to avoid gaining weight or to keep shedding kilos. 

They try reducing their calorie intake by throwing up after eating or by abusing laxatives, diet supplements, diuretics, or enemas. They might also make an effort to lose weight by overexerting themselves through exercise.

Low self-esteem 

Some anorexic people have low self-esteem. People with a fundamentally low sense of worth perceive themselves as having little to no value and label themselves as worthless, useless, dumb, unlovable or a failure.

Due to their inability to meet the so-called ideal shape, weight and eating control goals, most people with eating disorders are self-critical. This is referred to as secondary self-criticism since it develops as a result of another factor.

Extremely restricted eating 

Restrictive anorexia nervosa causes a person to restrict their calorie intake drastically, and they typically lose weight through dieting, fasting and extreme exercise. Their food intake is very minimal, and if at all they overeat, anorexic individuals tend to vomit post-eating.

Fixation on body image 

People with Anorexia are extremely concerned about their body image and how they look. They are extremely concerned about their body shape and are obsessed with weight. 

Self-esteem and body image have a direct impact on one another as well as on a person’s feelings, ideas, and behaviours. Poor body image makes it difficult for young people to feel good about themselves.

Obsession with calories 

Calorie counting is a common symptom of restrictive eating disorders like Anorexia. Concentration on nutrient-dense foods is frequently linked to orthorexia, and this association can easily lead to an obsession with calorie counting. 

People with orthorexia compulsively check food labels for calories or ingredient listings. Anorexic individuals commonly have orthorexia as well.

Throwing up after eating 

Anorexic individuals frequently take restroom trips following meals. They also are addicted to using laxatives, diuretics and dietary supplements. This can make them throw up post-meals. 

People with Anorexia Nervosa tend to run the water to cover up vomit sounds or return smelling like mouthwash or mints.

Compulsive exercising 

Individuals with this eating disorder usually follow a strenuous workout routine designed to burn calories. They are also okay with enduring illnesses and injuries while exercising. Anorexics also follow a poor diet pattern, compensating by working out more vigorously.

Anxiety or depression 

When a person has Anorexia, their body’s lack of nutrition alters the way their brain functions, frequently resulting in a change in mood that makes them depressed. Moreover, anxiety and depression can be sparked by having a poor self-image and a negative body image.

Severe constipation 

Constipation affects people with Anorexia more frequently because they don’t consume enough food and liquids, which can reduce gastric motility or the ability to move freely. This indicates that the intestines have difficulty moving food through the digestive tract and causing a bowel movement.

Diagnosis of Anorexia Nervosa 

To narrow down a diagnosis, rule out alternative medical causes for weight loss or other symptoms, and look for any associated consequences, a doctor will often do several examinations and tests if they have a suspicion that a person is suffering from Anorexia.

Physical examination 

Physical examination entails checking the height and weight, evaluating the vital signs—such as temperature, blood pressure and heart rate—as well as the skin and nails. It may also entail listening to the heart and lungs and having one’s abdomen visually inspected.

Laboratory tests 

A complete blood count and more specialised tests to examine electrolytes, protein, liver, kidney and thyroid function are some examples of these. It’s also possible to perform a urinalysis.

Psychological evaluation 

Psychological evaluation involves discussing the ideas, feelings and eating routines with a therapist or mental health professional. A psychological self-assessment questionnaire can also be given to evaluate a person.

Other tests

It may be necessary to get an X-ray to determine the bone density, look for fractured bones or stress fractures, or to test for pneumonia or heart issues. To find heart irregularities, electrocardiograms may be used. 

Energy expenditure may also be analysed to plan an individual’s nutritional needs.

A suitable treatment plan will be suggested based on the findings of the examinations and tests.

Treatment for Anorexia Nervosa 

A multidisciplinary team of medical experts often treats Anorexia Nervosa. This may require a dietitian, psychiatrist, psychologist, speciality nurse or counsellor, as well as a general practitioner.

The best course of treatment for Anorexia Nervosa is still under research. There is no one therapeutic approach that works for everybody. Most patients will recover from their disease with the help of treatment.

Psychological therapy 

• Family Based Treatment (FBT) – The most effective form of treatment for children and adolescents has been identified as family-based treatment. FBT is a strategy that requires the support of the entire family in the fight against the eating disorder and to help one take back control of their life.

• Cognitive Behaviour Therapy (CBT) – CBT focuses on modifying the unwanted beliefs and actions that are causing the eating disorder. The most studied and suggested adult treatment is CBT. A medical team will collaborate with the patient to help understand the connections between their thinking, emotional reaction and eating behaviour.

• Cognitive Analytic Therapy (CAT) – Cognitive analytic therapy targets problematic thinking and behaviour patterns that evolved in the past. The therapy involves reformulating the events, acknowledging their impact on the condition, and developing ways to break the bad habits. 

• Interpersonal Therapy (IPT) – In interpersonal therapy, the negative concerns and worries a person may have about their connections with others are examined, along with potential solutions.

• Focal Psychodynamic Therapy (FPT) – The focus of focal psychodynamic therapy is on certain unresolved conflicts from the past that might be influencing present-day eating habits and body image, as well as how these conflicts might be managed more effectively.

Dietary management 

The cornerstone of managing anorexia nervosa is dietary and psychological therapy methods. 

The first step in treating anorexia nervosa is returning to a healthy weight. This aids in treating the disorder and regaining the body’s strength.

A nutritionist or dietician frequently works with patients to determine their optimal weight objectives and create a food plan. To achieve a healthy body weight, there is a need for precise diet plans and energy needs.

It’s crucial to address any problematic behaviours that patients are engaging in that keep them from eating normally, including compulsive vomiting following binge eating. 

Pharmacological management 

Due to the lack of effectiveness of available pharmaceuticals in assisting patients  in regaining weight, no drugs are currently licenced for the treatment of Anorexia.

However, in anorexic individuals, antidepressants and other psychiatric drugs are frequently used to treat mental health conditions that are either a symptom of or the cause of the illness.

Non-conventional treatment 

Non-conventional treatment or alternative treatment may occasionally be used to treat Anorexia nervosa. These techniques have received less research, although they might work for some people to reduce the anxiety that could be caused by Anorexia.

A few non-conventional treatment options include,

• Acupuncture
• Massage 
• Yoga 
• Meditation

Prevention of Anorexia Nervosa 

Developing a positive body image 

Body positivity, also known as body contentment, entails accepting the natural body shape and size and feeling at ease and secure in their own skin. It also requires understanding that one’s physical attributes don’t necessarily reflect their worth as a person.

Developing a healthy food attitude 

The goal of healthy dieting is to manage weight. Developing a healthy food attitude is important. Patients see losing weight as a means to look better and feel better. Therefore, losing weight in a healthy way is advisable.

When to consult a doctor? 

It’s important to consult a doctor as early as possible to help recover from the eating disorder. 

General Practitioner (GP) makes the initial diagnosis. They will refer the patient to an eating disorders specialist if they suspect having an eating disorder.

Scheduling a consultation with a doctor is advisable if one has a doubt that they have an eating disorder or are concerned about their connection with food, body image, or fitness routine.

Conclusion 

Anorexia nervosa is a type of eating disorder. Anorexics have a phobia of putting on weight. They aggressively restrict their food intake, which can cause them to become extremely thin.

Anorexia usually begins in the teenage years. It affects females far more frequently than males. Early intervention can be helpful. The likelihood that someone with Anorexia may recover increases with time spent in treatment. 

Starvation and major health issues such as kidney damage, heart issues and bone weakening (osteoporosis) can result from untreated Anorexia. 

Getting the right treatment early is helpful. The longer the disorder persists, the more difficult it is to treat. A person with Anorexia can feel better over time and maintain a healthy weight with the help of treatment.

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