Anorexia nervosa is a serious and life-threatening mental health condition, one that encompasses much more than just a warped relationship with food and weight. Anorexia goes deep into the individual’s mind, heart, genetics, and personal history, and it manifests in profound physical and psychological symptoms.
In this article, we delve into these complexities and consider the comprehensive support systems needed on the path toward recovery, restoration, and healing. By shedding light on this heartbreaking illness, we hope to foster empathy, sensitivity, and hope for people struggling with anorexia and their loved ones.
What Is Anorexia Nervosa?
Anorexia nervosa is a serious illness. Its hallmarks are significantly low weight due to restricting food intake, an intense fear of weight gain, and a distorted body image, according to the National Eating Disorders Collaboration’s (NEDC) article on anorexia.
To diagnose and treat clients with anorexia, mental health providers use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The official DSM-5 criteria for anorexia include:
- Restriction of energy intake relative to requirements, which leads to significantly low body weight in the context of age, sex, developmental trajectory, and physical health
- Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain
- Being disturbed by one’s body weight or shape, feeling one’s self-worth is influenced by body weight or shape, or persistently not recognizing the seriousness of low body weight
However, the criteria aren’t everything. The National Eating Disorder Association (NEDA) emphasizes that a serious eating disorder may be present even if not all points are met. Also, ED diagnoses aren’t always as clear-cut as the manual suggests. Christy Barongan, a licensed clinical psychologist with Grow Therapy, notes that symptoms may overlap across disorders. “[People with anorexia] primarily restrict, but they also may binge and purge,” she says.
Subtypes of Anorexia
Generally, people with anorexia can be classified into one of two subtypes:
- Binge eating/purging type: In the last three months, the person has regularly engaged in binge eating and/or purging.
- Restricting type: In the last three months, the person has not regularly engaged in episodes of binge eating and/or purging.
Atypical Anorexia Nervosa
Atypical anorexia is a subtype of the DSM category other specified feeding or eating disorders (OSFED). Someone with atypical anorexia meets the diagnostic criteria for anorexia nervosa, including significant weight loss; however, their weight is within or above the “normal” BMI range, according to the NEDC.
Don’t be fooled by the name. Atypical anorexia is life-threatening and has similar medical complications as anorexia nervosa. Also, NEDA’s anorexia resource page reiterates that someone doesn’t have to be underweight or emaciated to be severely struggling.
How Common Is Anorexia Nervosa?
Anorexia is the least common eating disorder. About 0.9% of women will struggle with this disorder in their lifetimes compared to 1.5% with bulimia and 3.5% with binge eating, according to Eating Disorder Hope’s (EDH) statistics. Also, anorexia is clinically more common among women than men. The National Institute of Mental Health reports that lifetime prevalence is three times higher in women (0.9%) than men (0.3%).
However, there’s a persistent, inaccurate notion that anorexia only affects thin, white adolescent girls and women. As a result, doctors ask Black, Indigenous, and People of Color about eating disorder symptoms significantly less than they ask white people, according to National Association of Anorexia Nervosa and Associated Disorders (ANAD) statistics. This negligence can have life-changing implications. Research on race and eating disorders found that Black people are less likely to be diagnosed with anorexia than white people but may experience the condition longer.
Where Is Anorexia the Most Common?
Our World in Data’s research in 2019 on eating disorder prevalence reports that India had the most people affected by anorexia nervosa at over half a billion people (570,752 cases). China followed with 467,965 people with anorexia and then the United States at 370,503.
Not all countries produce regular publications or reports of eating disorders, and not all cultures have rigid expectations of body shape and size. But the Eating Disorder Hope’s blog on EDs around the world notes that the predominance of Western media — and therefore culture — may be partly to blame for rising case counts around the world.
Anorexia recovery is possible
Signs and Symptoms of Anorexia
This condition deeply affects both the body and the mind. NEDA reports that anorexia symptoms —what the individual experiences — include:
- Stomach cramps and other gastrointestinal complaints (e.g., acid reflux and constipation)
- Difficulty concentrating
- Dizziness
- Fainting
- Insomnia
- Muscle weakness
- Poor wound healing
- Weakened immune system
- Cold hands and feet
Signs of anorexia — what providers and loved ones can perceive — include:
- Dramatic weight loss
- Preoccupation with food
- Refusal to eat certain foods or food groups
- Denial of hunger
- Frequently skipping meals
- Not wanting to eat in public or around others
- Comments about feeling “fat” or overweight despite thinness and/or weight loss
- Unusual food rituals
- Eating only a few “safe” foods
- Withdrawal from usual friends and activities
- Less interest in sex
- Excessive exercise regardless of health, weather, or injury
- Difficulty maintaining a body weight appropriate for age, height, and build
- Fear of weight gain
- Frequent weighing or measuring of the body
- Frequent body checking in the mirror
- Distorted body image
- Abnormal lab findings (e.g., anemia, low thyroid or hormone levels, or slow heart rate)
- Menstrual irregularities
- Flat mood
- Dry skin, brittle hair and nails
- Swelling of arms or legs
- Fine hair on the body (lanugo)
What’s Happening Mentally in Those Suffering From Anorexia?
The causes of anorexia are as diverse as the people who experience this mental disorder. The Mayo Clinic suggests that, while the exact cause is unknown, biological, psychological, and environmental factors likely all play a role.
- Biological: Genetic changes may put some people at higher risk of developing anorexia, although it’s unclear which genes are involved. The Mayo Clinic notes that some people may have a “genetic tendency” toward traits associated with anorexia: perfectionism, sensitivity, and perseverance.
- Psychological: Some people may have obsessive-compulsive personality traits that make sticking to strict diets and ignoring hunger easier. Their perfectionism may drive them to unhealthy weight loss; or, they may restrict their food intake to deal with high anxiety levels. As Barongan puts it, “They tend to be high achievers, but don’t talk about or even recognize their emotions.” Additionally, traumatic experiences can lead to anorexia and other eating disorders, as it can be a source of self devaluation and maladaptive coping skills. Also, food habits in the house when growing up can also lead to eating disorders – such as being forced to eat a certain way or at certain times, etc.
- Environmental: Modern Western cultures often prioritize thinness over health, and women’s societal worth is related to their body weight and shape. For adolescents, peer pressure may also be a factor.
Unfortunately, the physical symptoms of anorexia can complicate recovery. Barongan explains, “Changes that happen in the brain because of starvation and malnutrition can make it hard for a person with anorexia nervosa to recognize that they are unwell, or to understand the potential impacts of the illness.”
Complications of Anorexia
Anorexia is a severe disorder that can be fatal, even when the person isn’t severely underweight. Eating Disorder Hope reports that about 4% of people with anorexia die from the disease’s medical complications.
About one-third of these deaths are due to cardiac events, noted an International Archives of Internal Medicine case study. Anorexia often causes “cardiac alterations” (changes to the heart’s functioning), including bradycardia (low heart rate), hypotension, arrhythmia, and sudden death.
Anorexia affects bone density, as well. When someone isn’t eating enough, their body stops producing hormones (e.g., estrogen) that increase bone production. Starvation also increases cortisol in the body, a stress response, which accelerates bone loss. Osteoporosis sets in when bone loss is happening faster than bone production. The result? As Barongan puts it, “[They] have the bone density of a much older person.”
Lastly, anorexia compromises the reproductive health of female patients. However, a Diseases meta-analysis published in 2020 offered hope for survivors. Appropriate treatment and weight restoration appeared to reverse these effects, although the authors note more research into anorexia and infertility is needed.
Anorexia and Menstruation
Anorexia can stop your period by disrupting your body’s hormonal cycle, according to Eating Disorder Hope’s page on anorexia and the menstrual cycle. Clinicians call this condition amenorrhea, when starvation causes the body to stop producing the estrogen that triggers ovulation. Not all women with anorexia skip periods. Research in the Journal of Eating Disorders reports that about 25% won’t, and the DSM’s diagnostic criteria for anorexia no longer requires missing cycles. But for those who experience amenorrhea, it’s a serious concern that can have a lasting impact. A treatment team is crucial in identifying and treating your concerns.
How Does Anorexia Affect Relationships?
As shared on NEDA’s anorexia resource page, the condition can affect people’s social lives — in fact, changes in social behavior can be a warning sign. For example, someone with anorexia may withdraw from their friends and usual activities; they may become isolated, secretive, and withdrawn, or have limited social spontaneity (e.g., never joining spontaneous plans).
The Emily Program’s blog on EDs and relationships elaborates that active eating disorders are incompatible with the vulnerability, honesty, and open communication needed for healthy intimate relationships. Part of anorexia treatment is re-learning how to have healthy relationships, and loved ones can be key supports as someone recovers.
Treatment for Anorexia
If you or a loved one are struggling with anorexia, know that making a full recovery is possible. Treating this condition requires an interdisciplinary team who can evaluate your needs and recommend the best level and type of care for you.
A treatment team for anorexia recovery usually includes at a minimum:
- Registered Dietitian (RD): The registered dietitian assesses the client’s nutritional needs and provides the structure, education, and support for getting healthier. This person also may monitor the client’s vitals, weight, measurements, and other nutrition metrics.
- Primary Care Provider (PCP): For adolescents, this would be a pediatrician; adults would have a general physician, nurse practitioner, or other qualified health practitioner. The PCP offers medical monitoring and treats the medical complications related to anorexia.
- Mental Health Professional: This team member could be a psychologist, psychiatrist, licensed clinical social worker, mental health counselor, therapist, or another qualified practitioner. This person should have expertise in anorexia recovery or at least general ED treatment. The mental health professional diagnoses the ED, develops and implements the treatment plan, and helps the client heal their relationships with food, exercise, loved ones, and themselves. Cognitive behavioral therapy has been shown to be effective in addressing an ED by first helping one to recognize the influence their thinking has on their emotions and behaviors and then developing skills and tools to challenge and replace those thoughts with healthier ones – leading to less frequent symptoms.
During intake and throughout treatment, this team will evaluate the individual’s needs and recommend the appropriate level of care. ED treatment has different levels of care including:
- Intensive outpatient/outpatient: For clients who are medically stable and psychiatrically stable, able to make progress in recovery in their usual social, educational, or vocational settings.
- Partial hospital (PHP): For clients who are medically stable but need daily assessment of physical and mental status, OR clients who are psychiatrically stable but can’t function in their social, educational, or vocational lives.
- Residential: For clients who are medically stable but psychiatrically impaired and unable to make progress in PHP or outpatient settings.
- Inpatient: For clients who are at acute health risk, have quickly deteriorating mental health status, and/or are suicidal.
How to Help Someone with Anorexia
Resources exist to guide you through supporting a loved one who may be anorexic. Check out NEDA’s guide on helping a friend or family member. Know that this conversation is delicate and may not be received well.
Barongan offers context for loved ones: “It’s very hard to have an intervention with someone who has anorexia because they are ambivalent about being seen,” she says. “Their bodies are the obvious sign that they have a problem, but they get defensive if you point it out and it may damage the relationship.”
The critical thing is connecting them with professionals who can guide them through their next steps.
Recovering From Anorexia Is Possible
Anorexia recovery can be a long, back-and-forth process — but it’s absolutely possible and completely worthwhile. Healing requires both a qualified treatment team and the support of family and friends. If you’re searching for professional support, you can search for a therapist that specializes in eating disorders through Grow Therapy.
