What is Anorexia?
Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for age, stature, and height; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.
Additionally, men and women who suffer from anorexia nervosa exemplify a fixation with a thin figure and abnormal eating patterns. Anorexia nervosa is interchangeable with the term anorexia, which refers to self-starvation and lack of appetite.
Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Psychologists and historians have found evidence of people displaying symptoms of anorexia for hundreds or thousands of years. People in non-Westernized areas, such as rural China and Africa, have also been diagnosed with anorexia nervosa.
The disorder most frequently begins during adolescence, an increasing number of children and older adults are also being diagnosed with anorexia. Nor does a person need to be emaciated or underweight to have anorexia. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.
To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met:
1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the psychological and medical impacts of anorexia and atypical anorexia.
Major Types of Anorexia
There are two common types of anorexia, which are as follows:
Binge/Purge Type– The individual suffering from this type of eating disorder, will purge when he or she eats. This is typically a result of the overwhelming feelings of guilt a sufferer would experience in relation to eating; they compensate by vomiting, abusing laxatives, or excessively exercising.
Restrictive– In this form, the individual will fiercely limit the quantity of food consumed, characteristically ingesting a minimal amount that is well below their body’s caloric needs, effectively slowly starving him or herself.
Two classifications of anorexia nervosa exist, both types exhibit similar symptoms, such as irrational fear of weight gain and abnormal eating patterns.
Woman Running at Sunset battling anorexia
Causes of Anorexia
Anorexia is not a simple disorder. It has many symptoms and effects, and its causes are complex. Currently, it is thought that anorexia nervosa develops as a result of multiple factors, both environmental and biological.
Examples of environmental factors that would contribute to the occurrence of this eating disorder are:
The effects of the thinness culture in media, that constantly reinforce thin people as ideal stereotypes
Professions and careers that promote being thin and weight loss, such as ballet and modeling
Family and childhood traumas: childhood sexual abuse, severe trauma
Peer pressure among co-workers and friends to be thin or be sexy.
Examples of biological factors include:
Irregular hormone functions
- Genetics (the tie between anorexia and one’s genes is still being heavily researched, but we know that genetics is a part of the story).
- Nutritional deficiencies
- Joyous Woman Who Overcame Anorexia Laying in the Grass
Anorexia Symptoms & signs
An individual suffering from anorexia nervosa may reveal one or several signs and symptoms such as:
- Chronic dieting despite being hazardously underweight
Obsession with calories and fat contents of food
Engaging in ritualistic eating patterns, such as cutting food into tiny pieces, eating alone, and/or hiding food
Continued fixation with food, recipes, or cooking; the individual may cook intricate meals for others but refrain from partaking
- Amenorrhea: an abnormal absence of menstruation, or loss of 3 consecutive menstrual cycles
- Depression or lethargic stage
- Development of lanugo: soft, fine hair that grows on face and body
- Reported sensation of feeling cold, particularly in extremities
Loss or thinning of hair
- Avoidance of social functions, family, and friends. May become isolated and withdrawn
- Dieting Vs. Anorexia
While someone might diet in an attempt to lose weight as the primary goal, in anorexia they may diet because they perceive losing weight as a way to achieve happiness and self-mastery.
The restrictive eating patterns that characterize anorexia nervosa are similar to dieting behaviors, there are stark differences between the two. The effects of the extreme behaviors resulting from anorexia nervosa are far more consequential and devastating than dieting.
Given the complexities of this eating disorder, a professional treatment team involving medical doctors, dietitians, and therapists is necessary for the recovery from this eating disorder. Effective, holistic eating disorder treatment of anorexia involves three necessary components:
Medical: The highest priority in the treatment of anorexia nervosa is addressing any serious health issues that may have resulted from malnutrition, such as an unstable heartbeat.
Nutritional: This component encompasses weight restoration, implementation and supervision of a tailored meal plan, and education about normal eating patterns.
Therapy: The goal of this part of treatment is to recognize underlying issues associated with the eating disorder, address and heal from traumatic life events, learn healthier coping skills and further develop the capacity to deal and express with emotions.
Facts About Anorexia Nervosa
Anorexia Nervosa continues to have the highest mortality of all psychiatric conditions. Researchers from the University of North Carolina are currently leading the largest genetic study of anorexia nervosa ever conducted known as the Anorexia Nervosa Genetics Initiative (ANGI). Learn more about how the ANGI study is set to find causes and cures for this disease.
Most women struggling with anorexia are battling a co-occurring issue. Often, anorexia is existing alongside depression, substance, and anxiety.
Anorexia is not simply a woman’s disease. There are more men developing the eating disorder, but often, males develop anorexia as a way to keep weight off for competition.
The negative impact of anorexia can be as devastating as any other addiction or disease. Please read this article to learn more about “How Dangerous Are The Long Term Effects of Anorexia”.
Historically, research has indicated that those suffering from anorexia nervosa often live isolated lives and are socially inhibited. Read more about “Anorexia’s Ability to Damage Social Relations”.
With the increasing pressures that college students are facing and the mass amount of misguiding media circulating about food and body image, it is not surprising that more students are struggling with eating disorders today. Read this article to learn more about what college students and parents should expect in the college transition and how to prepare for it and fight anorexia.
Until college, most students have been living at home with their families who see them every day. A person might have disordered eating and abnormal exercise patterns throughout their adolescence, however, it may be mistaken for “healthy” or “picky” eating or masked by competitive sports and athletics. Being at college and away from home for the first time, and only seeing family during school breaks, can allow severity of symptoms to increase before being noticed.
While we understand a lot more about disordered eating these days, it is important to know the origin of modern treatment approaches from a historic perspective. There was a famous starvation study done almost 60 years ago, which provides some excellent insight for those seeking to empathize and understand with the anorexia sufferer in their life.
Let’s be clear, to most people the word ‘diet’ means restrictive eating, and this approach is often a gateway to developing disordered eating habits. When we consume too much food, exercise too little and gain weight– our typical solution is to restrict our eating and exercise more. Close to 100 million Americans are dieting at any given time.
Celebrities are speaking out on body image issues as well as their own battles with eating disorders. We do not often hear about the consequences that come with battling an eating disorder, in particular, anorexia nervosa and Amenorrhea. Amenorrhea is defined as the absence of the menstrual cycle in a woman of childbearing age.
It’s not a diet, it’s a lifestyle change. This refrain reverberates throughout many weight control programs and philosophies. It is claimed so often, by so many diverse approaches, that it begins to sound like a campaign slogan, repeated robotically but lacking in meaning and depth.
Someone making the life-changing decision to begin anorexia treatment might be afraid of what to expect in daily life at a residential treatment. Worries about the “unknowns” of treatment can be an anxiety provoking and keep people from seeking help. There is, however, an even scarier unknown, and that’s the reality regarding the dangers of untreated anorexia.
He has had two episodes of dizziness which he attributes to not drinking enough water while working out in a hot gym. His parents describe him as a highly motivated, accomplished young man, a little perfectionistic and rule-driven, and somewhat stubborn about his eating and exercise.
We find it heartbreaking to observe lively and formerly vibrant family members or friends become a seeming shell of their former selves avoiding aspects of a human life that add beauty and depth to our existence.
When walking along the days, weeks, and months of a life in recovery from an eating disorder there are times when questions come up of diet. For individuals with a history of anorexia nervosa, the question of whether or not dietary restrictions are ever appropriate is actually a very serious fact to consider.
Since anorexia is an illness in which an individual starves herself, weight is certainly relevant. For a diagnosis of anorexia to be rendered, there must be more evidence than low weight.
A review of nearly fifty years of research confirms that anorexia nervosa has the highest mortality rate of any psychiatric disorder (Arcelus, Mitchel, Wales & Nelson, 2011). Anorexia Nervosa is a life-threatening disorder due to the effects of weight loss and starvation on the body and brain.
NEDA has gathered data on the prevalence of eating disorders from the US, UK, and Europe to get a better idea of exactly how common anorexia is. Older data from other countries that use more strict definitions of anorexia and bulimia give lower prevalence estimates:
In a study of 31,406 Swedish twins born from 1935-1958, 1.2% of the women had strictly defined anorexia nervosa during their lifetime, which increased to 2.4% when a looser definition of anorexia was used (Bulik et al., 2006).
For twins born between 1975 and 1979 in Finland, 2.2-4.2% of women (Keski-Rahkonen et al., 2007) and 0.24% of men (Raevuori et al., 2009) had experienced anorexia during their lifetime.
At any given point in time between 0.3-0.4% of young women and 0.1% of young men will suffer from anorexia nervosa
Several more recent studies in the US have used broader definitions of eating disorders that more accurately reflect the range of disorders that occur, resulting in a higher prevalence of eating disorders.
A 2007 study asked 9,282 English-speaking Americans about a variety of mental health conditions, including eating disorders. The results, published in Biological Psychiatry, found that 0.9% of women and 0.3% of men had anorexia during their life
When researchers followed a group of 496 adolescent girls for 8 years (Stice et al., 2010), until they were 20, they found:
5.2% of the girls met criteria for DSM5 bulimia, anorexia, or binge eating disorder.
When the researchers included nonspecific eating disorder symptoms, a total of 13.2% of the girls had suffered from a DSM-5 eating disorder by age 20.
Combining information from several sources, Eric Stice and Cara Bohon (2012) found that
Between 0.9% and 2.0% of females and 0.1% to 0.3% of males will develop anorexia
Subthreshold anorexia occurs in 1.1% to 3.0% of adolescent females
Other statistics related to anorexia:
– Young people between the ages of 15 and 24 with anorexia have 10 times the risk of dying compared to their same-aged peers.
– Subclinical eating disordered behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss) are nearly as common among males as they are among females.
– An ongoing study in Minnesota has found incidence of anorexia increasing over the last 50 years only in females aged 15 to 24. Incidence remained stable in other age groups and in males.
– Anorexia is the third most common chronic disease among young people, after asthma and type 1 diabetes.
– Males represent 25% of individuals with anorexia nervosa, and they are at a higher risk of dying, in part due to the fact that they are often diagnosed later since many people assume males don’t have eating disorders.
– Eating disorder symptoms are beginning earlier in both females and males, which agrees with both formal research and clinical reports.
Researchers from the University of North Carolina are currently leading the largest genetic study of anorexia nervosa ever conducted known as the Anorexia Nervosa Genetics Initiative (ANGI). Midlife anorexia typically is seen in women who have had an eating disorder in the past, those that have hidden their disorder for years and/or newly acquired cases of anorexia nervosa.