Anorexia Nervosa

What is Anorexia Nervosa? | Types |  Symptoms | Causes & Risk Factors | Treatment | FAQ

Anorexia Nervosa, otherwise known as anorexia, is a serious, potentially life-threatening eating disorder that constitutes a partial (1) or total abstinence from foods. This often due to a distorted body image and fear of gaining weight.

Individuals with anorexia nervosa tend to view themselves as overweight despite usually being (severely) underweight, causing them to enforce drastic self-imposed food restrictions that affect their body’s ability to function well. While this disorder is frequently associated with females, males are also not immune to it. The stigma of help-seeking and the condition’s characterisation as a predominantly feminine disorder cause many male cases of anorexia to go undiagnosed.

Anorexia Nervosa often occurs together with depression (2), panic and anxiety disorders, substance abuse, low self-esteem and extreme perfectionist mentalities (3).

There are two main types of anorexia nervosa, differing in the way weight loss is achieved (4):

• Restricting type:
  • Restricting nearly all types of food 
  • Cutting sweets and snacks from diet, eventually followed by cutting other foods 

• Binge-eating / purging type:
  • Vomiting after meals 
  • Taking of laxatives, diuretics or thyroid pills to increase bowel movement
  • Excessive exercise
  • Bingeing episodes (uncontrolled eating for a short period of time)

In general, individuals with anorexia nervosa tend to:

• Have low body-mass index (BMI)
• Experience amenorrhea (absence of menstruation)
• Frequently check in the mirror for flaws
• Repeatedly weigh themselves
• Have rigid eating rituals (such as measuring proportions/calories of food)

Due to poor/restricted diet, individuals also often experience disruptions in blood pressure (5), brittle nails and hair, fatigue and weakness, insomnia and arrhythmia (irregular heartbeat).

Biological, psychological and social factors influence an individual’s decision to restrict food. Recent research also suggest genetics to be another possible factor contributing to an individual’s vulnerability towards the condition, due to unstable or excessive responses to stress that are related to impulsive/emotional eating.

Psychologically, individuals who are more vulnerable to the condition are generally more anxious, tending to feel a heightened sense of uncertainty. As such, when perceiving situations around them, they may be more likely to focus disproportionately on negative feedback. Controlling one’s diet and appearance is often a means to manage their anxiety and increase their sense of control. Social pressures and expectations for thinness are also contributing factors.

Usually, the first step for treatement would be to restore the individual’s physical health and mitigate the risk of death before managing his/her psychological health. For example, heart rhythm disturbances, dehydration and imbalances may require treatment. Additionally, further psychiatric problems or severe malnutrition due to the continued refusal to eat may require hospitalisation. As such, the treatment for anorexia may involve:

1. A primary care doctor who provides medical care and supervises calorie needs and weight gain
2. A psychologist or other mental health professional, who works with the individual to develop behavioral strategies to help him/her return to a healthy weight
3. Psychotherapy
   1. Family-based therapy: This form of therapy for adolescents enables parents to help their child with refeeding and weight restoration until the child can make good choices about their health
   2. Individual therapy: Research suggests ognitive behavioral therapy — specifically enhanced cognitive behavioral therapy — to be effective for adults. The main goal is to normalise eating patterns and behaviors to support weight gain. The second goal is to help change distorted beliefs and thoughts that encourage restrictive eating behaviours
4. A dietitian, who offers guidance in returning to regular patterns of eating and provides specific meal plan sto help the individual meet his/her weight goals
5. Family, who provide support and are involved in helping the individual maintain normal eating habits