Anorexia Nervosa

What is an Anorexia Nervosa

Anorexia nervosa is an eating disorder that results in a lower-than-normal body weight. The disorder usually starts in the teenage years. People with anorexia nervosa are intensely afraid of gaining weight or being fat.

They often see themselves as fat even though they may be very thin. To prevent weight gain or to lose weight, they engage in unhealthy behaviors, such as:

• Starving themselves.
• Fasting.
• Exercising too much.
• Trying to get rid of food they have eaten (purging), such as by:
  • Making themselves throw up (vomit) after eating.
  • Using laxatives or enemas.

These behaviors often interfere with normal life activities. They can lead to serious medical problems and even death. People with anorexia nervosa are also at risk for substance abuse and death due to suicide.

What are the causes?

Common causes of this condition include:

• Depression and other psychological problems.
• Pressure from peers and society to have a thin body.
• Hormone changes at puberty.
• Stress.
• Factors that are inherited from family (genetics).

What increases the risk?

The following factors may make you more likely to develop this condition:

• Being a teenager.
• Being female. Anorexia nervosa can affect males, but it is more common in females.
• Having a mental health disorder, such as depression or anxiety.
• Having a family member who has an eating disorder.
• Participating in sports or activities that put an emphasis on weight and appearance, such as dancing, cheerleading, running, ice-skating, gymnastics, wrestling, or modeling.
• Feeling anxious or tending to be obsessive, even as a young child.
• Thinking a lot about being perfect and following rules.

What are the signs or symptoms?

Symptoms of this condition include:

• Changes in appearance. These may include hair loss, dry hair and skin, spotty skin, brittle nails, and a thin layer of hair covering the skin (lanugo).
• Discolored teeth or cavities.
• Loss of muscle and fat.
• Lower-than-normal body weight.
• Low blood pressure.
• Slow heart rate.
• Feeling cold all the time.
• Fatigue.
• Constipation.
• Missed menstrual periods.

Other symptoms include:

• An intense fear of gaining weight or being fat.
• Having a distorted body image, such as thinking that you are fat when you are not.
• Basing your self-worth on being thin.
• Wearing lots of clothes to hide your body.
• Being in denial that your low body weight is a problem.
• Eating in secret.
• Binge eating.
• Checking your body frequently by:
  • Looking in a mirror.
  • Pinching the skin on the sides of your body.
  • Weighing yourself.
• Doing things that prevent weight gain, such as:
  • Limiting (restricting) your calorie intake, starving yourself, or not eating for a long period of time (fasting).
  • Purging.
  • Exercising excessively.

How is this diagnosed?

This condition may be diagnosed based on:

• An assessment by your health care provider. He or she may ask about:
  • Your thoughts, feelings, and eating habits.
  • Your symptoms.
  • Your use of medicine, alcohol, or other substances.
• Measurements of your weight. 
• Checking your body temperature, pulse, blood pressure, and breathing rate (vital signs).
• Results of a physical exam.

Your health care provider may also order tests or studies to look for health problems. You may be referred to a mental health specialist for evaluation.

After you have been diagnosed, your level of anorexia nervosa will be rated from mild to severe. The rating depends on your degree of weight loss compared to other people of your age, gender, and stage of development.

How is this treated?

The first goal of treatment is to stabilize medical problems and mental health issues that are related to the disorder. The type and length of treatment will depend on your specific situation.

You may need to be treated at the hospital if you have:

• Severe malnutrition.
• Dehydration.
• An imbalance in important chemicals (electrolytes) in your body.
• An abnormal heart rhythm.
• Depression.
• Suicidal thoughts.

The second goal of treatment is to restore your body weight to a healthy level. Successful treatment usually requires a combination of:

• Close monitoring of weight and feeding (behavioral feeding plan) to increase your calorie intake.
• Counseling with a diet and nutrition specialist (dietitian).
• Talk therapy or counseling with a mental health specialist. A form of talk therapy called cognitive behavioral therapy (CBT) can be especially helpful. This therapy helps you recognize the thoughts, beliefs, and emotions that lead to unhealthy eating habits and helps you change them.
• Medicines. Some people with severe anorexia nervosa may benefit from certain medicines that help them to gain weight. Antidepressant medicines can help with symptoms of depression and anxiety.

For adolescents, Family-Based Treatment (FBT) may also be helpful. This is a form of therapy in which your family is invited to have an active role in your treatment and recovery.

Follow these instructions at home:

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Follow a meal plan as directed by your health care provider.
• Avoid checking your weight.
• Avoid isolating yourself from your family and friends, especially during mealtimes.
• Keep all follow-up visits as told by your health care provider. This is important.

Where to find more information

• National Eating Disorders Association (NEDA): www.nationaleatingdisorders.org
• National Alliance on Mental Illness: www.nami.org
• U.S. Department of Health and Human Services: www.mentalhealth.gov

Contact a health care provider if:

• Your symptoms get worse.
• You start having new symptoms.

Get help right away if:

• You fall down (collapse) or lose consciousness (faint) because of exhaustion or malnutrition.
• You have chest pain or abnormal heart rhythms.
• You vomit blood.
• You have serious thoughts about hurting yourself or someone else.

If you ever feel like you may hurt yourself or others, or have thoughts about taking your own life, get help right away. You can go to your nearest emergency department.

Summary

• Anorexia nervosa is a serious condition. Low body weight is its main symptom.
• People who have anorexia nervosa often think that they are overweight (body image disturbance). They may even try to lose weight by denying themselves food, try to get rid of the food they have eaten (purge), or use certain medicines to prevent weight gain.
• If anorexia nervosa is not treated, it can lead to death.
• Effective treatments usually involve close monitoring of weight and feeding (behavioral feeding plans) and cognitive behavioral interventions. In some cases, treatment may include medicines.