Anorexia Nervosa: Guide To Symptoms, Risks & Treatment

Anorexia nervosa is a serious eating disorder characterized by deliberate and extreme weight loss, where individuals often become obsessed with food and body weight, leading to potentially life-threatening health complications.

What is anorexia nervosa?

Anorexia nervosa is an eating disorder in which a person intentionally restricts food intake to achieve or maintain a significantly low body weight, often perceiving themselves as overweight despite being underweight. This condition involves a distorted body image and an intense fear of gaining weight, dominating the individual’s thoughts and behaviors around food and eating. It is classified as a mental health disorder affecting the nervous system, leading to severe calorie restriction, malnutrition, and physical and psychological symptoms.

The disorder typically emerges in adolescence or early adulthood but can affect people of any age. There are two main subtypes: restricting type, where weight loss occurs primarily through dieting and excessive exercise, and binge-eating/purging type, involving episodes of bingeing followed by purging behaviors like vomiting or laxative use. Atypical anorexia occurs in individuals who meet criteria except for low body weight.

Anorexia symptoms

Deliberate weight loss

The hallmark symptom of anorexia nervosa is intentional weight loss through severe dietary restriction, avoiding ‘fattening’ foods, or even all food intake. Individuals may deceive others about their eating habits, claiming to eat more than they do, while engaging in excessive exercise, self-induced vomiting, laxative abuse, or diuretic use to prevent weight gain.

Other common symptoms

• Intense fear of gaining weight or becoming fat, even when underweight.
• Distorted body image, seeing oneself as overweight despite evidence to the contrary.
• Refusal to maintain a minimally normal body weight (e.g., BMI below 17.5 kg/m² in adults or below 85% of expected weight in children).
• Extreme thinness (emaciation), muscle wasting, and fatigue.
• Menstrual irregularities or amenorrhea in women (though no longer a strict diagnostic criterion).
• Behavioral signs: social withdrawal, denial of hunger, preoccupation with food (e.g., cooking for others but not eating), excessive exercise, and rituals around eating.

Physical signs include dry skin, thinning hair, brittle nails, cold intolerance, low blood pressure, slowed heart rate (bradycardia), and lanugo (fine hair growth on body).

Anorexia nervosa health risks

Being underweight due to anorexia nervosa starves vital organs like the brain, heart, and muscles of essential energy, leading to numerous life-threatening complications. Do not be misled by the anorexic mindset that equates thinness with health; undernutrition causes severe damage.

Immediate physical risks

• Cardiovascular problems: Low heart rate, low blood pressure, irregular heartbeat, and risk of heart failure or sudden death.
• Gastrointestinal issues: Constipation, bloating, abdominal pain, nausea, indigestion; laxative abuse can cause permanent bowel damage.
• Bone health: Osteoporosis, fractures due to low estrogen and calcium.
• Electrolyte imbalances: From vomiting or laxatives, leading to seizures or cardiac arrest.

Long-term complications

Refeeding syndrome—a dangerous shift of electrolytes during nutritional rehabilitation—poses additional risk if not medically supervised. Mortality is high: anorexia has the highest death rate among psychiatric disorders, with risks 5x higher for premature death and 18x for suicide.

What is the cause of anorexia nervosa?

The exact cause of anorexia nervosa is multifactorial, involving a combination of genetic, biological, psychological, and environmental factors. No single cause exists, and it is not due to vanity or family blame—it is a legitimate illness.

• Genetic predisposition: Family history increases risk; twin studies show heritability up to 70%.
• Biological factors: Brain chemistry imbalances in serotonin and dopamine pathways affecting appetite, mood, and reward.
• Psychological traits: Perfectionism, low self-esteem, anxiety, obsessive-compulsive tendencies.
• Sociocultural influences: Media portrayal of thinness as ideal, peer pressure, dieting culture—though not sufficient alone.
• Triggers: Stressful life events, trauma, sports emphasizing leanness (e.g., ballet, wrestling).

Rates are rising, with a 70% increase in male hospital admissions over six years, per NHS data.

Are any tests needed?

Diagnosis relies on clinical history and DSM-5 criteria: restriction causing low weight, intense fear of weight gain, and body image disturbance. No single test confirms anorexia, but assessments rule out other conditions.

• Physical exam: BMI calculation (<17.5 kg/m²), vital signs, body composition.
• Blood tests: Electrolytes, glucose, liver/kidney function, hormones (thyroid, cortisol), CBC for anemia.
• Bone density scan (DEXA): For osteoporosis risk.
• ECG: For cardiac abnormalities.
• Psychological evaluation: To assess mental health comorbidities like depression or OCD.

For children/teens, BMI centiles are used instead of adult BMI.

What is the treatment for anorexia nervosa?

Treatment is multidisciplinary, aiming to reduce mortality risk, restore weight/nutrition, alleviate symptoms, and address psychological roots. Early intervention improves outcomes; hospitalization may be needed for severe cases (e.g., BMI <15, medical instability).

General management

• Nutritional rehabilitation: Supervised meal plans, gradual refeeding to avoid refeeding syndrome, eating diaries.
• Regular weighing and health education on anorexia’s dangers.
• Motivational interviewing to overcome denial.
• Reassurance: No blame on patient or family.

Psychological therapies

For adolescents: Family-based treatment (Maudsley approach)—most effective; involves parents in refeeding, then restoring autonomy.

For adults:

• Cognitive behavioral therapy (CBT-ED): 40 sessions over 40 weeks, challenges distorted thoughts.
• MANTRA: 20 sessions, educational/self-monitoring focus.
• Specialist supportive clinical management (SSCM): Builds coping skills.

Medications (e.g., antidepressants) for comorbidities, but not first-line for weight gain.

Prognosis

With treatment, improvement takes weeks to years. About 50% fully recover, 30% improve significantly, 20% have chronic issues. Factors for better prognosis: early treatment, shorter illness duration, higher pre-morbid weight, family support. Relapse risk persists; long-term monitoring aids sustained recovery.

Frequently Asked Questions (FAQs)

Q: Can men get anorexia nervosa?

A: Yes, though less common; rates are rising, with a 70% increase in male hospitalizations.

Q: Is anorexia nervosa life-threatening?

A: Yes, it has the highest mortality of any mental disorder due to medical complications and suicide.

Q: How is refeeding done safely?

A: Under medical supervision, starting with low calories and monitoring electrolytes to prevent refeeding syndrome.

Q: Does anorexia only affect young women?

A: No, it affects all ages, genders, and backgrounds, including atypical cases without low weight.

Q: Can anorexia be cured completely?

A: About half fully recover with treatment, though some need ongoing management.

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Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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