“Anorexia is the third most common chronic disease among young people, after asthma and Type 1 diabetes.”
~National Eating Disorder Association
Written by: Dr Kim Langdon MD
Reviewed by: Dr. RY Langham PhD
Table of Contents
Anorexia nervosa (AN), also known simply as anorexia, is an eating disorder that prevents a person from maintaining a normal or minimally-normal weight.
It is also an abnormal fear of weight gain, continuous attempts to control food intake, and a distorted perception of one’s own body weight and shape .
Types of Anorexia Nervosa
Anorexia nervosa is divided into two subtypes: restricting and bing-eating/purging.
The restricting type involves limiting food intake to the bare minimum to maintain a specific weight.
The binge-eating/purging type involves vomiting after ingesting food, using enemas, and/or taking laxatives or diuretics for weight management.
A recent study on eating disorders found that 0.2% of adolescents have anorexia nervosa, 0.6% have bulimia nervosa, 1.6% have a binge-eating disorder, 0.9% have a sub-threshold anorexia nervosa, and 1.1% have a sub-threshold binge-eating disorder .
A less recent chart from The National Institute of Mental Health shows the following lifetime prevalence of eating disorders for adolescents:
Common symptoms of anorexia include [8, 13, 14]:
- Temperature & Blood Pressure Fluctuations
- Sudden & Dramatic Weight Loss
- Dry, Flaky Skin
- Yellow Skin & Eyes (Jaundice)
- Baby-Fine Body Hair
- Blue Fingertips and Toes (Poor Circulation)
- Decreased Breast Volume
- Swollen Lymph Nodes and Jaw Glands
- Swollen Feet and Legs (Edema)
The exact cause of anorexia varies, but biological, psychological, and social factors appear to play significant roles in its development.
Still, in some cases, the cause is completely unknown.
Research suggests that if you have a history of depression and anxiety, you are more prone to developing anorexia than someone who does not have that specific background.
In addition, anorexia is more common in females than males, and adolescents develop it more often than older women.
Early-onset anorexia is linked to anxiety disorders. Ultimately therefore, anorexia stems from fear.
It is important to note, however, that contrary to popular belief, vanity (an obsession with being beautiful) is not linked to anorexia .
There are several risk factors associated with anorexia, such as :
- Family Crises
- “Perfectionist” Tendencies
- Difficulty Communicating Negative Emotions
- Difficulty Resolving Conflicts
- Low Self-Esteem
- Inability to Face Age-Appropriate Challenges
- A Family History of Depression, Anxiety, and/or Eating Disorders
- Maternal Psychological Problems – i.e. Negative Expressed Emotions, Maternal Encouragement of Weight Loss, etc. .
Anorexia complications usually stem from starvation. Starvation leads to malnutrition, which leads to a protein deficiency and/or a disruption in multiple organ systems.
Listed below are common complications associated with this eating disorder [9, 11,12,13,14]:
- Delayed-Onset Puberty
- Lack of Menstrual Periods, Infertility, & Small Testicular Growth
- Low Estrogen Levels
- Underdeveloped Breasts
- Increased Growth Hormones
- Decreased Kidney/Adrenal Hormone Secretions
- Low Electrolytes – i.e. Potassium & Sodium
- Low Glucose Level – i.e. Blood Sugar
- Enlarged Heart – i.e. Rhythm Disturbances and/or Abnormal Heart Rate
- Low Blood Pressure
- Kidney Malfunction – i.e. Kidney Stones, Swelling, and/or Elevated Levels of Waste Products (Nitrogen Build-Up)
- High Cortisol Levels
- Stunted Growth
- Weak Bones
The truth is, there is no way to prevent or predict this condition, but there is a way to treat it – if you know the signs and symptoms.
It is important to note that one study found that approximately 40% anorexia sufferers have at least one psychiatric condition, such as anxiety, depression, or ritualistic eating behaviors, and approximately 44% of them have family history of psychiatric disorders.
Therefore, it is important to pay attention to your child’s self-esteem and body image. More specifically, take note if your child experiences insomnia, uncontrollable crying spells, self-destructive tendencies, and/or suicidal ideation (suicidal thoughts) [19,20].
Here is a table from The National Institute of Mental Health that shows similar figures for how many sufferers of anorexia also have other psychiatric conditions:
When to Seek Professional Help
It is important to recognize the early warning signs and risk factors (i.e. anxiety, depression, obsessive compulsive tendencies, etc.) associated with anorexia, so you can seek treatment for your child, as quickly as possible. Why? Well, because research suggests that early intervention and nutritional counseling can save lives.
Early warning signs are [6,7]:
- A Dislike of Public Eating
- Continuous Complaints of Being “Fat”
- Repeatedly Looking into the Mirror
- Dressing in Loose-Fitting Clothes and/or Layering Extra Clothes to Disguise “Thinness”
- Frequent Bouts of Insomnia
- Social Isolation/Withdrawal
- Emotionless Expressions
So, if you notice that your child is playing with his/her food – i.e. moving it around on the plate, hiding some of it, and/or feeding it to the dog on a regular basis, you may have cause for concern.
Also, if your child’s clothes sizes never change – from year-to-year, you may want to consult a pediatrician to inquire about healthy growth curves.
It is important to understand, however, that anorexia treatment is multidisciplinary.
In other words, it includes: consultations with adolescent medicine specialists, nutrition classes, psychiatric or behavioral-developmental pediatrics, and/or psychotherapy sessions in some cases.
Therefore, if you notice any of the above symptoms or warning signs, seek emergency treatment.
Also, seek treatment, if your child expresses suicidal ideations (thoughts), psychosis, and/or “disordered” thinking [15,16].
Lastly, fainting, swollen extremities, and/or any other changes in appearance or behavior should be assessed by a healthcare professional .
Treatment & Therapy Options
If your child is diagnosed with anorexia nervosa, there are treatment strategies that can help.
These strategies include the following:
> Medical Management
Medical management involves correcting/preventing complications and re-establishing healthy eating patterns. If caught early and managed properly, hospitalization is rare.
> Hospital Admission
Hospital admission may be necessary for patients, who are extremely ill, and/or who have cardiac arrhythmia or severe metabolic abnormalities.
> Drug Therapy
Drug therapy is only required, when there is also a psychological condition like depression or anxiety. Prozac may beneficial for those suffering from depression, however, a common side-effect of the drug is sudden weight gain (in some people). Lastly, estrogen, commonly found in oral contraceptives, may be used to restore the menstrual cycles and preserve bone strength in females.
Current research suggests that drug therapy is most effective when combined with cognitive behavioral therapy (CBT). It is also recommended that one not take drug therapy alone. An low-dose of olanzapine, an anti-psychotic medication that alters your brain chemicals, may be useful for treating anorexia nervosa, especially if your child is hospitalized due to anxiety, obsessive eating practices, and/or failure-to-engage in the recovery process.
> Vitamins & Minerals Supplementation
Vitamins and minerals like vitamin D and calcium may help combat bone loss in anorexia sufferers.
Types of Psychological Therapy
Thankfully, there are also a wide-variety of psychological therapies that can help anorexics, such as [2,3,4,10]:
- Individual Therapy (Insight-Oriented)
- Cognitive Analytic Therapy(CAT)
- Cognitive Behavioral Therapy (CBT)
- Enhanced Cognitive-Behavioral Therapy (CBT-E)
- Cognitive Remediation Therapy (CRT)
- Interpersonal Therapy (IPT)
- Motivational Enhancement Therapy (MET)
- Dynamically-Informed Therapies (DIT)
- Group Therapy (GT)
- Family-Based Therapy (FBT)
- Specialist Supportive Clinical Management (SSCM)
- Conjoint Family Therapy (CFT)
- Separated Family Therapy (SFT)
- Multi-Family groups (MFG)
- Family Support Groups (FSG)
Also, don’t avoid or overly accommodate your child, because it may delay early treatment, which has been proven to help anorexia patients.
A nutritionist or dietitian should also be an integral part of your child’s treatment plan. And, while it is not known if a slow or aggressive food introduction is best for success, a comprehensive, individualized program is mandatory for recovery .
Although anorexia cannot be predicted or prevented, early warning signs can signal a problem or a potential problem.
With quick action and therapy, this condition can be successfully treated, managed, and wrangled into control!
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