What is anorexia nervosa?
Anorexia nervosa is an eating disorder characterized by distorted body image, emaciation, fear of weight gain, self-starvation, and an unwillingness to maintain a healthy weight. Patients with anorexia nervosa refuse to maintain a minimally normal body weight of at least 85 percent of that expected for age and height. People who have anorexia nervosa may carefully control their food intake, exercise excessively, vomit, or use pills to lose weight. They often do not recognize they have a problem and may even think they are overweight.
Anorexia nervosa most commonly affects adolescent and young adult women, but it can also affect men, children, and older adults. The cause is not known, but genetics and cultural environment may play a role. Identified risk factors include childhood digestive problems, concerns about weight, family history of anorexia nervosa or addiction, low self-esteem, perfectionism, and stress. Coexisting physical and psychiatric conditions are common.
Women who have anorexia nervosa typically do not have menstrual periods (amenorrhea) although it is still possible for them to become pregnant. Cold sensitivity, constipation, development of fine hair (lanugo), dry skin, hair loss, and muscle loss are common symptoms. The pulse and breathing rate may be slow and the blood pressure may be low.
Anorexia nervosa is treatable, although some people relapse following treatment. Hospitalization may be required at the beginning, especially if medical complications, ongoing weight loss, severe depression, or severe malnutrition is present. Psychotherapy is typically recommended. Treatment may include medications, such as antidepressants or antipsychotics, especially if the person is experiencing mood or anxiety symptoms.
Anorexia nervosa is a serious medical condition with potentially life-threatening complications, including severe dehydration, electrolyte disturbances, abnormal heart rhythms, malnutrition, infections, and seizures. Seek immediate medical care (call 911) for serious symptoms, such as chest pain or pressure, cold and clammy skin, confusion loss of consciousness for even a brief moment, decreased or absent urine output, dry mucous membranes, fever, irregular heart rate (arrhythmia), pale skin or pallor, profuse sweating, rapid breathing (tachypnea) or shortness of breath, rapid heart rate (tachycardia), seizure, weakness, or thoughts of suicide or self-harm.
Seek prompt medical care if you, or someone you are with, are severely underweight; have a preoccupation with food, exercise or weight; or are being treated for anorexia nervosa but symptoms recur or are persistent.
What are the symptoms of anorexia nervosa?
Many symptoms of anorexia nervosa are related to preoccupation with weight. Others are related to changes in the body and its functions due to malnutrition and dehydration.
Common weight-related symptoms of anorexia nervosa
People who have anorexia nervosa have a deep preoccupation with their weight to the extent that they are very careful and particular about what they will eat, will try to lose weight even when they are emaciated, and may even consider themselves overweight. Symptoms related to their weight preoccupation include:
- Cutting food into tiny pieces
- Distorted body image
- Diuretic, laxative, or appetite suppressant abuse
- Eating only certain foods
- Excessive exercise
- Fear of gaining weight
- Refusal to eat with others
- Refusal to gain weight
- Seeing oneself as overweight despite being underweight
Other symptoms of anorexia nervosa
Anorexia nervosa can lead to bone, cognitive, hair, menstrual, mental, skin and other changes. These changes include:
- Absent, irregular or light menstrual bleeding
- Cold sensitivity
- Confusion and slowed thought processes
- Depressed mood
- Dry skin
- Hair and nail brittleness
- Hair loss
- Muscle weakness and mass loss
- Replacement of normal hair with fine hair called lanugo
- Slowed respiratory and heart rates
- Yellowish or blotchy skin
Serious symptoms that might indicate a life-threatening condition
In some cases, anorexia nervosa can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:
Cold, clammy pale skin
High fever (higher than 101 degrees Fahrenheit)
Not producing any urine
Rapid heart rate (tachycardia) or irregular heart rhythm (arrhythmia)
Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing
Severe abdominal pain
Thoughts of suicide or self-harm
What causes anorexia nervosa?
The cause of anorexia nervosa is not known. Genetic and environmental factors may play a role. Even though the cause is not known, risk factors have been identified.
A number of factors increase the risk of developing anorexia nervosa. Not all people with risk factors will get anorexia nervosa. Risk factors for anorexia nervosa include:
- Age in the adolescent or young adult range
- Caucasian race
- Digestive problems in childhood
- Excessive stress
- Family history of addiction or eating disorders
- Female gender
- Low self-esteem
- Personal or parental concern about one’s weight
- Strong goal orientation
- Tendency toward overachievement
How is anorexia nervosa treated?
The first step in the treatment of anorexia nervosa is getting the person to recognize that a problem exists. Oftentimes, hospitalization for health problems caused by anorexia nervosa provides the first opportunity to recognize and candidly discuss the problem. This can still be challenging, because anorexics usually deny that they have an eating disorder and may even see themselves as overweight.
Treatment often involves a multidisciplinary approach incorporating nurses, physicians, dietitians or nutritionists, and mental health practitioners. Working together, they help the individual develop normal eating habits and increase weight to a healthy level. Hospitalization may be needed at first, especially if complications exist, if the person is depressed, or if the person continues to lose weight despite treatment. Psychotherapy is a common component of therapy. Medications may be recommended. Support groups may also be helpful.
Types of psychotherapy used to treat anorexia nervosa
Psychotherapy often plays an important role in the treatment of anorexia nervosa. It can be helpful to explore the psychological issues related to the disease as well as to develop thoughts and behaviors that lead to healthy eating. Types of psychotherapy include:
- Family therapy
- Group therapy
- Individual therapy
Medications used in the treatment of anorexia nervosa
Medications are sometimes used in the treatment of anorexia nervosa, especially if mood and anxiety issues are also present. Studies of these medications in individuals who have anorexia nervosa have shown mixed results and none have been specifically approved by the U.S. Food and Drug Administration (FDA) for this use. Medications used in the treatment of anorexia nervosa may include:
Atypical antipsychotics such as olanzapine (Zyprexa)
Selective serotonin reuptake inhibitor (SSRI) antidepressants such as fluoxetine (Prozac)
Complications of untreated or poorly controlled anorexia nervosa can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of anorexia nervosa include:
Anemia (low red blood cell count)
Arrhythmias (abnormal heart rhythms)
Dehydration (loss of body fluids and electrolytes, which can be life threatening when severe and untreated)
Frequent infections due to a decrease in white blood cells
Hormone imbalances (growth, thyroid, reproductive)
Osteoporosis (thinning and weakening of the bones)
Tooth decay and enamel erosion