What Is Anorexia Nervosa?

Springfield High School: David F., Brianna L., Khaysi S. View Transcript Hide Transcript

Let’s make a change. Let’s stick together. Let’s end this. Before it ends us. Don’t let them suffer. Let’s make a promise. I promise. I promise. I promise.

In 2020, during the COVID-19 pandemic, the National Eating Disorders Association (NEDA) experienced a 70 to 80 percent increase in hotline calls. A July 2020 survey in the International Journal of Eating Disorders revealed that 62 percent of Americans with anorexia had experienced a worsening in symptoms during the first few months of the pandemic. NEDA’s CEO Claire Mysko said, “We know that eating disorders have a strong link to trauma. Many people with eating disorders have past experiences with trauma, and this [pandemic] is a collective trauma.”

Anorexia nervosa, commonly called anorexia, is a deadly illness. But unlike the flu or a sexually transmitted disease (STD), anorexia isn’t spread by bacteria or a virus. Instead, anorexia stems from your thoughts and emotions. Anorexia is manifested when a person refuses or is unable to maintain a normal body weight. People with the disorder generally restrict their food intake and the types of food that they eat. They might have a distorted body image and an intense fear of gaining weight (typically weighing themselves repeatedly). Some people with anorexia have an abnormal fear of food. They may develop food rituals or become preoccupied with counting calories and tracking meals and exercise. According to NEDA, some people with anorexia also purge via vomiting and laxatives, or binge eat.

The word “anorexia” literally means “loss of appetite.” But anorexia is more like self-starvation—becoming so obsessed with losing weight and dieting that you ignore your body’s hunger signals. Although people with anorexia are always hungry, they may take pride in denying hunger, feeling more in control and independent. This belief has very dangerous consequences. If anorexia progresses far enough, you can lose massive amounts of body weight—enough to cause psychological problems, physical problems, and even death.

NEDA estimates that twenty million women and ten million men in America will have an eating disorder at some point in their lives. Canada’s National Initiative for Eating Disorders (NIED) estimates that about one million Canadians have a diagnosis of an eating disorder such as anorexia or bulimia. However, it’s difficult to determine how many people actually struggle with eating disorders because many people do not seek treatment or are never formally diagnosed.

Anorexia is a complicated illness. It is possible to recover, but it typically requires time and treatment. With proper medical care, people can work toward recovery and develop healthier eating habits and coping skills.

The Definition of Anorexia

Doctors and psychiatrists rely on the Diagnostic and Statistical Manual of Mental Disorders (frequently known as the DSM) for the definitions they use in diagnosing conditions. The fifth edition of the DSM lists three criteria for a diagnosis of anorexia. The patient must:

• Restrict the amount of food consumed, leading to a significantly low body weight.

• Have an intense fear of gaining weight, despite being underweight.

• Have a distorted idea of what they look like, have their self-esteem be too closely tied to body shape or weight, or refuse to accept the serious health risks of having a low body weight.

What Are Eating Disorders?

Eating disorders are serious mental and physical illnesses that can severely impact a person’s physical and emotional health and can impair their ability to function in everyday life. The conditions often develop in adolescence and young adulthood, though people of all ages have been diagnosed with eating disorders.

The National Alliance on Mental Illness (NAMI) defines eating disorders as “a group of related conditions that cause serious emotional and physical problems.” The most common eating disorders diagnosed in North America are anorexia nervosa, bulimia nervosa, and binge eating disorder, though there are a number of other conditions that are recognized by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

No one knows for sure what causes eating disorders. NEDA suggests that they are likely caused by a range of biological, psychological, and sociocultural factors. For example, one biological risk factor is having a close relative with an eating disorder or a mental health condition. An eating disorder may arise when other influences, such as low self-esteem, abuse in the home, or peer pressure, contribute to food becoming an avenue to control something in a person’s life or a symptom of other things that might be happening in a person’s life. These negative feelings about food become overwhelming enough to interfere with your health and nutrition. Your eating becomes “disordered,” causing both physical and emotional troubles. Recent research points to a genetic component to anorexia nervosa, as well.

Who Is at Risk?

Studies have shown that anorexia is more common in girls and women than boys and men. This may be because society typically puts much more pressure on young women than on young men to be thin. However, NEDA says “Despite the stereotype that eating disorders only occur in women, about one in three people struggling with an eating disorder is male, and subclinical eating disordered behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss) are nearly as common among men as they are among women.” Men, as well as women of color, may be underdiagnosed because health care providers think of anorexia as a disease that affects primarily white women. Additionally, a study published in the American Journal of Preventative Medicine found that gender minority (GM) students exhibited significantly higher rates of eating disorder symptoms than their cisgender counterparts. A study by the U.S. National Library of Science also found that transgender college students are four times more likely to have an eating disorder and twice as likely to engage in purging compared to cisgender college students.

Common Signs of Anorexia

A person with anorexia may not exhibit all the signs and symptoms of the disease right away. Some of the emotional and behavioral signs of the illness include:

• Drastic weight loss

• Dressing in layers to hide the weight loss or to stay warm

• Having an intense fear of weight gain or “being fat” even when underweight

• A preoccupation with dieting, fat grams, weight, and calories

• Refusing to eat certain foods

• Denying feeling hungry

• Developing food rituals, such as eating foods in certain orders or rearranging food on a plate

• Cooking meals for others but not eating

• Frequently making excuses to avoid situations involving food

• Social withdrawal

Anorexia and Your Body

Anorexia can have a big effect on your body and mind. At first, the drop in weight may not be noticeable or look unhealthy. But in a short time, the weight loss can become dramatic and threaten your health.

Anorexia affects all of your body functions. As the disorder progresses, your digestion slows down and you become constipated. Later, during the progression, you’re always cold because you’ve lost the protective layer of fat that insulates you. Fine hair, called lanugo, grows all over your body. If you’re a girl, your menstrual period stops. You also will look and feel tired and weak, have a sickly pallor, lose your hair, and may have fainting spells and headaches. The soles of your palms and feet turn yellow because your body is lacking many of the nutrients it needs to function properly. Some of these symptoms may not occur until severe weight loss has taken place.

When you aren’t getting enough nutrition from food, your body will start to break down muscles in order to produce energy. Your liver and kidneys are damaged from this stress, leading to kidney failure. This can be fatal, or require you to be on dialysis for the rest of your life.

Anorexia may make women infertile, or unable to have children, because fertility depends on having a certain amount of body fat. You may also develop osteoporosis—a condition in which your bones become brittle and may even break. Low bone mineral density in adolescent women who suffer from anorexia is a common problem, partly because of low calcium intake. Even young women who take calcium in their food or in supplements can get osteoporosis due to amenorrhea. Amenorrhea is the absence of menstruation by the age of sixteen or so or where the menstrual cycle has stopped for about six months or for the time of about three menstrual periods. Amenorrhea can prevent the body from totally absorbing the calcium.

Your heart can be especially affected by anorexia. The disease disturbs the mineral balance in your body, which can cause cardiac arrest and death.

Other physical symptoms of anorexia that can develop over time include:

• Stomach cramps

• Difficulty concentrating

• Muscle atrophy (when muscles waste away)

• Dizziness and fainting

• Sleep problems

• Feeling cold all the time

• Anemia (a red blood cell disorder)

• Brittle hair and nails

• Thinning of hair on head

• Low blood pressure

• Brain and heart damage

Mortality

Anorexia has the highest mortality, or death rate, of all psychiatric disorders. It also has one of the highest suicide rates of any mental health condition. According to the American Psychological Association (APA), those with anorexia are fifty-six times more likely to take their own lives than their healthy peers. In addition, a landmark 2016 study reported that 32.7 percent of people with eating disorders engage in non-suicidal self-injury (NSSI). This increases their likelihood of death through accidental injury. Self-harm can also lead to an increase in suicidal behaviors.

Other Eating Disorders

If you have anorexia, you might have had a bout with another eating disorder, although this should not be assumed. Besides anorexia, the most common eating disorders are bulimia nervosa and binge eating disorder.

Bulimia Nervosa

People with bulimia binge (eat a large quantity of food in a short time) and then purge (eliminate the food, usually by vomiting). Purging can also include using laxatives, diuretics, and enemas. Some people with bulimia don’t purge, but they use other calorie-ridding methods such as fasting, dieting, or exercising excessively. Unlike people who are diagnosed with anorexia, people with bulimia often have a normal body weight.

Bulimia is a serious and potentially life-threatening eating disorder. It can do major damage to the body. It can cause ulcers (holes or tears) in the stomach, throat, and mouth. People with bulimia can develop yellow, damaged teeth from the acids brought up into the mouth through repeated vomiting. Abusing laxatives causes painful stomach cramps and weakens the digestive system. While recovery from bulimia—as with any eating disorder—is possible, some people may struggle with the illness for years after its initial onset.

Binge Eating Disorder (BED)

Binge eating is a disorder in which a person eats a significant amount of food in a short time but doesn’t purge afterward. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) makes a distinction between overeating and binge eating. People with BED eat large amounts of food very quickly whether or not they feel hungry. They usually do this in private and feel unable to control how much or what they eat. They may also have extreme feelings of guilt, embarrassment, or disgust. Anyone can overeat on occasion, but for those with BED, excessive overeating becomes a regular occurrence and feels out of control. To meet the DSM-5 criteria for BED, a person must overeat on average at least once a week for three months.

Some of the complications that may develop with BED include obesity and medical conditions related to obesity such as sleep-related breathing disorders, joint problems, heart disease, type 2 diabetes, and gastrointestinal issues. Sometimes psychiatric disorders are linked to BED. They include depression, anxiety, bipolar disorder, and substance abuse disorders.

The Mayo Clinic has listed several risk factors that can increase the likelihood of developing BED. They include family history (you’re more likely to have an eating disorder if your siblings or parents have had them), mental health issues, dieting, and age. BED typically begins in the late teens or early twenties, though both young children and older adults have been diagnosed with the disorder, according to NEDA.

OSFED

People whose symptoms do not allow them to be diagnosed with anorexia, bulimia, or binge eating disorder may be diagnosed with Other Specified Feeding and Eating Disorder—often known by its acronym, OSFED. It has several subtypes, including atypical anorexia—in which a patient demonstrates many of the features of anorexia but is not significantly underweight. Other subtypes include purging disorder, where a person purges their food without having binged beforehand, and night eating syndrome, which involves getting up in the middle of the night to eat or eating a large amount after an evening meal.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant/restrictive food intake disorder (ARFID) is like anorexia in that an individual with the disorder severely restricts their food intake. But unlike with anorexia, the restriction is not related to body image. Although there is no definitive cause of ARFID, some health experts think it might be an extreme reaction to the taste or texture of food, or anxiety caused by having vomited or choked in the past. People who don’t outgrow childhood picky eating, and those with ADD or autism, are most likely to develop ARFID.

Orthorexia Nervosa

Orthorexia nervosa is not an officially recognized eating disorder, but there is growing interest and concern among medical professionals. According to the NEDA, people suffering from orthorexia are obsessed with healthy or “clean” eating. In fact, the term “orthorexia nervosa” means “fixation on healthy eating.” People with orthorexia usually start out by trying to eat more healthy foods, but they become fixated on the quality and purity of their diet. They may develop rigid rules about what they can and cannot eat, such as refusing to eat anything that contains sugar, salt, caffeine, alcohol, wheat, gluten, yeast, soya, corn, and dairy. Orthorexia can develop out of any restrictive diet, including vegan, paleo, and keto diets. NEDA says, “Eventually food choices become so restrictive, with both variety and calories, that health suffers—an ironic twist for a person so completely dedicated to healthy eating.” NEDA advises that eating healthfully is not a problem unless “1) it is taking up an inordinate amount of time and attention in your life; 2) deviating from that diet is met with guilt and self-loathing; and/or 3) it is used to avoid life issues and leaves you separate and alone.”

Other Eating-Related Problems

Having an eating disorder doesn’t mean only restricting what you eat. Many eating disorders have different diagnoses from anorexia, based on the other behaviors involved with the eating disorders. For example, some people with eating disorders might exercise compulsively or abuse medicines. Compulsive exercise is an unhealthy drive to overexercise in order to burn calories and stay thin. This may mean running dozens of miles a day or vowing to do twenty sit-ups for every bite of food you take. Compulsive exercise puts stress on your organs and joints, causing stress fractures and torn muscles.

People with eating-related problems may also abuse medicines and drugs. This includes taking appetite suppressants (drugs that speed up your metabolism), diuretics (drugs that make your body lose water through frequent urination), laxatives (drugs that bring on a bowel movement), and drugs to induce vomiting.

By forcing food and water out of your body, you are upsetting your body’s normal functions. Abusing laxatives can cause you to lose control over your bowels. When you stop using laxatives, your body becomes swollen from retaining water. Other over-the-counter diet drugs can help bring on mineral imbalances that lead to heart failure.

Abusing laxatives can also cause dehydration, which often requires medical treatment. Severe dehydration can cause blurry vision, tremors, weakness, fainting, and kidney damage. Extreme cases of dehydration may cause death.