Anorexia, or anorexia nervosa, is a life-threatening eating disorder characterized by significant weight loss due to the restriction of calorie intake.¹ This extreme weight loss is accompanied by an intense fear of gaining weight, denial of the seriousness of the weight loss, and perceiving one’s own body differently than reality.¹ Anorexia affects all people regardless of class, age, sex, or race. Anorexia is most commonly diagnosed during adolescence; however, it can affect anyone at any age, and an increasing number of adults and youth are being diagnosed.² Typically, adolescents suffering from anorexia also exhibit perfectionist tendencies. Though it has been present in society for thousands of years, the incidence of anorexia has been increasing over the last few decades due to the presence of the media.²

Diagnostic and Statistical Manual Categorization

According to the American Diagnostic and Statistical Manual V (DSM V) of Mental Disorders, anorexia is classified as an eating disorder. In order to be diagnosed with anorexia, a person must meet all three criteria established by the DSM V. The following criteria define anorexia:²

• A person must restrict their food intake that leads to a significantly low body mass index (BMI) in the context of age, sex, developmental trajectory, and physical health.
• A person must have an intense fear of gaining weight or becoming fat, despite being dangerously underweight.
• A person must exhibit a discrepancy between the way they perceive their own body and the way others perceive their body. Their body image must influence their own self-worth, and/or they must be in denial of the seriousness of their low body weight.

Although a person must exhibit all three of these requirements in order to be diagnosed with anorexia, if a person exhibits only one or two possibly mixed with requirements of another eating disorder, they may be diagnosed with atypical anorexia or an eating disorder not otherwise specified (EDNOS).

Types of Anorexia

There are two types of anorexia that are most common: binge/purge type and restrictive type.¹ People suffering from binge/purge type of anorexia will purge their calories after they eat. Purging may take the form of self-induced vomiting, laxative use, or excessive exercising. Individuals may purge in response to guilty feelings after eating. The other most common type of anorexia is the restrictive type. Individuals with restrictive anorexia will refrain from consuming a sufficient amount of calories in order to lose weight, essentially starving themselves.¹ Each eating disorder is unique; a person may exhibit symptoms of both types of anorexia as well.

Symptoms

There are many physical symptoms and signs of anorexia. A person diagnosed with anorexia may exhibit one or more of the following symptoms:¹

• A person diagnosed with anorexia may be severely underweight and have visibly protruding bones.
• A person with anorexia may often discuss a new diet they are trying, despite being severely underweight.
• A person with anorexia may often complain of stomach cramps.
• A person suffering from anorexia may experience amenorrhea, which is the cessation of her menstrual cycle.
• A person with anorexia may notice their hair thinning or falling out.
• A person struggling with anorexia  may feel cold all the time, particularly in their hands and feet.
• A person with anorexia may notice fine, translucent hair called lanugo growing all over their body including their face.

Anorexia can be a silent struggle. Some people do not exhibit any obvious symptoms, yet are still struggling with the eating disorder.  Some behavioral and emotional symptoms may include the following:¹

• A person with anorexia may be obsessed with food and counting calories.
• A person struggling with anorexia may also suffer from depression or anxiety.
• A person with anorexia may become withdrawn and avoid social interaction.
• A person diagnosed with anorexia may have a strict exercise routine and complain about needing to burn off extra calories.
• A person may exhibit eating rituals such as cutting food into small pieces, holding the food in their mouth, or avoiding eating in public.
• A person with anorexia may frequently cook new meals for friends and family, yet never eat the food themself.
• A person with anorexia may also suffer from body dysmorphic disorder (BDD).
• A person with anorexia may dress in multiple layers to stay warm or hide their weight loss.
• A person with anorexia may deny being hungry or lie to friends and family about having already eaten.¹

Most people struggling with anorexia will exhibit a combination of physical, behavioral, and emotional symptoms. However, an individual may exhibit one type of symptom more than the other.

Causes of Anorexia

Anorexia is a complex disorder that can be the result of a multitude of factors. There are many factors that could increase a person’s chance of developing anorexia. A diagnosis of anorexia can be the result of both environmental factors and biological factors. Cultures that idolize thinness tend to have a higher prevalence of anorexia. Most media plays a large role in idolizing being thin. Commercials, magazines, TV shows, and more all reinforce thin people, and especially women, as the ideal stereotype.¹ People with careers that place an importance on being thin may be at a higher risk of developing anorexia. For example, ballerinas and models must stay thin to be successful in the industry, and as a result have a higher chance of becoming anorexic.¹ People who have traumatic childhood experiences may be at an increased risk of developing anorexia as well. For example, individuals who were sexually abused as children may develop anorexia as a coping mechanism. Peer pressure from friends and family is another large environmental factor that contributes to the prevalence of anorexia in society. Because being thin is idolized by society, friends and family may pressure an individual to lose weight or be thin.¹

Biological factors also may increase a person’s chance of developing anorexia. There is currently research being done that suggests anorexia may be hereditary. Genetics may influence a person’s susceptibility to the disorder.¹ If a person has a hormone imbalance, they also may be at an increased risk of developing anorexia. Nutritional deficiencies also contribute to the development of anorexia.1 There may be many other causes of anorexia. The disorder differs from person to person and each case is unique.

Long-Term Effects

Anorexia is a serious mental illness with lasting effects. It has the highest mortality rate of any psychiatric disorder. People who do not receive treatment early enough may experience complications for the rest of their lives. A person with anorexia may cause damage to their major body systems and organs such as the ones listed below.

Cardiovascular System

The cardiovascular system can be significantly impacted by anorexia. Restrictive anorexia can result in a severely slowed heart rate and blood pressure. This disorder increases one’s risk for heart failure. A weakened heart or an irregular heartbeat is a very serious medical condition that can result in death. Inadequate nutrition can also result in anemia. A person diagnosed with anemia does not have enough red blood cells in their body.⁵

Gastrointestinal System

Restrictive and binge/purge type of anorexia can have drastic consequences on the gastrointestinal system. Gastroparesis, or delayed gastric emptying, can result from anorexia complications. This can cause severe stomach pain, vomiting, nausea, bacterial infections, or feeling full after eating only a small amount. Constipation can also occur due to restricting one’s caloric intake, which can cause severe stomach pains and nausea. Binge/purge type can also cause severe complications such as a ruptured esophagus, a ruptured stomach, and pancreatitis, all of which are life threatening illnesses.⁵

Neurological System

Restrictive anorexia can lead to neurological issues because the brain is not getting enough calories to function properly. By restricting food, a person may have difficulty concentrating, obsess about food, have difficulty falling asleep or staying asleep, and feel dizzy or pass out. Severe dehydration can also lead to muscle cramps, seizures, and a tingly feeling in the extremities due to weakened signals between the brain and body.5

Endocrine System

The endocrine system, which controls the body’s hormones, can also be significantly impacted by anorexia. Hormone synthesis is dependent upon fat and cholesterol intake. By restricting the amount of food a person consumes, there may not be enough fat or cholesterol in the body to create necessary the hormones. Thyroid hormones, estrogen, and testosterone are the three hormones that are most affected hormones by anorexia. Lowered estrogen and testosterone can lead to the cessation of the menstrual cycle, or amenorrhea. Starvation can also lead to bone loss, or osteoporosis, which can significantly increase a person’s risk for broken bones and fractures. Lowered hormone levels also leads to a slowed metabolism, which can cause the body’s temperature to drop.⁵

Treatment

Most people suffering from anorexia never seek treatment. However, it is imperative to seek professional help in order to achieve and maintain a full recovery. Once diagnosed by a licensed, medical professional, a doctor will decide the best treatment plan. Their first goal is to be sure the patient is medically stable. Typical treatment plans include help from a physician, a dietician, a psychiatrist, and a psychotherapist. It may also be helpful to seek help from an eating disorder specialist who has more experience with these types of medical cases. Treatment plans can range from outpatient (not residing in a medical facility) therapy to inpatient (residing in a medical facility) medical treatment. The following types of treatment courses may be decided by a physician after assessing the details of the case:²

Outpatient Treatment

Most cases of anorexia can be successfully treated with outpatient therapy. This level of treatment works best if the patient is mentally and physically stable. The patient must be able to cope with their disorder and be able to function normally in society. Outpatient treatment may consist of regular visits with a therapist and dietitian to be sure the patient continues in their recovery.²

Partial Hospital Treatment

The next level of treatment is partial hospital treatment which consists of an intensive series of in-person meetings with dietitians and physicians. This is more involved than outpatient treatment, but still allows the patient to live on their own. Partial hospitalization may be appropriate if the patient is medically stable, yet their disorder is impairing their bodily functions without immediate risk. The physicians may carry out this treatment plan in order to monitor the patient’s physiological health on a daily basis. This treatment plan may also be best if the patient is mentally stable, yet struggles to cope with their disorder in social situations. The patient may also be engaging in daily eating behaviors such as binging/purging, starving, or compulsive exercising.²

Residential Treatment

Residential treatment is the next intensified level of treatment for anorexia. Patients with this treatment plan are required to live in a facility that will monitor their behavior and provide treatment in the facility. These patients are physically stable but mentally unable to cope with their disorder on their own. Their vital signs and body functioning is normal, but their disorder causes them severe mental distress and interferes with their everyday functioning. These patients may require intensive therapy and close monitoring to maintain their recovery.²

Inpatient Treatment

Inpatient treatment is the most intense level of treatment for anorexia. Inpatient treatment consists of patients staying in a hospital because they are both medically and mentally unstable. These patients may need around-the-clock care to monitor their vital signs and disordered behavior. If a patient’s behavior is worsening, they are not responding to treatment, or they become suicidal, they will be admitted to inpatient treatment where they will receive immediate medical care.²

Therapy

After deciding which type of treatment is best, the team of professionals will then decide which type of therapy will most benefit their patient. Therapy is intended to solve the underlying causes of anorexia. The patient must learn to recognize what triggers their disorder and learn how to cope with their feelings in a healthy manner. Therapies range from cognitive to behavioral therapy. Therapists can recommend individual therapy, group therapy, or therapy with a patient’s family.Treatment is different for everyone; one technique may work for one person but be useless for another. It is highly important to consult medical professionals on which path is right for you.²

Relapse

The goal of treatment is to achieve and maintain recovery. An individual may be experiencing a relapse if they begin to engage in eating disorder behavior again during their recovery. When experiencing a relapse, an individual should seek immediate medical help. Relapse is a normal part of the recovery process and does not mean failure.²

Statistics

Anorexia is much more prevalent in the United States and in European countries compared to other regions of the world. This is largely due to the social and cultural contexts of the Western world. The following statistics are representative of populations within the United States and Europe:²

• Anorexia is the third most common chronic disease among adolescents.
• Anorexia has the highest fatality rate of any mental disorder.
• Approximately 0.9 to 2% of women and 0.1 to 0.3% of men will suffer from anorexia at some point in their lives.
• Adolescents with anorexia are 10 times more likely to die than their peers without anorexia.
• Over the last few decades, symptoms of anorexia have been appearing in increasingly young children.
• Approximately 50 to 80% of the risk for developing anorexia is genetic.
• About 4% of those diagnosed with anorexia will die from complications of the disorder.
• Only one third of those suffering from anorexia will seek treatment.²

These statistics reflect data collected in the Western world. Statistics for other regions of the world may differ due to the social and cultural contexts of those countries.

Anorexia and Intimacy

Anorexia affects many avenues of a person’s life, including their intimate relationships. Some people with restrictive anorexia tend to be averse towards sexual activity and may have a fear of intimacy.⁴ This can be due to a decreased libido from not consuming enough calories, or from underlying psychiatric reasons. People suffering from anorexia may also be suffering from anxiety that inhibits their sex life.⁴ Body image issues may also dictate how a person chooses to engage in sexual activity. For example, someone with anorexia may want to keep their shirt on during sex, turn the lights off, or avoid any position that gives their partner a full view of their body. They also may not want their partner to touch certain areas of their body that they are insecure about.³ Anorexia may also cause a person to appear unemotional and detached. It is often hard for people with anorexia to open up about their feelings, so extra communication, kindness, and patience may be necessary between partners.⁴ Communication, trust, and openness between partners is important to ease the individual’s anxiety and insecurities about their own body.³

Resources

Anorexia is a serious mental illness that can have fatal consequences if left untreated. If you or someone you know is suffering from anorexia, there are many resources available to get the help you need. The following are hotlines that may be helpful for you:⁶

NEDA Helpline- 1-800-931-2237

ANAD Eating Disorders Helpline- (630) 577-1330

ANAD Crisis Text Line- Text “hello” to 741741

National Alliance on Mental Illness Hotline- Call: (800) 950-NAMI, (800) 950- 6264

If you live in the USA, and there is an emergency, call 911.

Concluding Remarks

Anorexia is the most fatal psychiatric disorder and has severe mental and physiological health consequences. Anorexia affects a person’s daily life including their personal relationships and physical and mental health. It is imperative for someone with anorexia to seek treatment.

References

1. “About Anorexia: Signs, Symptoms, Causes & Articles For Treatment Help.” Eating Disorder Hope.
2. “Anorexia: Overview and Statistics.” National Eating Disorders Association.
3. “Sex and Eating Disorders: A Guide.” Sex and Eating Disorders: A Guide | National Eating Disorder Information Centre (NEDIC).
4. “Intimacy Issues and Eating Disorders in Women.” Eating Disorder Hope, 16 Aug. 2017.
5. “Health Consequences.” National Eating Disorders Association.
6. “Eating Disorder Hotlines.” Project Know, 2 May 2017.

Last Updated: 22 January 2018.