Anorexia Nervosa: When Eating Behaviors Become Disordered and Dangerous

Many people participate in weight-limiting or eating-restrictive behaviors in some manner, whether it's through dieting, careful meal prep or exercise. But at what point do these behaviors become disordered and cross over into anorexia nervosa or other eating disorders?

Anorexia nervosa and other eating disorders have less to do with the what—dieting, exercise, controlled eating—and more to do with the why: people with anorexia partake in extreme body-related behaviors because of their distorted and obsessional relationship with body-image.

Here we'll discuss the causes, symptoms and treatment options for anorexia nervosa, and hopefully remind the reader that this disorder is never their fault and that the hope of recovery is always available.

What is anorexia nervosa?

Anorexia nervosa is the deadliest eating disorder and among the most common, along with bulimia nervosa and binge eating disorder. And it's a mental health disorder that severely impacts someone's body image. As such, people with anorexia nervosa will engage in obsessional weight-restrictive behaviors out of an intense fear of gaining weight.

People with anorexia nervosa will experience one or more of the following:

• A constant perception of being overweight, even when dangerously underweight
• An obsession with and avoidance of caloric intake
• Excessive exercise to further limit and burn calories
• Purging behaviors like vomiting, use of laxatives or other diuretics
• Denial of low body weight and its dangers

If you've noticed these warning signs in yourself or others, it might be anorexia nervosa.

How is anorexia nervosa diagnosed?

According to the Diagnostic Statistical Manual-5, the authoritative guide for the diagnosis of mental health disorders, the following criteria must be met to diagnose anorexia nervosa:

• Restriction of energy intake relative to a person's requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health
• Intense fear of gaining weight or persistent behavior that interferes with weight gain
• Feeling disturbed by one's body weight or shape, and an unhealthy connection between self-worth and body weight or shape
• Persistent lack of recognition regarding the seriousness of low body weight

Symptoms of anorexia nervosa may mimic other health issues, so receiving an evaluation from a licensed professional is extremely important for an accurate diagnosis. And even if the criteria for anorexia nervosa are unmet, the assessment may indicate other eating disorders or disordered eating habits that will interfere with quality of life and deserve medical attention.

How common is anorexia nervosa?

Anorexia nervosa affects people of all ages, races, ethnic backgrounds and socioeconomic levels, but it usually appears in someone's teen or early adult years. This may be a partial result of puberty and its ongoing effects on a young person's body, as well as the social pressures within young peer groups to have a certain body weight and shape.

According to the National Institute of Mental Health (NIMH), the lifetime rate of diagnosis among females was estimated to be three times higher than males, with 0.9 percent of females reporting anorexia compared with 0.3 percent of males.

It's important to note: the statistics may underrepresent anorexia's prevalence because many study respondents downplay the severity of their symptoms or are reluctant to admit to them, especially males. In fact, experts believe that anorexia is increasing among males, and going undiagnosed at greater rates when compared with females.

What causes anorexia nervosa?

According to the NIMH, the exact cause of anorexia and other eating disorders is not fully understood, but research suggests a combination of factors, including:

• Genetic
• Biologic
• Behavioral
• Psychological
• Social

Other behavioral and situational risk factors that heighten the likelihood of anorexia nervosa include being an overachiever or perfectionist, or dealing with a transitional period like divorce, moving, changing jobs or schools, etc.

What are the symptoms of anorexia?

The emotional, behavioral and physical symptoms of anorexia are listed below.

Emotional symptoms of anorexia include:

• Intense fear of gaining weight
• Self-worth highly connected to one's body weight and thinness
• Difficulty recognizing the danger of food- and body-related behaviors
• Irritability or lack of emotion
• Social withdrawal
• Depression
• Anxiety

Behavioral symptoms of anorexia include:

• Using weight-loss supplements like laxatives
• Limiting food intake
• Lying about food consumption
• Wearing big/baggy clothing to hide thinness
• Wearing many layers of clothes due to low body temperature
• Not eating in front of others
• Eating only foods that are low in fat and calories
• Exercising obsessively
• Checking weight frequently, or looking for physical flaws in the mirror
• Creating food rituals, like spitting food out after chewing it

Physical symptoms of anorexia include:

• Extreme weight loss and thinness
• Weakening and thinning of bones
• Brittle hair and nails
• Insomnia
• Reduced sex drive
• For females, discontinuation of menstruation as the result of low body fat
• Yellowing of skin
• Infertility
• Heart problems
• Dizziness and fainting
• Low energy
• Organ failure
• Growth of fine hair all over the body, known as lanugo
• Severe constipation

Unfortunately, many people with anorexia initially dismiss concerns if they don't fit the stereotypical body type associated with very severe anorexia. But many individuals who don't appear to struggle with anorexia—with a BMI that approaches the "normal" range—still meet the diagnostic criteria and would benefit from treatment.

What are the differences between anorexia nervosa and bulimia nervosa?

Although there are a few similarities between anorexia and bulimia—the restricting and purging behaviors to manage body weight and shape—there are important differences that affect a person's diagnosis. Whereas people with anorexia engage mostly in food and calorie restriction, people with bulimia will often binge, consuming large amounts of food and calories in a short period of time before engaging in purging and weight-restricting behaviors. Many of the emotional symptoms are the same for both eating disorders, but some additional symptoms of bulimia nervosa include:

• Eating large amounts of food very quickly
• Engaging in body weight control measures like vomiting, fasting or excessive exercise
• Cycling between restriction of food intake and compensatory binging
• Stomach problems with digestion or acid reflux
• Chronic sore throat
• Severe dehydration
• Sensitive or decaying teeth
• Puffy face
• Bloodshot eyes or eyes with broken blood vessels

What are the complicating risks of anorexia?

Anorexia is a very serious mental illness, and people with anorexia often experience co-occurring mental health diagnoses like:

• Clinical depression
• Anxiety disorders
• Bipolar disorder
• Substance use disorders

When compared with their peers, adolescents and young adults diagnosed with anorexia nervosa also have a ten times greater risk of dying, and anorexia has the highest mortality rate of any mental disorder. Additionally, people with anorexia may suffer from or even die from the resulting medical conditions and complications associated with starvation. It's essential that people with anorexia receive proper and timely medical attention for higher chances of recovery and improved health outcomes.

Is treatment necessary to manage the symptoms of anorexia?

For people diagnosed with anorexia nervosa, their ongoing relationship with food is unavoidable. Even in recovery, people with anorexia are forced to confront their disorder and body image at least several times a day during meal times. This complicating trademark of eating disorders underscores the urgent need for professional help because a person with anorexia needs to fundamentally change the way they approach food and body image.

The first step is to consult a licensed eating disorder specialist to receive an assessment for diagnosis and treatment recommendations. From there, treatment, therapy and nutritional guidance will help a person correct their eating habits, form a healthier relationship with body image and enter into sustained recovery.

How effective is treatment for anorexia?

Like other mental health disorders, the effectiveness of anorexia treatment is greatly improved by early diagnosis and administration. A few factors will complicate treatment's efficacy, including:

• A person's willingness to accept treatment
• The existence of co-occurring mental health and physical disorders
• The variety of treatments available to effectively treat a person's anorexia and co-occurring disorders

Restoring healthy weight is an important part of treatment, but psychotherapy is necessary to help individuals address their distorted thoughts and beliefs about body size, self-worth, etc. A number of evidence-based treatments like cognitive-behavioral therapy and interpersonal therapy, along with other emerging medicines, show promising results and can help a person find their rightful path back to happiness and health.

If you have noticed unhealthy eating behaviors or suspect a potential eating disorder, please consult a professional to get expert advice and proper treatment. Disorders of all varieties are commonplace. Don't feel shame—whether it's anorexia or another eating disorder—and don't let it affect your livelihood, self-esteem or happiness. Help is always available.