Patients who are diagnosed with anorexia nervosa often have an extremely low body weight, a pathological fear of becoming fat or gaining weight, and a distorted body image, which means that they believe they are overweight when they are underweight.
To be diagnosed with anorexia nervosa, patients meet the following three criteria listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5):
1) Restricting caloric intake to lose weight or maintain a low body weight
2) Maintaining a very low body weight due to an excessive fear of becoming fat
3) Having a disturbance in self-perception in terms of weight and body image or persistently being unable to recognize the severity of their low body weight
Two types of anorexia
Anorexia nervosa is divided into two subgroups based on the behaviors that the patient has exhibited over the past three months:
- Restricting type
- Binge eating/purging type
The restricting type of anorexia involves restricting caloric intake to maintain an extremely low body weight. Patients who have the restricting subtype may diet, fast and/or exercise excessively, but they have no current episodes of binge eating or purging behavior. Patients who self-induce vomiting or use medications such as enemas, laxatives or diuretics to eliminate excess calories from the body have the binge-eating/purging subtype.
The binge-eating/purging subtype of anorexia can easily be confused with bulimia nervosa. The main difference is in the person’s body weight. Unlike individuals with either type of anorexia, individuals with bulimia nervosa generally maintain a body weight that is at or above a minimally normal level.
These subtypes may overlap during the course of the disease and are used to describe current symptoms rather than past symptoms the patient has experienced.
Who is affected?
Anorexia nervosa can affect every person of every age, race, ethnicity and gender; however, the majority of patients affected are young females of middle to high socioeconomic classes. It is possible, yet very uncommon, for a woman to be diagnosed with anorexia at 40 years of age. Women with anorexia typically start to develop severe eating habits in their early teenage years. Environmental factors, personality traits and genetics can increase a person’s risk for developing an eating disorder.
Signs and symptoms
Many patients with anorexia present with accompanying signs and symptoms other than being excessively thin. Common signs and symptoms seen in patients with anorexia include:
- Dental caries
- Loss of menstrual cycles (amenorrhea)
- Excoriations (scratches and abrasions) on the knuckles
- Loss of hair or new growth of fine baby hair (called lanugo)
- Low body temperature
- Elevated heart rate
- Low blood pressure
- Disturbance in electrolytes
- Low bone mineral density
The death rate from anorexia is 12 times higher than that associated with all other causes of death in females aged 15 to 24 years. In the United States, the lifetime prevalence of anorexia is an estimated 0.3 to 1 percent; in women some studies have shown rates as high as 4 percent. The high risks associated with anorexia are what make anorexia treatment so important.
No definitive diagnostic tests are used for anorexia. The diagnosis of anorexia is based on the three diagnostic criteria mentioned above. Once a diagnosis is made, it is important to obtain a full blood chemistry panel to check for electrolyte imbalances such as phosphate, potassium and magnesium. An EKG should be obtained, as electrolyte disturbances can bring on cardiac arrhythmias, which can be dangerous and even deadly.
Eliminating food from the daily routine can have extremely harmful and even potentially lethal effects on the body. Some of the common health complications that affect patients with anorexia include:
- Electrolyte disturbances such as low potassium, magnesium and phosphate
- Fatal cardiac arrhythmias due to electrolyte imbalances
- Low bone mass, which can lead to osteoporosis
- Thyroid abnormalities
- Kidney stones
- Arrested growth
When treating patients with anorexia, it is important to introduce food very slowly while obtaining daily electrolyte panels. If food is introduced too much or too fast, refeeding syndrome can occur, which includes:
- cardiovascular collapse
- starvation-induced hypophosphatemia (low phosphate levels in the blood)
- dangerous fluctuations in potassium, sodium and magnesium levels
The initial goal of treating anorexia is to medically stabilize the patient and to correct or prevent any of the disease complications. Patients may need to be hospitalized depending on the severity of the disease and their support system.
Long-term therapy is needed to reestablish patients’ normal eating patterns, treat any associated psychological diseases and prevent relapse. Common psychiatric disorders associated with anorexia nervosa include obsessive-compulsive disorder, bipolar disorder and anxiety disorder.
Psychological treatments such as psychotherapy, cognitive behavioral therapy (CBT), family therapy, motivational enhancement therapy and many other approaches can be useful in the treatment of anorexia nervosa. Complementary treatments such as yoga, meditation, acupuncture and massage may also be helpful for improving well-being and reducing anxiety in patients with anorexia.
Medication therapy has not been found to be extremely helpful in anorexia treatment, although fluoxetine has been found to be generally helpful in patients who have been stabilized with weight restoration. Psychotherapy with adjunctive low-dose olanzapine may be useful for anorexia during inpatient treatment. Just like any other psychological disease, treatment may be a lifelong process.
Sovereign Health treats adult and adolescent women with anorexia nervosa and bulimia nervosa in our San Clemente and Rancho San Diego locations. For more information, please call our 24/7 helpline.