Anorexia – Causes, Symptoms, Treatments

What is Anorexia?

Anorexia nervosa, often simply referred to as anorexia, is a serious and potentially life-threatening eating disorder  characterized by self-starvation and an abnormal obsession with weight loss. People with anorexia restrict their food intake to the point where they become severely underweight. They often have a distorted body image, seeing themselves as overweight even when they are dangerously thin.

Anorexia can affect people of all ages, genders, ethnicities, and socioeconomic backgrounds. However, it is most common in adolescent girls and young women.

There are two main types of anorexia:

• Restrictive type: People with this type of anorexia severely restrict their food intake and may exercise excessively.
• Binge-purge type: People with this type of anorexia may also purge the food they eat through vomiting, laxatives, or diuretics.

Anorexia can have serious health consequences, including:

• Malnutrition
• Electrolyte imbalance
• Heart problems
• Kidney problems
• Bone loss
• Muscle wasting
• Amenorrhea (absence of menstruation)
• Depression
• Anxiety
• Suicidal thoughts or behaviors

Symptoms of Anorexia

Distorted Body Image is a hallmark symptom of anorexia. People with anorexia see themselves as overweight even when they are dangerously underweight. This distorted perception can be unshakeable by facts or compliments.

Extreme fear of weight gain is another distinct facet of Anorexia. Even the slightest weight gain can trigger immense anxiety and distress. This fear can become all-consuming, dictating thoughts and behaviors. People with anorexia may spend excessive time thinking about food, calories, dieting, and recipes. They may research weight loss methods or create elaborate food rituals and rules, gaining an obsession with food and weight control.

Often people will develop restricted eating habits. This involves severely limiting food intake, often skipping meals, eating very small portions, or avoiding certain food groups altogether. There might be a focus on “safe” or “healthy” foods with low calorie content. Despite being malnourished, individuals with anorexia may deny feeling hungry or ignore hunger cues. To hide their restricted intake, they might lie about how much they’ve eaten or pretend to eat normally around others.

A strong desire for control and a tendency towards perfectionism in regards to weight management and food can manifest in eating and exercise habits. Social situations involving food can become a source of anxiety, leading to isolation and withdrawal from friends and family.

Malnutrition and stress resulting from anorexia can contribute to mood swings, irritability, and are common with anorexia and can worsen the overall well-being. In severe cases, the emotional distress and negative self-image can lead to thoughts of suicide or self-harm.

Physical Symptoms:

• Rapid Weight Loss: This is a defining symptom of anorexia. Weight loss can be rapid and significant.
• Fatigue and Low Energy: Malnutrition leads to low energy levels, making it difficult to concentrate, participate in daily activities, or feel motivated.
• Dry and Brittle Hair and Nails: Nutrient deficiencies impact hair and nail health, causing them to become dry, brittle, and easily breakable.
• Thinning Hair or Hair Loss: Severe malnutrition can lead to hair loss on the scalp and other body parts.
• Skin Problems: Dry, flaky, or yellowing skin can be a sign of malnutrition.
• Difficulty Concentrating or Problems with Memory: Brain function can be impaired due to lack of essential nutrients.
• Feeling Cold Most of the Time: The body struggles to maintain its core temperature due to decreased metabolism and low body fat.
• Constipation: Restricted food intake and lack of fiber can lead to constipation and digestive difficulties.
• Irregular Sleep Patterns: Sleep disturbances like insomnia or excessive sleepiness are common.
• Slow Heart Rate and Low Blood Pressure: The heart becomes weak and struggles to pump blood efficiently.
• Muscle Weakness and Loss of Muscle Mass: The body breaks down muscle tissue for energy when food intake is insufficient.
• Amenorrhea (Absence of Menstruation): In females, hormonal imbalances caused by malnutrition lead to missed or irregular periods.

Causes of Anorexia

The exact cause of anorexia nervosa is unknown, but experts believe it’s a complex interplay of several factors. 

Having a family member with anorexia increases an individual’s risk. This suggests a possible genetic predisposition. Imbalances in brain chemicals like serotonin and dopamine, which regulate mood and reward, might also play a role.

Psychological Factors also play a significant role in causing anorexia. A need for control and a relentless pursuit of perfection can contribute to unhealthy eating habits and body image concerns. Anxiety and depression can worsen eating disorder symptoms and vice versa. People with anorexia might also use food restriction as a way to cope with difficult emotions or stressful situations.

The media and social media often portray unrealistic body image standards, which can fuel body dissatisfaction and unhealthy weight loss goals. 

Certain professions (ballet dancers, models) may emphasize thinness as a requirement, creating pressure and anxiety.

A history of trauma or abuse can increase the risk of developing an eating disorder as a coping mechanism. Major life changes like puberty, moving, or a death in the family can trigger the onset of anorexia in vulnerable individuals.

Potential Complications of Anorexia

Anorexia nervosa can have a devastating impact on the body due to severe malnutrition and starvation. 

1. Cardiovascular Complications:
   • Heart arrhythmias: Irregular heartbeats can occur due to electrolyte imbalances and disruption of electrical signals in the heart.
   • Slow heart rate (bradycardia): The heart slows down to conserve energy, putting a strain on the entire cardiovascular system.
   • Weak heart muscle: Malnutrition weakens the heart muscle, making it harder for it to pump blood effectively.
   • Increased risk of heart failure: In severe cases, complications can lead to heart failure, where the heart is unable to pump blood sufficiently.
2. Electrolyte Imbalances:
   • Electrolytes are minerals in the body that help regulate various functions like muscle movement and nerve transmission.
   • Malnutrition disrupts electrolyte balance, leading to problems like fatigue, muscle weakness, heart arrhythmias, and even seizures.
3. Gastrointestinal Complications:
   • Constipation: Restricted food intake and lack of fiber can lead to constipation and difficulty passing stool.
   • Bloating and abdominal discomfort: Digestive issues like bloating, nausea, and stomach pain can be common.
   • Gastroparesis: In severe cases, delayed stomach emptying (gastroparesis) can occur, causing nausea, vomiting, and malnutrition.
4. Bone Loss:
   • Anorexia significantly increases the risk of osteoporosis, a condition where bones become weak and brittle, raising the risk of fractures.
   • This is because the body lacks the essential nutrients needed for bone growth and maintenance.
5. Kidney Complications:
   • Chronic malnutrition can impair kidney function, putting a strain on these organs to filter waste products from the blood.
   • In severe cases, kidney failure can develop.
6. Reproductive Complications:
   • Women: Malnutrition disrupts hormone production, leading to amenorrhea (absence of menstruation). Fertility problems and irregular menstrual cycles are also common.
   • Men: Low testosterone levels can cause decreased sex drive, erectile dysfunction, and difficulty producing sperm.
7. Blood Cell Abnormalities:
   • Anorexia can lead to anemia, a condition where the red blood cell count is low, causing fatigue, weakness, and shortness of breath.
   • White blood cell count might also decrease, making the body more susceptible to infections.
8. Brain Abnormalities:
   • Chronic malnutrition can affect brain development and function, leading to problems with memory, concentration, and decision-making.
   • In some cases, brain atrophy (shrinkage) can occur.
9. Psychological Complications:
   • Depression, anxiety, and social isolation are common co-occurring conditions with anorexia.
   • These can worsen the eating disorder and vice versa, creating a vicious cycle.
10. Increased Risk of Suicide:
    • Anorexia nervosa has one of the highest mortality rates of any psychiatric disorder.
    • Suicide is a significant risk, particularly in cases with severe malnutrition, depression, and lack of support.

How is Anorexia Treated?

Anorexia requires a comprehensive treatment approach that typically involves a combination of medical, nutritional, and psychological interventions. As anorexia can lead to severe medical complications such as malnutrition, electrolyte imbalances, and organ damage, medical monitoring is crucial to address these issues. This may involve regular check-ups with a physician, monitoring of vital signs, blood tests, and other medical assessments.

Restoring and maintaining a healthy weight is essential in the treatment of anorexia. This often involves working with a registered dietitian to develop a structured meal plan tailored to the individual’s nutritional needs. Nutritional therapy aims to help the individual establish regular eating patterns and rebuild a healthy relationship with food.

Various forms of psychotherapy, such as cognitive-behavioral therapy (CBT), are commonly used in the treatment of this disorder. Therapy aims to help individuals understand the underlying factors contributing to their eating disorder, challenge distorted thoughts and beliefs about food and body image, develop healthier coping strategies, and improve self-esteem. Family-Based Treatment, also known as the Maudsley approach, is a specialized form of therapy for adolescents with anorexia nervosa. It involves active involvement of the family in the treatment process, with parents taking a central role in helping their child regain weight and normalize eating behaviors.

In some cases, medication may be prescribed to manage co-occurring symptoms such as depression, anxiety, or obsessive-compulsive disorder. However, medication alone is not typically sufficient as a primary treatment for anorexia nervosa and is often used in conjunction with other therapies. In cases of severe malnutrition or when outpatient treatment is not effective, hospitalization or residential treatment programs may be necessary to provide intensive medical and psychological care in a structured environment.

Recovery from anorexia nervosa can be a long and challenging process. Long-term follow-up with healthcare providers is essential to monitor progress, address any relapse risk factors, and provide ongoing support.

What Medications are most often prescribed for Anorexia

It’s important to understand that there are no medications specifically approved to treat anorexia nervosa. However, doctors may prescribe medications to address certain aspects of the illness or co-occurring conditions. Here’s a breakdown of what you might encounter:

• Antidepressants:  Medications like SSRIs (Selective Serotonin Reuptake Inhibitors) might be prescribed if the person with anorexia also struggles with depression or anxiety. These medications can help improve mood and reduce negative thoughts, which can indirectly support recovery efforts.
• Anti-Anxiety Medications:  In some cases, anti-anxiety medications like benzodiazepines might be used to manage severe anxiety that interferes with treatment or daily functioning. However, their use is generally discouraged due to potential dependence and addiction risks.
• Medications for Physical Complications:  Depending on the individual’s health status, medications might be needed to address electrolyte imbalances, bone loss, or other physical complications caused by malnutrition.