This article will address the symptoms, diagnosis, and management of the condition anorexia nervosa. Symptoms include calorie counting or restriction, an intense fear of weight gain, a distorted perception of weight, and a low body mass index, among others.
What Is Anorexia?
Anorexia nervosa is a type of eating disorder. Anorexia usually affects adolescents or adults. While weight loss is the primary feature of anorexia, this condition can affect many organ systems throughout the body. Symptoms include a preoccupation with food, a low body mass index, calorie counting and restriction, extreme exercise to avoid weight gain, as well as social withdrawal, depression and anxiety, and poor sleep quality, among others. Treatment involves nutrition rehabilitation and therapy.
You should visit your primary care physician who will coordinate care with a psychologist, counselor, or other mental health professional. It is important to monitor
- Calorie counting
- Calorie restriction
- Intense fear of weight gain
- Distorted perception of weight
- Low body mass index
Anorexia is considered a psychiatric condition and is oftentimes accompanied by other psychiatric stressors including:
- Intense pursuit of low body weight
- Preoccupation with food preparation
- Fear or restriction of certain foods
- Overuse of artificially sweetened foods
- Social withdrawal
- Regimented or intense exercise
- Poor sleep quality
- Low libido
- Depressed or anxious mood
An estimated 0.6 percent of Americans suffer from and the prevalence of this condition is estimated to be three times higher in women than in men. The median age of onset of this condition is 18 years.
While the exact physiologic changes in the brain leading the anorexia nervosa are not known, but higher prevalence in family members suggests that there are likely genetic components to the condition in addition to . While structural changes in the brain have been linked to anorexia, it is not clear yet whether lead to the development of the condition or result from it.
Based on the DSM-V, the medical text used for psychiatric conditions, a diagnosis of anorexia nervosa requires all three of the following:
- Restriction of energy intake leading to a low body weight
- Intense fear of gaining weight
- Distorted perception of body weight and shape
The DSM-V also has criteria for the severity of anorexia as follows:
- Mild: BMI 17 to 18.49 kg/m2
- Moderate: BMI 16 to 16.99 kg/m2
- Severe: BMI 15 to 15.99 kg/m2
- Extreme: BMI <15 kg/m2
It is generally recommended that the following are assessed if anorexia nervosa is suspected: Height and weight: These metrics are used to calculate an individual’s BMI.
- Frequency of self-weighing
- Meal patterns
- Present and past eating disorder symptoms
- Menstrual status: This evaluation includes the last menstrual period, regularity, and duration of periods.
- Prescription medications
- Co-existing psychiatric conditions
- A family history of eating disorders
Treatment Options and Prevention for Anorexia
Nutrition rehabilitation usually involves pre-set goals for weight gain and can be done on an outpatient or inpatient basis depending on your willingness to gain weight. Dietary plans usually follow a standardized framework of calorie distribution (45 to 65 percent calories from carbohydrates, 20 to 35 percent from fat, and 10 to 35 percent from protein). People with anorexia are often times deficient in vitamins as well and are usually given a multivitamin.
Risk of refeeding syndrome
The most commonly feared complication of treatment for anorexia nervosa is called refeeding syndrome. Refeeding syndrome can occur when the body has been in a state of starvation and then suddenly receives nutrition in an attempt to treat the condition. This sudden surge of energy intake in the form of food causes a release of insulin, which leads to shifts in the body’s stores of phosphate and potassium. Serious complications of refeeding syndrome include arrhythmias, cardiac arrest, or respiratory failure. Efforts to prevent refeeding syndrome usually entail a very gradual increase in calorie intake in order to allow the body to adapt. Some research also suggests that can help prevent refeeding syndrome including thiamine, folate, selenium, and zinc.
For people who do not gain weight despite therapy and nutritional rehabilitation, there is evidence to suggest the efficacy of the antipsychotic olanzapine.
There is evidence to suggest that education programs targeting certain societal pressures and drivers of a thin body can be effective in preventing the development of . Programs that have been studied address issues of idealization of thinness, body dissatisfaction, dieting, and body mass index.
When to Seek Further Consultation for Anorexia
If you are experiencing the symptoms described above, including fixation with weight loss and fear of weight gain, you should consult your physician. If you are suspected of having anorexia nervosa and are deemed medically unstable, you will likely be hospitalized and monitored until you are better. The criteria for medical instability :
- A pulse less than 40 beats per minute
- Blood pressure less than 80/60 mmHg
- Decrease in systolic blood pressure by 20 mm Hg when standing from sitting
- Abnormal heart rhythm
- Marked dehydration
- BMI <15 kg/m2
Questions Your Doctor May Ask to Determine Anorexia
- Do you have trouble sleeping?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Any fever today or during the last week?
- Have you experienced any nausea?
- How long has your current headache been going on?
- Attia E, Walsh T. Anorexia Nervosa. Merck Manual Consumer Version. Reviewed July 2018.
- Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61(3):348-358.
- Steinhausen HC, Jakobsen H, Helenius D, Munk-Jørgensen P, Strober M. A nation-wide study of the family aggregation and risk factors in anorexia nervosa over three generations. Int J Eat Disord. 2015;48(1):1-8.
- Phillipou A, Rossell SL, Castle DJ. The neurobiology of anorexia nervosa: A systematic review. Aust N Z J Psychiatry. 2014;48(2):128-152.
- Attia E, Walsh BT. Behavioral management for anorexia nervosa. N Engl J Med. 2009;360(5):500-6.
- Birmingham CL, Goldner EM, Bakan R. Controlled trial of zinc supplementation in anorexia nervosa. Int J Eat Disord. 1994;15(3):251-5.
- Stice E, Shaw H. Eating disorder prevention programs: A meta-analytic review. Psychol Bull. 2004;130(2):206-227.
- American Psychiatric Association. Practice guideline for the treatment of patients with eating disorders. 3rd ed. American Psychiatric Association; 2005.