Anorexia Nervosa
Information about the causes, early symptoms, and prognosis of restrictive eating disorders.
Symptoms and Causes
Anorexia nervosa, commonly referred to simply as anorexia, is an eating disorder characterized by an intense pathological fear of gaining weight and a distorted perception of body image. As a result, individuals engage in various behaviors to prevent weight gain, even though their weight is often below the recommended level for their age, height, and sex.
There are two types of anorexia nervosa, depending on the patient’s behavior:
- Restrictive anorexia: based on strict caloric restriction through dieting and fasting.
- Purging or compulsive anorexia: a combination of food restriction and binge episodes compensated by vomiting, laxatives, or enemas, although it is not equivalent to bulimia.
Although often confused, bulimia and anorexia—even the purging type—are two distinct disorders. The main difference lies in body weight, as individuals with bulimia typically maintain a normal weight or may even be overweight. Moreover, fasting periods in anorexia are continuous, while in bulimia they are occasional.
Anorexia nervosa is a serious illness that, if left untreated, can be fatal. With proper treatment, patients can recover most of the lost weight and lead a normal life.
Symptoms
Patients with anorexia are typically very perfectionistic and demanding of themselves. They often present the following symptoms:
- Distorted body image: patients perceive themselves as overweight despite having a weight below the recommended range for their height and sex.
- Intense fear of gaining weight.
- Food restriction and fasting.
- Excessive exercise.
- Malnutrition.
- Calcium deficiency.
- Amenorrhea: absence of menstruation.
- Weakness.
- Gastrointestinal disturbances: diarrhea, constipation.
- Hypothermia or increased sensitivity to cold.
- Dry skin.
- Hair loss.
- Lack of concentration.
- Mood swings.
- Insomnia.
- Irritability.
- Sadness.
- Anxiety.
- Low self-esteem.
- Social withdrawal.
Causes
The specific causes of anorexia nervosa remain unknown, though it is believed to result from a combination of factors:
- Biological: family history of anorexia, personal history of being overweight.
- Personal (psychological vulnerability): perfectionism, introversion, low self-esteem, depression, anxiety, dieting.
- Family-related: family conflict, excessive concern about weight, overprotection, lack of affection.
- Cultural: social pressure to conform to beauty standards that equate thinness with attractiveness, weight-related harassment, bullying at school.
Risk Factors
Anorexia nervosa can affect anyone, but certain groups are at higher risk:
- Female sex.
- Between 12 and 25 years of age.
Complications
Some complications resulting from anorexia include:
- Anemia.
- Malnutrition.
- Hormonal and endocrine alterations: androgen or estrogen deficiency, amenorrhea, high cortisol levels, hypothyroidism.
- Low sodium, calcium, and potassium levels.
- Heart problems: heart failure, mitral valve prolapse.
- Kidney problems: renal failure, decreased glomerular filtration, fluid retention, increased urination.
- Osteoporosis.
- Loss of muscle mass.
- Depression.
- Obsessive-compulsive disorder.
Prevention
There is no definitive way to prevent anorexia, but promoting a healthy relationship with food and body acceptance can help reduce the risk of developing it.
Which Specialist Treats Anorexia Nervosa?
Anorexia nervosa requires a multidisciplinary approach involving clinical psychology, psychiatry, endocrinology and nutrition. The disorder is often first detected during family and community medicine or pediatrics.
Diagnosis
Family members and close friends play a key role in encouraging patients to seek medical help, as individuals with anorexia often deny their condition. Some warning signs include:
- Noticeable weight loss.
- Defensive attitude toward comments about physical changes.
- Rejection of high-calorie foods.
- Increased physical activity.
- Preference for eating alone.
- Excessive interest in the composition of foods.
Once at the consultation, specialists usually perform the following evaluations:
- Medical history (anamnesis): recording medical and family history and assessing the patient’s lifestyle habits.
- Physical examination: BMI, blood pressure, heart rate, auscultation, abdominal palpation, and inspection of eyes, skin, nails, and hair.
- Blood and urine tests: to assess overall health and rule out other medical conditions.
- Imaging tests: to determine whether weight loss is due to another underlying condition.
- Psychological evaluation: the specialist conducts an initial assessment and administers various tests to determine the level of impairment and potential triggers of the disorder.
Treatment
Treatment for anorexia should be multidisciplinary and personalized. It is usually led by a mental health specialist and focuses on the following key components:
- A plan to restore lost weight.
- Nutritional education program.
- Psychotherapy to address both the disorder itself and its underlying causes (bullying, anxiety, low self-esteem, depression). Includes individual, family, and group therapy (cognitive-behavioral therapy, motivational therapy).
- In some cases, pharmacological treatment to alleviate symptoms such as sadness, depression, anxiety, or impulsivity. This may involve antidepressants, anxiolytics, or antipsychotics.
- To address nutritional deficiencies, vitamin supplements and adequate caloric and fluid intake are administered.
- In severe cases, enteral nutrition through a nasogastric tube may be necessary to provide the nutrients required to combat malnutrition.
In most cases, patients attend outpatient treatment while continuing their daily routines. Only the most severe cases require hospitalization for closer monitoring.
