Anorexia Nervosa

Symptoms Of Anorexia Nervosa

 

Anorexia nervosa symptoms differ from person to person. The most prominent and visible symptoms are excessive weight loss and physiological changes.

Some of the common signs and symptoms of anorexia nervosa include:

1. Physical symptoms

Restricting the necessary calorie intake over time can have a devastating effect on your mind and body. If the adverse effects of starvation are left untreated and unnoticed over time, it can cause a permanent loss in the functioning of vital organs.

Some of the most common physical signs and symptoms of anorexia include:

• Extreme tiredness/fatigue

• Dry skin

• Insomnia or sleep disorder

• Thinning of hair

• Low blood pressure

• Discoloration of skin or pale skin

• Severe loss of muscle and weight

• Osteoporosis or loss of bone density

• Discoloration and brittleness of nails

• Constipation

• Emaciation or extreme thinness

• Lanugo or growth of soft hair all over the body

• Irregular heartbeats

• Infertility

2. Emotional and behavioral symptoms

Constant hunger can trigger unpleasant emotions such as anger and depression. Some of the warning signs of emotional and behavioral anorexia symptoms include:

• Low self-esteem

• Irritability

• Aversion to food

• Anxiety 

• Depression 

• Difficulty concentrating

• Suicidal thoughts

• Lack of interest or emotional flat-lining

• Mood swings

• Obsessive thoughts and social anxiety

• Exercising extensively  

• Avoidance of social gathering

• Denial of hunger

• Withdrawal from regular activities

• Feeling stressed

3. Cognitive symptoms

Not many people know that anorexia nervosa can also lead to cognitive symptoms such as:

• An obsession with counting calories and monitoring fat contents of food.

• Preoccupation with food, recipes, or cooking; may cook elaborate dinners for others, but not eat the food themselves or consume a very small portion.

• Admiration of thinner people.

• Thoughts of being fat or not thin enough.

• An altered mental representation of one's body.

• Difficulty in abstract thinking and problem solving.

• Rigid and inflexible thinking.

• Poor self-esteem.

• Hypercriticism and clinical perfectionism.

4. Perceptual symptoms

This condition can also affect how you perceive your body and can lead to self-criticism with respect to your weight and body. It causes: 

• Perception of self as overweight, in contradiction to an underweight reality (namely "body image disturbance" )

• Intolerance to cold and frequent complaints of being cold; body temperature may lower (hypothermia) in an effort to conserve energy due to malnutrition.

• Altered body schema (i.e. an implicit representation of the body evoked by acting)

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Causes Of Anorexia Nervosa

 

The specific reasons that cause anorexia nervosa are still unclear. But it is believed to be caused by multifactorial biological, environmental, and psychological factors. Some of the causing factors that increase a person’s risk of developing anorexia nervosa are as follows: 

1. Psychological factors

Anorexia nervosa, an overwhelming phobia of being a normal weight, is often believed to be associated with personality and behavioral traits. In most cases, anorexic people tend to seek perfection in their looks and body image. This can cause them to restrict their diet to the point of starvation to achieve unrealistic goals. 

Some other psychological factors that can contribute to the development of anorexia are as follows:

• Excessive fear and uncertainty

• Medical history of depression and anxiety

• Painful or traumatic childhood experience

• Reduced ability to regulate and adapt behavior as per different situations

• The feeling of inadequacy and loneliness

• Stressful life events such as accidents, loss of a loved one

2. Environmental factors

The current culture emphasizes being unrealistically thin as a beauty standard. This external pressure and competitiveness on achieving unhealthy body goals can increase the obsession to restricting vital food intake. 

3. Social media effects

Social media pressure and high social risk environments such as sports, modeling, and acting can contribute to the development of anorexia nervosa. Persistent exposure to media that present body ideals may constitute a risk factor for body dissatisfaction and anorexia nervosa. The cultural ideal for body shape for men versus women continues to favor slender women and athletic, V-shaped muscular men. A 2002 review found that, of the magazines most popular among people aged 18 to 24 years, those read by men, unlike those read by women, were more likely to feature ads and articles on shape than on diet. Body dissatisfaction and internalization of body ideals are risk factors for anorexia nervosa that threaten the health of both male and female populations.

Websites that stress the importance of attainment of body ideals extol and promote anorexia nervosa through the use of religious metaphors, lifestyle descriptions, "thinspiration" or "fitspiration" (inspirational photo galleries and quotes that aim to serve as motivators for attainment of body ideals). Pro-anorexia websites reinforce internalization of body ideals and the importance of their attainment.

The media portray a false view of what people truly look like. In magazines and movies and even on billboards most of the actors/models are digitally altered in multiple ways. People then strive to look like these "perfect" role models when in reality they are not near perfection themselves

4. Biological factors

The correlation between biological factors and anorexia is not clearly understood. However, a family history of anorexia, drug abuse, and co-existing health illness increases the risk of developing anoxia. Abnormalities in the structure or function of the hypothalamus, a part of the brain, can alter eating behaviors.

5. Genetic factors

Genetic or inherited predisposition, although the mechanism to extract responsible genes associated with anorexia is not well understood, research is being conducted to increase the understanding of the role of genes in anorexia. Anorexia nervosa is highly heritable. Twin studies have shown a heritability rate of between 28 and 58%. First-degree relatives of those with anorexia have roughly 12 times the risk of developing anorexia.

A 2019 study found a genetic relationship with mental disorders, such as schizophrenia, obsessive–compulsive disorder, anxiety disorder and depression; and metabolic functioning with a negative correlation with fat mass, type 2 diabetes and leptin.

One gene that has been linked to anorexia might be of particular interest. This gene codes for a protein called the estrogen related receptor alpha (ERRalpha). In some tissues, this gene alters the ability of estrogen and estrogen receptors to interact with DNA and change the function of cells.Since estrogen has potent effects upon appetite and feeding, any genetic abnormality in the estrogen signaling pathway could contribute to the symptoms of anorexia and explain why anorexia typically appears in young women just after the onset of puberty

Risk Factors For Anorexia Nervosa

Several factors can increase your risk of anorexia nervosa, from psychological factors, such as relationship break and life transition to type 1 diabetes. Anorexia nervosa can occur in both men and women but more in women, as they are more likely to develop negative body perceptions.

Anorexia nervosa is a complex psychological disorder. Like many other eating disorders, several risk factors such as biological, sociocultural issues, psychological triggers can increase the risk of developing it. 

Some of the most common risk factors associated with anorexia nervosa are listed below:

• Having a family history of an eating disorder. 

• Diabulimia, an eating disorder in a person with diabetes, wherein the diabetic individual purposefully restricts insulin therapy to lose weight.

• Extreme dieting and starvation can change the thinking pattern of vulnerable individuals and make them perpetuate their restrictive eating behaviors.

• Loneliness and boredom can bring psychological stress and increase the risk of developing anorexia nervosa.

• Age is also a factor. Although anorexia can occur in any age group, it commonly occurs during adolescence and puberty. 

Diagnosis Of Anorexia Nervosa

If you are experiencing any symptoms of anorexia nervosa, such as weight loss, increased obsession with body image, extreme dietary restriction, psychological stress, or increased fear of gaining weight, it is wise to consult a psychiatrist or nutritionist. Early diagnosis and prompt treatment for anorexia reduce the risks associated with its own.

Based on the severity and duration of your condition, your doctor might do some physical exams and a medical history analysis to rule out other mimicking health conditions. If the signs and symptoms are unclear, your physician may recommend one or a few tests to diagnose your condition.

1. Physical examination

Physical examination for anorexia nervosa may include:

• Evaluation of your physical appearances, such as dry skin, sunken eyes, and growth of smooth hair over the body

• Calculation of your body mass index (less than 17.5 in adults, or less than 85% of expected weight in children)

• Checking your vitals such as cardiac heart rate, blood pressure, the temperature of your body, and other signs of malnutrition in your body

• Examination of your abdomen for stretch marks and liver palpation

2. Psychological evaluation 

Psychological evaluation for anorexia may include:

• Behavioral pattern change analyses such as substance abuse, self-harming, or suicidal attempts.

• Analysis of your family or medical history of other psychological disorders. 

• Evaluation of your attitudes toward eating, appearance, and exercise.

DSM-5 guidelines

Anorexia nervosa is classified under the Feeding and Eating Disorders in the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). There is no specific BMI cut-off that defines low weight required for the diagnosis of anorexia nervosa.

The diagnostic criteria for anorexia nervosa (all of which needing to be met for diagnosis) are:

• Restriction of energy intake relative to requirements leading to a low body weight. (Criterion A)

• Intense fear of gaining weight or persistent behaviors that interfere with gaining weight. (Criterion B)

• Disturbance in the way a person's weight or body shape is experienced or a lack of recognition about the risks of low body weight. (Criterion C)

Relative to the previous version of the DSM (DSM-IV-TR), the 2013 revision (DSM5) reflects changes in the criteria for anorexia nervosa. Most notably, the amenorrhea (absent period) criterion was removed. Amenorrhea was removed for several reasons: it does not apply to males, it is not applicable for females before or after the age of menstruation or taking birth control pills, and some women who meet the other criteria for AN still report some menstrual activity

Levels of severity

Body mass index (BMI) is used by the DSM-5 as an indicator of the level of severity of anorexia nervosa. The DSM-5 states these as follows:

• Mild: BMI of greater than 17

• Moderate: BMI of 16–16.99

• Severe: BMI of 15–15.99

• Extreme: BMI of less than 15

3. Laboratory tests 

Although there is no specific confirmatory test for anorexia, assessment of your blood work may provide clues to determine any underlying health illness. 

Some of the common lab test used to diagnose anorexia are as follow:

• Blood sugar test: Diabetic patients, particularly type 1 diabetes mellitus patients, have an increased risk of developing anorexia.

• Electrolyte level test: It is done to determine the severity and effect of anorexia on your health condition.

• Complete blood count (CBC): This test may help your physician to determine the underlying cause of your anorexic condition.

• Comprehensive metabolic profile (CMP): This test measures 14 different parameters in the blood. The result of this test provides a picture of overall body chemical balance and metabolism. 

• Urine routine analysis: Medical evaluation of your urine sample can be used to determine a wide range of underlying disorders causing anorexia. This test also gives clues to your hydration and fluid intake levels.

• Electro-cardiogram studies: They are done to access your cardiac patterns and other related ailments. 

• Liver function test: A series of tests used to assess liver function some of the tests are also used in the assessment of malnutrition, protein deficiency

• Luteinizing hormone (LH) response to gonadotropin-releasing hormone (GnRH): Tests the pituitary glands' response to GnRh, a hormone produced in the hypothalamus. Hypogonadism is often seen in anorexia nervosa cases.

Prevention Of Anorexia Nervosa

Although there are no specific proven methods to prevent anorexia, some of the following measures and tricks can help you prevent and manage the symptoms caused by anorexia nervosa. These include: 

1. Early detection of anorexia

Anorexia has a multifactorial etiology, and it shares similar symptoms with other related psychological disorders. This makes the identification of the root cause of anorexia disease difficult. However, if the symptoms are recognized early, interventions can reduce the risk of complication and death.

2. Follow healthy eating habits

The malnutrition that accompanies anorexia may have seriously damaging effects on the body. One of the simple tips to overcome the risk of developing internal organ damage is to consume nutrient-rich food in small yet frequent meals. This is because eating a large amount of food is often easy at the early stages of anorexia. You can consult a dietitian or nutritionist to get an optimal diet plan to meet your body’s nutritional requirements.

3. Don’t consume alcohol

Drunkorexia is a term that denotes the behavior of replacing food consumption with excessive alcohol. A study published on Alcohol Health and Research World has reported the association of alcohol and effects on triggering eating disorder anorexia nervosa. According to various other related studies, the combination of alcohol and anorexia can cause serious, even potentially, deathly health complications. So, avoiding alcohol can reduce the risk of developing alcohol-related injuries.

4. Stop judging yourself

Anorexic people often seek to achieve perfection in everything they do. Though perfectionism is often seen as a positive trait, in most cases, it may cause unwanted pressure, stress, and other mental health issues. Working on accepting the present state of your body, weight, and physical appearance can effectively prevent the development of your negative self-perception.

5. Don’t encourage body shaming

When you allow someone to make harsh criticism of your body, it can hurt your self-esteem. Body shaming has become a prevalent issue on social media platforms. As with any other form of harassment, body shaming can severely affect a person’s mental health. Body shaming is unavoidable in the digital world, so try not to let negative comments affect you and practice self-love affirmations.

6. Be aware of anorexia and other related eating disorders

Anorexia nervosa has the highest death rate of all other mental illnesses. Becoming aware of the possible risk factors and triggers associated with anorexia can help you eliminate unwanted dissatisfaction with your self-image.

7. Seek professional help to understand your condition better

If you are experiencing any signs of anorexia or suspect having anorexia, fix an appointment with a doctor to understand your condition better. Early detection of the underlying root cause of anorexia allows for quicker action and recovery.

Do you know what foods to eat and what to avoid for anorexia? Are you aware of the common home remedies for anorexia? Do you have an idea about what lifestyle changes can be made to improve eating disorders? 

Specialist To Visit 

The signs of anorexia are not always visible from the outside. In most cases, people with anorexia often don’t realize their symptoms and deny having a problem. In such cases, the symptoms of anorexia can rapidly get worse or lead to serious health complications.

Early diagnosis of anorexia can increase the chance of complete recovery. So, if you are concerned about your mental health or experiencing any warning signs and symptoms of anorexia nervosa, it is always better to seek immediate medical assistance and eliminate the progression and associated risks.

Specialists that can help manage anorexia include:

• Primary care physician

• Nutritionist

• Psychiatrist

• Gastroenterologist

To get the right diagnosis, it is important to consult the right doctor. Consult India’s best doctors online.
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Treatment Of Anorexia Nervosa

The treatment of anorexia aims at restoring the body to normal weight and psychological and mental well-being. There are several therapies available to treat anorexia nervosa. However, the choice of treatment is determined based on the individual's age, complications, and health factors. In most cases, a combination of therapies is recommended to treat emotional issues such as low self-esteem, anxiety, and other related mental health problems.

Some of the common strategies to treat anorexia nervosa are as follows:

1. Psychotherapy

Psychotherapy can help anorexic people cope up with their mental health problems associated with anorexia. It helps the patient understand the issue in a better way and how to cope with it. Various forms of psychotherapy used to treat anorexia include:

• Family-based therapy (FBT): Also called the Maudsley method, it engages parents/family in the process of restoring their child to a healthy weight at home. The family as a whole is encouraged to engage more with the patient in ensuring a proper diet to gain a healthy weight.

• Cognitive behavior therapy (CBT): This therapy aims to improve mental health, and the primary focus is on addressing the distorted views on your body image.

• Dialectical behavior therapy (DBT): This therapy aims at recognizing the triggers and methods to manage the factors causing anorexia nervosa. DBT also helps patients in managing their mental health balance.

• Acceptance and commitment therapy: This therapy aims at developing self-motivation rather than changing your thoughts and feelings.

• Interpersonal therapy (IPT): This therapy helps patients to recognize and solve problems in their relationships. Improving relationships and mental health has been found to reduce eating disorder symptoms.

• Nutrition counseling: A counseling with a nutritionist can help you understand the importance of diet and restoring normal eating patterns.

2. Medications

There are no specific medications approved to treat anorexia because none has been found to work very well. However, antidepressants or other psychiatric medications can help treat other mental health disorders associated with anorexia. Some of the antidepressant drugs commonly prescribed by a psychiatrist to treat anorexia include:

• Cyproheptadine: Cyproheptadine is an antihistamine medication that blocks the chemical messengers responsible for itching, congestion, inflammation, and other allergic reactions. It also stimulates the appetite because of constant stimulation of growth hormone secretion and increased energy intake.

• Marinol: Marinol is a cannabinoid. Using this medicine regularly may improve your appetite and overall quality of life.

• Megestrol: Megestrol is a manufactured version of the human hormone progesterone. The use of megestrol can increase appetite.

• Olanzapine: Olanzapine is an atypical antipsychotic. It works by affecting the levels of chemical messengers (dopamine and serotonin) to improve mood, thoughts, and behavior.

3. Diet

Diet is the most essential factor to work on in people with anorexia nervosa, and must be tailored to each person's needs. Food variety is important when establishing meal plans as well as foods that are higher in energy density. People must consume adequate calories, starting slowly, and increasing at a measured pace. Evidence of a role for zinc supplementation during refeeding is unclear.

Home-care For Anorexia Nervosa

Recovery from anorexia nervosa can be challenging. However, with some nutritional and dietary changes, it is possible to reverse the effects caused by anorexia.

Here are some do’s and don’ts you can follow at home to manage your anorexia: 

Do’s 

• The use of micro nutritional supplements, including whole grains, citrus fruits, leafy greens, and more, is recommended for individuals with severe anorexia.

• Refeeding for significantly underweight individuals. It is a process where a person is given food after starvation or malnourishment. However, refeeding should be gradual and progressive.

• Take fresh juices to replenish your mineral and vitamin deficiency. 

• Stay hydrated. Try to consume at least 2-3 liters of water every day.

• Include fiber-rich foods such as beans, lentils, broccoli, berries, and avocados. 

• Include herbs such as cardamom, asafoetida, trikatu, quality-rich, and ginger in your diet.

Don’ts 

• Avoid aerated drinks and alcohol.

• Avoid intake of caffeinated drinks such as coffee and tea.

• Say no to refined food items like pasta, noodles, polished rice, and sugar.

• Avoid eating food items at unhygienic places.

• Do not overeat ready-made food items like canned or preserved food.

• Avoid eating high sodium and salt content food such as pickled meat, highly salted breakfast cereals, buns, cakes, packed soups, and sauces.

Complications Of Anorexia Nervosa

The medical complications associated with anorexia are as follows:

• Increased risk of cardiovascular problems, such as cardiac value complications, mitral valve prolapse, mitral valve prolapse, arrhythmia (abnormal heart rhythms), or heart failure

• Kidney problems, including issues with digestion

• Osteoporosis, in which the bones gradually decrease in density due to the development of pores

• Electrolyte imbalance such as decreased levels of sodium, potassium, and chloride in the body

• Eye problems such as lagophthalmos, a condition wherein the eyelids do not cover the eye during sleep. This condition can irritate and cause mild discomfort to the cornea in the eye. 

• Metabolic and endocrine complications such as thyroid abnormalities and infertility

• Amenorrhea, as the name suggests, is a condition that refers to the absence of menstruation

• Gastrointestinal problems such as nausea, bloating, constipation, or slowed gastric emptying

• Hematological disorders such as anemia (low RBC in the blood) or leucopenia (low WBC in the blood)

• A neurological complication of anorexia includes brain atrophy changes, resulting in mild mood disturbance to permanent memory loss

Other psychological complications of anorexia nervosa include:

• Obsessive-compulsive disorder (OCD), a condition characterized by repetitive or excessive thoughts

• Anxiety

• Personality disorder

• Drug or substance abuse

Alternate Treatment For Anorexia Nervosa

Ayurvedic Remedies For Anorexia

 

Here are a few herbal and natural methods that may help with anorexia nervosa:

1. Ginger (Adrak)

Ginger is loaded with benefits of antioxidant, antibacterial, antiviral, and anti-inflammatory properties. Add a pinch of lime juice and rock salt to the ginger juice. This stimulates your taste buds and also neutralizes excess gastric secretion.

2. Tamarind (imli) and salt

A mixture of tamarind and saltwater juice can be used to stimulate the taste receptors in the tongue. This, in turn, can trick your mind and grow your appetite.

3. Black cardamom (Badi elaichi) 

Black cardamom is rich in antioxidant and antispasmodic properties, so it can also be used to relieve the stress associated with eating disorder-anorexia.

4. Trikatu

Trikatu comprises three powerful herbs, namely black pepper (kali mirch), ginger (adhrakh), and long pepper (pippali). A combination of herbs helps in secreting gastric juices, which in turn ease indigestion and gas. You can take trikatu powder with water or with a tablespoon of honey.

Living With Anorexia Nervosa

Living with anorexia nervosa can make you feel dissatisfied with your body, leading to limiting calories intake, exercising excessively, or overusing medication to achieve unrealistic fitness goals. If untreated, the persistent fear of weight gain can cause serious physiological problems such as depression, suicidal thoughts, anxiety, and social aggression. Fortunately, early diagnosis and prompt treatment for anorexia reduce its risks and complications in most cases. 

Here are a few tips that can help you manage anorexia:

• Understand and recognize your triggers

• Check your vitals regularly

• Practice meditation or yoga

• Keep yourself engaged

• Stay hydrated

• Seek professional help if need

• Participate in support groups