Encyclopedia

Photo by Colin Logan

Overview
Symptoms
Diagnosis
Causes and Risk Factors
Epidemiology
Effects of Anorexia
Treatment Approaches
What can I do for myself?
Comorbidities
Summary
Infographic

 

Overview

Anorexia is a psychological disorder that affects an individual’s relationship with food and causes an unrealistic view of one’s body image. It affects both men and women of all ages but is more prevalent in women, with 0.3 – 1.0% of all women being affected. The age of onset tends to be mid to late adolescence, usually between 15 and 19 years old.

 

Symptoms
Anorexia creates an unrealistic view of one’s own body image - a person with Anorexia thinks that their body is much bigger than it actually is and may be very afraid of gaining weight. This distorted body image leads to excessive dieting in which the individual will try and lose weight by restricting their food intake, fasting, over-exercising, and/or purging food that is ingested.

Anorexia can therefore sometimes be categorized into 2 types;

1. Restricting type: weight loss achieved by restricting caloric intake (following diets, fasting, and over exercising)
2. Binge-eating/Purging type: weight loss achieved by vomiting or using laxatives/diuretics.

Anorexia is characterized by an unhealthy relationship with food where food is viewed as an enemy that will cause them to gain weight.

 

Physical symptoms

• Rapid weight loss without medical cause
• Menstruation stops
• Read about more physical symptoms in Effects of Anorexia Nervosa (link to section)

Psychological symptoms

• The belief that weight dictates self-worth.
• Fear of gaining weight.
• Distorted body image (thinking that you are fat even though others say you are not)
• Extreme fixation on body image (E.g. obsession with weight, clothing size or body shape. Frequent weigh-ins and attention to even very small fluctuations in weight).
• Weight loss is viewed as gateway to happiness (“I’ll be happy once I lose X lbs/kg”)
• Becoming thin is your only concern (health does not matter).
• Preoccupation with food (constant thinking about food even when restricting own intake).
• Feeling fat despite being underweight (overall or in certain places E.g. stomach, thighs).
• Critical of appearance (E.g. never thin enough).

Behavioral symptoms

• Restricting food intake, over-exercising and/or purging as ways to feel in control of your life and emotions.
• Obsessive counting and recording of intake (of calories, fat grams, nutritional information, etc).
• Food rituals (E.g. not eating in front of other people, chewing food and then spitting in out, cutting up food in specific ways).
• Pretending to eat or lying about eating.
• Denial of thinness (Denying that low weight is a problem. May try and hide weight loss through excessive drinking of water, concealing weights on one’s person or wearing baggy clothes).

• Use of laxatives, diuretics or diet pills.
• Vomiting after eating.
• Compulsive exercising aimed at burning calories, often to punish self for bingeing or eating “badly”.

[Read More]

 

Questions to ask yourself: (from here)

1.Does your weight dictate your self-worth?

2.Are you afraid of gaining weight?

3.Do you hide your eating habits from others? (Lie about how much you eat, eat in private, etc)

4.Do you restrict your food intake, over-exercise, or purge?

5.Do you think you’re fat even though others tell you you’re not?

6.Are your friends/family concerned about your appearance, weight loss, or eating habits?

 

Anorexia does not look the same in all people. You cannot tell by looking at someone if they have Anorexia or not! Cautionary signs of Anorexia can start a long time before any significant weight loss is noticed.

The crucial point is the REFUSAL to maintain a normal weight for your body type. [Read More]

 

Diagnosis
To be diagnosed with Anorexia Nervosa, an individual must display the following criteria as listed by the DSM-V:

• Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health).
• Intense fear of gaining weight or of becoming fat (even though underweight), or persistent behaviour that interferes with weight gain.
• Disturbance in the way one's body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Click here to view the changes made in the DSM-V criteria for the diagnosis of Anorexia Nervosa.

 

Causes and Risk Factors
Psychological risk factors and causes
People who develop Anorexia are often perfectionists and over-achievers who are highly critical of themselves and have low self-esteem.

Other personality traits that appear to have a role in Anorexia Nervosa (are either present before, during or after recovery of an eating disorder):

• Obsessive-compulsiveness (excessively careful, perfectionistic or fixated).
• Neuroticism (tendency to be in a negative state of mind for an extended period of time, and is characterized by moodiness, anxiety, worry, envy and jealousy). [Source]
• Negative emotionality (a tendency towards anxiety, depression and a poor response to stressful stimuli – the opposite of positive thinking).
• Harm avoidance (personality trait associated with excessive worrying, a pessimistic outlook, shyness, uneasiness and uncertainty – results in avoiding behaviors that have previously resulted in a negative outcomes).
• Traits associated with avoidant personality disorder (self-consciousness, extreme shyness and anxiety, hypersensitivity to criticism, and withdrall)
• Difficulty expressing feelings

 

Social risk factors and causes
Many cultures and societal norms put pressure on being thin, which can contribute to the onset and perpetuation of Anorexia. This includes certain activities that put an emphasis on a slim body type or particular weight (E.g. ballet, modeling, swimming or gymnastics) as well as the view portrayed in the media that thinness is attractive which can encourage Anorexia.

Family plays a major role in the development of Anorexia - parents who controlling and are critical of their own or their children’s appearance are particularly significant risk factors of Anorexia. Difficult family relationships are also risk factors for the development of Anorexia.

Stressful life events (E.g. abuse, puberty, going to college, breakup) can also trigger Anorexia.

 

Biological risk factors and causes
Some research suggests that Anorexia is inheritable – a girl who has a sibling with Anorexia is 10-20 times more likely to develop it herself. Genes related to metabolism, food intake, appetite, mood and reward-pleasure responses appear to be implicated the inheritance of eating disorders [Read More].

Brain chemistry also seems to play a role; people with Anorexia tend to have high cortisol levels (stress hormone) and low levels of serotonin and norepinephrine (hormones related to depression).

 

Epidemiology
0.3-1% of Canadians have Anorexia, and 40% of women with Anorexia are between 15 and 19 years old.   Between 5-20% of people with Anorexia eventually die from it [Read More]. But, at any given time, 10% or more of women report symptoms of eating disorders that do not satisfy full diagnostic criteria.

 

Effects of Anorexia Nervosa
Extreme calorie restriction may have terrible consequences. As restriction of food progresses the body goes into starvation mode in order to preserve energy, some of the following physical symptoms develop:

Anemia (low blood count), changes in brain chemistry that cause difficulty thinking/focusing, mood swings, irritability, poor memory, nausea, fatigue, etc., tooth decay, hair loss, menstruation stops, increase in chances of kidney failure and an increase in chances of heart failure.
Click here to read more about the effects of Anorexia Nervosa.

 

Treatment Approaches
Treatment tends to involve both nutrition education and psychotherapy. In cases where the Anorexia has persisted to the point where immediate medical attention is necessary for survival (extreme malnourishment or suicidal intent), the individual will be hospitalized until he/she has reached a less critical weight and/or is a healthy mental state.

In cases where the Anorexia exists alongside another disorder, pharmacotherapy (medication) may be prescribed alongside psychotherapy and nutrition education.

Nutrition education and psychotherapy are discussed in further detail in the next section (What Can I Do For Myself?).

 

What Can I Do For Myself?
Making the choice to seek help or confide in someone about Anorexia is a very difficult choice to make - many feel like Anorexia has such a hold over them that they will never break free. Recovery is possible.

Acknowledge that your obsession with your weight is a problem. Disregard the thoughts that tell you you’ll finally be happy once you reach a specific weight, and realize the amount of emotional and physical suffering that Anorexia has put you through. Try and grasp the fact that your fear of gaining weight is a symptom of your eating disorder. Confiding in someone who can support you as you try to recover can be very beneficial.

Surround yourself with people, places and activities that promote a positive body image. Constantly being exposed to society’s “ideals”, friends/family who are overly concerned with their appearance, and messages promoting body shaming and Anorexia can make recovery all that more difficult.

Don’t be afraid to seek professional help. Counseling for your eating disorder is an extremely important part of the recovery process - doctors and psychologists can help you develop a healthy relationship with food and a more positive body image, as well as helping you deal with stressful situations in your life that don't involve self-destructive habits. Learning new coping skills to deal with your emotions is a very important part of recovery. Nutritionists/dieticians can also teach you about healthy eating and assist in developing meal plans [Read More].

Because of the low prevalence of Anorexia, not as much research has been done on treatment options. However, the few trials that have been done suggest that an enhanced form of Cognitive-Behavioral Therapy (CBT-E) used to treat outpatients with Anorexia is successful in 60% of those individuals [Read More].

Anorexia is often present alongside other disorders, such as depression and anxiety, so implementing self-help strategies such as realistic thinking can indirectly improve your feelings of self-worth and help in recovering from your eating disorder.

 

Comorbidities
Individuals with other psychological disorders (especially substance abuse, depression, anxiety disorders and personality disorders) are at higher risk for developing an eating disorder.

 

Summary
Anorexia is a psychological disorder that affects an individual’s relationship with food, and causes an unrealistic view of one’s body image. It affects both men and women of all ages but is more prevalent in women, with 0.3 – 1.0% being affected. The age of onset tends to be mid to late adolescence, usually between 15 and 19 years old.

This distorted body image leads to excessive dieting in which the individual will try and lose weight by restricting their food intake, fasting, over-exercising, and/or purging any food ingested.

Click here to view the changes made in the DSM-V criteria for the diagnosis of Anorexia Nervosa.  There are psychological, social and biological risk factors and causes for Anorexia. Individuals with other psychological disorders (especially substance abuse, depression, anxiety disorders and personality disorders) are at higher risk for developing an eating disorder. Treatment tends to involve both nutrition education and psychotherapy.

Making the choice to seek help or confide in someone about Anorexia is a very difficult choice to make - many feel like Anorexia has such a hold over them that they will never break free of. Recovery is possible.

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