What Is Anorexia Nervosa? Symptoms, Causes and Treatment Methods

Anorexia nervosa is a complex eating disorder that affects a person both physically and mentally. It can be described as an abnormal loss of appetite for food. Loss of appetite can lead to unhealthy weight loss and dangerous emaciation. It may result from cancer, AIDS, a mental disorder or various diseases. Although people with anorexia are often extremely thin, they may complain of being overweight, eat by counting calories, skip meals, and feel better when they see themselves as thin. It can cause unwanted conditions such as depression, constipation, bloating and abdominal pain. Treatment of anorexia is provided through the simultaneous interventions of mental health and nutrition specialists. Various nutritional supports and psychotherapy methods are included in the treatment procedures.

What Is Anorexia?

Anorexia, also known as anorexia nervosa, is an eating disorder characterized by self-starvation and weight loss, resulting in low weight for age and height. Many people with anorexia fear gaining weight or believe they are overweight. The body mass index of adults with anorexia nervosa is typically below 18.5. Anorexia is a health problem that can occur in both sexes and in all age groups, but 80% to 90% of patients are women. It has a prevalence of 0.3% among young women. It is known to be twice as common in women in adolescence, and the average age of onset is 15. Various studies have shown that eating disorders can also develop in women of middle age or older. Anorexia is divided into three subtypes. These are the restrictive type, the binge-eating and purging type, and atypical anorexia. The following information can be given about the types of anorexia:

Restrictive type: This is the type in which the person severely restricts food intake. It is the most common of the anorexia types. Restrictions can occur through obsessive and rigid rules, such as counting low calories, reducing the types of food eaten, limiting the number of meals, or eating only foods of one color. Excessive exercise may also accompany these behaviors.

Binge-eating and purging type: In addition to restriction in eating habits, this type of anorexia includes vomiting behaviors that accompany regular and excessive eating. Patients may induce vomiting themselves, or aim for weight loss by misusing excessive exercise, laxatives, diuretics and enemas. Incorrect use of these medications without medical supervision can lead to very risky situations.

Atypical anorexia nervosa: Atypical anorexia is a type of eating disorder called “other specified feeding or eating disorders.” This type includes all the behaviors of anorexia nervosa, but the body mass index is normal or above normal. That is, the patients’ weights do not fall into the low category.

What Are the Symptoms of Anorexia?

Anorexia is an eating disorder that can lead to serious health problems. It has the highest mortality and suicide rates among all other mental health disorders. Therefore, it is very important to take any warning sign or symptom of this eating disorder seriously. Symptoms of anorexia may go unnoticed in some cases, because patients tend to hide their weight loss, eating habits and physical problems. Symptoms of anorexia nervosa may appear in physical, psychological and behavioral categories.

Physical symptoms:

Neurological symptoms such as headache, fainting, dizziness, concentration problems and mood changes,

Cardiovascular and blood symptoms such as poor blood circulation, irregular and slow heartbeats, very low blood pressure, heart failure and low iron levels (anemia),

Hormonal problems such as irregular or absent menstruation, low libido and infertility,

Hair and skin problems such as dry skin, thinning hair, brittle nails, easy bruising, pale skin, fine white hair growth on various parts of the body, and intolerance to cold,

Bone and muscle health problems such as calcium loss in the bones (osteopenia), osteoporosis, muscle loss, weakness and fatigue,

Dehydration and kidney failure,

Tooth wear,

Not feeling hunger, or feeling full very quickly after a restricted diet,

Constipation, diarrhea, bloating and abdominal pain.

Behavioral symptoms:

Constant or repeated dieting,

Restrictive or rigid eating patterns,

Excessive and compulsive exercise,

Obsessive habits related to food,

Excessive focus on clean and healthy eating,

Preferring low-fat and low-calorie foods,

Changes in food preferences,

Repetitive and obsessive body-checking behaviors,

Skipping meals,

Dressing in layers to hide perceived flaws in the body,

Sleep problems,

Decline in school or work performance,

Avoiding social situations involving food and social withdrawal,

Making up excuses not to eat.

Psychological symptoms:

Preoccupation with body shape, weight and appearance,

Fear of gaining weight,

Being excessively preoccupied with activities related to eating,

Feeling anxious at mealtimes,

Negative or distorted body image,

Perceiving oneself as overweight despite being healthy or underweight,

Decreased self-esteem,

Mood changes, anxiety or depression,

Increased sensitivity to criticism about body shape, weight, appearance, eating and exercise habits,

Thoughts or behaviors of suicide and self-harm.

How Does Anorexia Develop?

The exact cause of anorexia nervosa is not fully known. Apart from being female, various risk factors may trigger the development of this disorder. These risk factors may arise from biological, psychological or social causes:

Biological risk factors:

Various studies have shown that anorexia may be 50% to 80% genetically heritable. The likelihood of developing anorexia is 10 times higher in people with first-degree relatives who have an eating disorder.

Neurotransmitters, which are chemical messengers, and the brain’s reward mechanism may cause changes in brain chemistry. Neurotransmitters such as serotonin and dopamine can affect appetite, mood and impulse regulation. This may lead to various eating disorders.

Some studies have shown that women with autism are more likely to develop anorexia. In these studies, it was found that 20% to 35% of women with anorexia meet the diagnostic criteria for autism.

Psychological risk factors:

Physical abuse and emotional trauma may contribute to the development of an eating disorder.

Perfectionism, impulsive behaviors and difficult relationships may lead to a decrease in a person’s self-esteem. This may make the person vulnerable to developing anorexia.

Experiencing ridicule and pressure over appearance or weight, especially due to bullying during childhood and adolescence, may contribute to the development of anorexia.

Social risk factors:

Body shapes considered ideal by social media and popular culture, social norms and anxiety about conforming to these norms may cause anorexia to develop.

In some professions, such as dancers, models and athletes, specific body shapes are required, and this may trigger eating disorders.

How Is Anorexia Diagnosed?

Anorexia is usually suspected when it is noticed by family, friends and others in the social environment. Symptoms such as depression, obsessive eating habits, infertility or irregular menstruation, which appear when weight loss is well hidden, are noticed by those around the person. At this stage, family members encourage the person to seek medical consultation. Patients may refuse to accept help. Basic medical examinations are performed during the health professional’s evaluation. The diagnosis can be confirmed through diagnostic procedures such as blood tests, electrocardiography, weighing the patient, calculating body mass index and mental assessment. Briefly, the methods used to diagnose anorexia can be described as follows:

Physical examination: During the physical examination, the patient’s height, weight, body temperature, heart rate, blood pressure, stomach, skin and nail health may be checked. A medical history is collected by asking various questions about eating and exercise habits, menstrual cycle processes, medications used, and whether there is an existing mental health problem.

Laboratory tests: Although there is no specific test for anorexia diagnosis, protein and electrolyte levels in these body fluids can be checked using various blood and urine tests.

Organ function tests: Depending on the patient profile, tests may be requested, such as bone density measurement with imaging tests and heart health assessment with electrocardiography.

Mental assessment: To diagnose weight loss not based on a physical cause, physicians may refer the patient to psychiatrists and psychologists. Mental health specialists may diagnose anorexia nervosa based on the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders. Diagnostic criteria for anorexia nervosa include restriction of calorie intake leading to weight loss or failure to gain weight, fear of gaining weight or becoming fat, and a distorted view of the seriousness of one’s health condition.

How Is Anorexia Treated?

Medical consultation should be sought as soon as possible after severe symptoms of anorexia are noticed. Health professionals may consider working simultaneously with nutrition specialists and mental health specialists in order to apply the treatment procedures most suitable for the patient’s condition. Treatment goals include reaching a healthy weight, coping with emotional problems such as low self-esteem, improving thought patterns and developing long-term behavioral changes. Anorexia treatment usually includes the following combinations:

Psychotherapy: Talk therapy, cognitive behavioral therapy and behavioral therapy focus on changing the patient’s thoughts and behaviors. Various strategies are applied in psychotherapy to develop healthy attitudes toward eating and weight.

Medication: Various antidepressant medications may be prescribed by doctors to control anxiety and depression associated with anorexia. Some antidepressants can relieve sleep disorders and increase appetite.

Nutritional counseling: A dietitian or nutrition specialist may be consulted to learn about nutrition and healthy eating behaviors.

Medical care: Long-term medical care may be needed to monitor fluid loss and nutrient levels. In severe cases, the use of a feeding tube or nutrition through a vein may be considered necessary. Hospitalization may be considered necessary for patients with severe weight loss and inadequate nutrition. Being in hospital may also be beneficial in managing other serious complications such as heart problems, severe depression and suicide risk.

Frequently Asked Questions

Anorexia nervosa is an eating disorder that can affect all of society. However, being female and being in adolescence are among the factors that can increase the risk of developing anorexia. For this reason, anorexia is more frequently seen in young women. The amount of calories consumed during the day by anorexia patients varies from person to person. However, all patients generally have eating habits that are far below their daily calorie needs. Excessive weight loss may develop due to eating disorders such as anorexia nervosa and bulimia nervosa, chronic diseases such as hyperthyroidism and diabetes, cancer, chronic infections, psychological problems, and gastrointestinal diseases such as Crohn’s disease and ulcerative colitis. Depending on the underlying cause of anorexia, many branches play a role in diagnosis and treatment. Psychiatry, dietetics and nutrition, clinical psychiatry and eating disorder centers are departments specializing in eating disorders. These branches support the patient’s recovery by addressing both the psychological and physiological symptoms of anorexia. Extreme thinness may lead to unwanted complications such as bone and muscle loss, anemia, heart problems, absence of menstruation, a drop in testosterone levels, nausea, bloating and constipation, kidney problems, various organ damage, depression, anxiety, suicide attempts, and substance and alcohol use disorders. Anorexia can arise from many factors, such as genetic predisposition, past physical and emotional trauma, being raised by controlling and overprotective parents, perfectionism, a socially accepted ideal body image, and various physical and mental health problems. Both anorexia and bulimia are among the eating disorders. The difference between anorexia and bulimia stems from differences in eating habits. Anorexia is characterized by not eating enough, while bulimia is characterized by overeating. Bulimia patients vomit out of regret for uncontrolled eating, or try to eliminate food by misusing various medications. Anorexia can lead to heart health problems such as heart failure and arrhythmia, digestive problems such as constipation, diarrhea and stomach problems, musculoskeletal diseases such as osteoporosis and muscle weakness, weakened immune system, neurological problems and kidney diseases. The weights of anorexia patients vary from person to person. The key indicator is not weight, but the body mass index, which gives the ratio of weight to height. Body mass index in anorexia is usually below 18. Diarrhea is a complication listed among the symptoms and side effects of anorexia nervosa.

Anorexia nervosa is an eating disorder that can lead to serious health problems in all age groups. Especially when it occurs in childhood and adolescence, it can cause serious complications such as stunted growth, impaired organ function and psychological breakdown. One of the most serious outcomes of anorexia is an increased risk of suicide. Therefore, if someone close to you shows signs of anorexia, it is of great importance to consult a health professional without delay.

At Hisar Hospital, we adopt a multidisciplinary approach to anorexia nervosa and other eating disorders. With our experienced team of psychiatrists, nutrition specialists and internal medicine physicians, we plan the diagnosis, treatment and follow-up processes individually for each person. With psychotherapy, nutritional counseling and, when necessary, medical treatment approaches, we offer our patients a healthy recovery process.

If you would like more information about the symptoms, causes and treatment process of anorexia nervosa, you can contact the Hisar Hospital Nutrition Department for a personal assessment and appointment, or apply easily through the online form.