What is Anorexia Nervosa?

Anorexia nervosa is a devastating illness, affecting millions of people each year. Anorexia nervosa is defined by the DSM5 (Diagnostic and Statistical Manual Version 5) as:

• Restriction of dietary intake relative to dietary energy requirement leading to a significantly low body weight in the context of age, sex, and physical health
• Intense fear of gaining weight or becoming fat
• Disturbance in the way in which one's body weight or shape is experienced, and persistent lack of recognition of the seriousness of the current low body weight.

Ninety percent of those diagnosed with anorexia nervosa are women. Estimated to affect 1% of adolescent females in the US, anorexia nervosa has one of the highest death rates of any mental health condition; 20% of whom die from suicide. Individuals with anorexia have a premature death rate that is more than 20 times higher than their peers who don't have an eating disorder.

Anorexia nervosa is often associated with other mental health conditions such as depression and anxiety. In addition to mental health conditions, people affected by anorexia may also develop digestive conditions (e.g., impaired gastrointestinal motility resulting in bloating, abdominal pain and constipation), heart complications (e.g. irregular heart rhythm, fainting), kidney disease, infertility, and osteoporosis.

How is Anorexia Nervosa treated? Can it be treated?

Treatment of anorexia nervosa and other eating disorders is best accomplished by an experienced multidisciplinary team including a physician, registered dietitian, and psychotherapist. Treatment is focused on understanding how an individual ended up with an eating disorder, how to get rid of the eating disorder, and how to not return to the eating disorder later in life. Medications have a limited role in the treatment of anorexia nervosa. There are no FDA (Food and Drug Association) approved medications for the treatment of anorexia nervosa, but a majority of those affected by this disease are taking psychotropic medication aimed at addressing mood disturbance and associated eating behaviors.

Since there is not an “anorexia-be-gone” pill, the primary treatment is provided by the dietitian and psychotherapist. Dietitians focus on helping their patient develop a healthy relationship with food, eating and body image, encouraging sufficient dietary intake and guiding appropriate weight gain. The therapist addresses the underlying causes of the eating disorder. A common thread for many affected by anorexia nervosa is the need for control. When something, or some things, are out of control, the one thing someone can control is their eating and body size, shape and weight.

Behaviors and symptoms

Early recognition and early intervention/treatment for anorexia nervosa is associated with better outcomes. Knowing early signs and symptoms of anorexia nervosa can help loved ones recognize the person at risk and get them into appropriate treatment. Behaviors and symptoms of anorexia nervosa include the following: skipping meals, eliminating food groups (e.g. not eating dairy, fat, meat, gluten containing foods), increased exercise, rigid eating – eating the same thing every day, refusal to eat in restaurants or outside the home. Commonly reported symptoms include: abdominal pain and/or bloating, decreased appetite, constipation, fatigue, amenorrhea (lack of menstrual periods), hair loss, dry skin, light headedness, and fainting.

Our society’s obsession with the female form, and especially tall, thin, willowy women is another driver for anorexia nervosa. Endless pictures of scantily clad celebrities online, on social media, and in magazines create unrealistic body image standards for women and girls. Efforts that promote healthy lifestyle and healthy body image in the media, at home, and in schools, can go a long way at reducing the pressure on young women to achieve unhealthy body size, shape and weight.