Anorexia Nervosa

Anorexia Nervosa Definition

Eating disorders can have disastrous effects on a person's body and mind. According to the Balance Eating Disorder Treatment Centre's (2020) most recent statistics, anorexia nervosa has the highest mortality rate compared to other psychiatric disorders and affects around 1 in 250 women and 1 in 2000 men. Let's explore some anorexia nervosa facts to learn more about it.

A person with anorexia nervosa may become very underweight by over-exercising or suppressing their diet. People with anorexia often think they are overweight, even when this is not the case, and suffer from body dissatisfaction.

Anorexia Nervosa Facts

Psychologists have tried characterising the symptoms of anorexia nervosa to help trained professionals such as therapists. Therapists can then use these as guidelines when diagnosing patients with eating-related disorders.

The DSM is a manual by psychologists that lists the different mental illnesses and the characteristics that trained professionals should use to diagnose mental illnesses. According to the DSM-5, to be diagnosed with anorexia nervosa, patients must meet all of the following criteria:

• Fear of becoming fat or gaining weight.

• Have a distorted view of themself.

• Restricting how much they eat to stop them from gaining weight or help them lose weight.

Figure 1: How we view ourselves is one of many characteristics that can help psychologists identify if people have eating disorders.

The Symptoms of Anorexia Nervosa

Some examples of symptoms are:

• Overwhelming fears of gaining weight

• Body dissatisfaction

• Use of laxatives or other methods to get rid of calories after eating

• Weight and height under healthy levels for their age

• Lower BMI

• Poor circulation

• Sleep issues

• Dizziness and vertigo

• Frequent headaches

• Digestive issues

Bulimia vs Anorexia Nervosa

A similar eating disorder to anorexia nervosa is bulimia. Some of the symptoms overlap in the two eating disorders.

For example, it is common to see in bulimia low or distorted body image or fear of gaining weight. And even more, in both cases, the person's goal is to lose weight. However, the two eating disorders manifest differently.

People with bulimia usually consume excessive food in a short period. This is called binge eating, which is another eating disorder itself.

A binge eating episode is when an individual over-consumes many calories in a short period, even though they felt full a long time ago.

The main characteristic of bulimia is using methods of purging as a method to control weight gain. So a person with bulimia would eat a great amount of food quickly and then get rid of the food to avoid gaining weight. This is usually done by taking laxatives or forcing oneself to throw up.

A way a person with bulimia may try to control weight gain is through extreme exercise. This is a non-purging type of bulimia in which the person would engage in frequent and high-intensity exercise practices. Although the person may have consumed a lot of food, these sports practices usually involve a higher caloric deficit than the food intake.

Atypical Anorexia Nervosa

Atypical Anorexia Nervosa is a type of anorexia nervosa, and they both share the most common symptoms. The main characteristic of atypical anorexia nervosa is that the person suffering from the disorder presents a weight within or above the normal range. These individuals are not as lean as those suffering from anorexia nervosa and do not show such a significant weight loss.

In anorexia nervosa, the weight loss of those suffering from it can be detrimental to their health. These individuals may reach the point where their body organs cannot continue their regular functioning, leading to serious health issues. Differently, atypical anorexia nervosa does not put individuals at such risk in the short term.

Causes of Anorexia Nervosa

Among psychologists, there are disagreements on what factors cause the onset of eating disorders. For example, biological psychologists argue that our genetic makeup causes such illnesses. In contrast, cognitive psychologists explain anorexia in terms of faulty thoughts.

Anorexia Nervosa: Biological Explanation

Family studies and twin studies show that genes influence the onset of eating disorders. Research has found individuals have a higher risk of developing anorexia if an immediate family member has the same eating disorder (Strober, Freeman, Lampert, Diamond & Kaye, 2001).

Twin studies found a 56% concordance rate in Monozygotic twins (identical, have the same genes) and 5% in dizygotic twins (share 50% of the same DNA) for anorexia nervosa (Holland, Sicotte & Treasure, 1988).

Specific genes have been linked to anorexia. We inherit our genes from our parents; a variant of the EPHX2 gene has been linked to anorexia. Anorexia nervosa affects more women than men, and women are more likely to report weight dissatisfaction than men.

The hypothalamus sends signals to the brain when we are hungry. However, research has shown disruptions in neural connections in the hypothalamus. Therefore, the brain may not be able to receive hunger signals well and, over time, cause the onset of anorexia. This is called the dual-centre theory of hypothalamic dysfunction.

Dopamine is involved in reward-motivated behaviour. This theory suggests people with anorexia nervosa may have high amounts of dopamine, which causes anxiety. They may not seek pleasure, e.g. eating tasty food, so they can carry out avoidant behaviour not eating food.

Neurodevelopmental (e.g. birth complications) abnormalities may also play a role in developing anorexia. Several birth complications have been associated with anorexia, including maternal anaemia (iron deficiency), premature heart issues, and diabetes.

Anorexia Nervosa: Cognitive Explanation

There are multiple cognitive theories exploring anorexia nervosa.

Fairburn et al. (1999) found perfectionism to be a common trait amongst those with anorexia nervosa when compared to other psychiatric disorders. Grave importance, especially in western society, is placed on controlled eating, and self-worth is judged based on shape and weight.

The traits mentioned above can then lead to the following dysfunctional cognitive patterns:

Under this psychological pressure, the person is easily influenced and sensitive. If someone gives them positive feedback about their weight, it encourages them to continue this maladaptive behaviour. Or, if the person starts on a restrictive diet and does not lose weight, this leads to negative feedback and may cause them to believe they need to be even more restrictive.

Treatment of Anorexia

Just as treating other psychiatric conditions, the treatment of eating disorders is complex. Usually, the treatment is supported by doctors and psychiatrists, psychologists or psychotherapists and the patient's family.

In most cases, eating disorders require the patient to be admitted to a hospital or clinic. This is usually done because doctors cannot guarantee patients' well-being outside the facilities or because other treatments do not work. Patients in hospitals and clinics usually participate in individual and group therapy. At the same time, they are given medicines and are encouraged to eat and gain weight. Additionally, individuals can be supported and taught how to cope with anxiety, stress and anger management.

In less extreme cases, individuals may benefit from family therapy and medication. Generally, patients who are not admitted to a clinic need to regularly talk to the doctor and attend check-in sessions in which their weight is checked, and they are supported in their recovery.