Anorexia means a loss of appetite or the inability to eat, and it can be a symptom of various diseases. When a person has anorexia nervosa, they intentionally restrict their food as part of a serious and potentially life threatening mental health disorder. This often involves emotional challenges, an unrealistic body image, and an exaggerated fear of gaining weight.

Who does anorexia affect?

Anorexia can occur in people of any age, sex, gender, race, gender, ethnicity, sexual orientation and economic status and individuals of all body weights, shapes and sizes. Anorexia most commonly affects adolescents and young adult women, although it also occurs in men and is increasing in numbers in children and older adults.

How common is anorexia?

Eating disorders affect at least 9% of the worldwide population, and anorexia affects approximately 1% to 2% of the population. It affects 0.3% of adolescents.

What is the difference between anorexia and bulimia?

Anorexia nervosa and bulimia nervosa are both eating disorders. They can have similar symptoms, such as distorted body image and an intense fear of gaining weight. The difference is that they have different food-related behaviors.

People who have anorexia severely reduce their calorie intake and/or purge to lose weight. People who have bulimia eat an excessive amount of food in a short period of time (binge eating) followed by certain behaviors to prevent weight gain. Such behaviors include:

• Intentional (self-induced) vomiting.
• Misuse of medications such as laxatives or thyroid hormones.
• Fasting or exercising excessively.

People with bulimia usually maintain their weight at optimal or slightly above optimal levels whereas people with anorexia typically have a body mass index (BMI) that is below 18.45 kg/m2 (kilogram per square meter).

Symptoms of Anorexia Nervosa

Those with anorexia nervosa lose weight and maintain their extremely low weight in different ways. While some put severe restrictions on their calorie intake, others exercise excessively. Some employ a binge and purge method similar to that used by those with bulimia. Others use laxatives, vomiting, or diuretics to rid themselves of calories. If you have anorexia nervosa, your symptoms may include:

• inability to maintain a normal weight
• fatigue
• insomnia
• skin that is yellow or blotchy and covered with soft, fine hairs
• hair thinning or falling out
• constipation
• more than three cycles without a period
• dry skin
• low blood pressure

You may also notice behaviors such as:

• excessive exercise
• pushing food around the plate instead of eating it, or cutting food into small pieces
• irritability
• withdrawal from social activities
• depressed mood
• hunger denial
• use of diuretics, laxatives, or diet pills

What Causes Anorexia Nervosa?

The exact cause of anorexia nervosa isn’t known. People who develop anorexia may have a negative body image. They may be focused on being “perfect.” They may be looking for ways to control their lives. Other factors like biology, environment, and psychology are believed to play a role.

Biology

Genetics and hormones might have an effect on the development of anorexia nervosa. Some evidence suggests a link between anorexia and serotonin, a chemical produced in the brain.

Environment

Pressure from society to look thin may also contribute to the development of anorexia nervosa. Unrealistic body images from media outlets like magazines and television can greatly influence young people and spark the desire to be thin.

Psychology

Someone with obsessive-compulsive disorder (OCD) might be more predisposed to maintaining the strict diet and exercise regimen that those with anorexia nervosa often maintain. That’s because people with OCD are prone to obsessions and compulsions.

How Is Anorexia Nervosa Diagnosed?

Your primary care provider will perform a physical exam to check your blood pressure and heart rate. They will also do a psychological exam or refer you to a mental health professional who will ask about your eating habits and feelings. They will look for any criteria that show:

• you are restricting food intake
• you have fear of gaining weight
• you have problems with body image

Your primary care provider may also order certain laboratory tests. Blood tests may be ordered to check your electrolyte levels and liver and kidney function. In addition, your primary care provider may check your bone density and look for heart irregularities.

Your primary care provider may also order other laboratory tests to rule out other possible causes for weight loss, such as celiac disease and inflammatory bowel disease.

Treatment and recovery

A healthcare professional will make a comprehensive plan to address the individual’s specific needs.

It will involve a team of specialists who can help the person overcome the physical, emotional, social, and psychological challenges that they face.

Strategies include:

• cognitive-behavioral therapy (CBT), which can help the person find new ways of thinking, behaving, and managing stress
• family and individual counseling, as appropriate
• nutritional therapy, which provides information on how to use food to build and maintain health
• medication to treat depression and anxiety
• supplements to resolve nutritional deficiencies
• hospital treatment, in some cases

It can be challenging for a person with anorexia nervosa to engage in treatment. As a result, the person’s participation in therapy may fluctuate. Relapses can occur, especially during the first 2 years  of treatment.

Family and friends can provide crucial support. If they can understand the condition and identify its signs and symptoms, they can support the individual during recovery and help prevent a relapse.

Hospital treatment

The person may need to spend time in the hospital if they have:

• a severely low BMI
• malnutrition
• complications due to inadequate food intake
• a persistent refusal to eat
• a psychiatric emergency

Treatment will allow for a gradual increase in food intake to restore overall health.

Complications

Complications can affect every bodily system, and they can be severe.

They include problems with:

• the cardiovascular system
• the blood, such as a low white or red blood cell count
• the digestive system
• the kidneys
• hormonal imbalances
• bone strength

Some of these issues can be life threatening. In addition to the physical effects of poor nutrition, the person may have an increased risk of suicide.

In fact, anorexia nervosa has the highest  mortality rate of all mental health conditions.

For this reason, early diagnosis and treatment are essential.

Prevention

Eating disorders can be caused by a variety of factors and there is currently no known way to prevent the development of anorexia nervosa.

However, recognizing the symptoms and seeking treatment early can help improve the chances of recovery.

According to the National Eating Disorders Association, prevention programs aimed at reducing factors for eating disorders could also be beneficial.

These programs typically involve changing public policy, encouraging people to question diet culture and the media, promoting body acceptance, and replacing restrictive diets with practices like intuitive eating.

How to support a loved one

It can be difficult for friends and family to approach someone they love with an eating disorder. They may not know what to say, or worry about isolating the person.

If you notice that someone you love is exhibiting signs of an eating disorder, however, speak up. Sometimes people with eating disorders are afraid or unable to ask for help, so you’ll need to extend the olive branch.

When approaching a loved one, you should:

• Pick a private location where you can both talk openly without distractions.
• Choose a time when neither of you will be rushed.
• Come from a loving place instead of an accusatory one.
• Explain why you’re concerned, without judging or criticizing. If possible, refer to specific situations and elaborate on why it caused concern.
• Share that you love them and want to help however they may need.
• Be prepared for some denial, defensiveness, or resistance. Some people may get mad and lash out. If this is the case, try to stay calm and focused.
• Be patient, and let them know that if they don’t want help now, you’ll be there if anything changes.
• Go into the conversation knowing some solutions, but don’t suggest them off the bat. Only share resources if they’re open to taking next steps.
• Encourage them to get help. Offer to help them find a therapist or go with them to the doctor if they’re scared. A doctor’s visit is crucial to help someone with an eating disorder get on track and to make sure they’re getting the treatment they need.
• Focus on their feelings instead of physical descriptions.

There are also a few things that you should avoid doing:

• Don’t comment on their appearance, especially as it relates to weight.
• Don’t shame someone about their potential disorder. To avoid this, use “I” statements like “I worry about you” instead of “you” statements like “You’re making yourself sick for no reason.”
• Don’t give medical advice you aren’t equipped to give. Saying things like, “Your life is great, you have no reason to be depressed” or “You’re gorgeous, you don’t need to lose weight,” do nothing to address the problem.
• Don’t try to force someone into treatment. Ultimatums and added pressure don’t work. Unless you’re the parent of a minor, you can’t make someone go into treatment. By doing so, you’ll only strain the relationship and take away a stem of support when they need it most.

If you’re a minor and you have a friend who you believe has an eating disorder, you can go to their parents to express your concern. Sometimes peers can pick up on things that parents don’t, or see behaviors that they hide from their parents. Their parents may be able to get your friend the help they need.