Anorexia Nervosa

What is Anorexia?

Anorexia is an eating disorder where an individual starves their body of calories in order to keep from gaining weight. Anorexia is a mental illness that alters the way an individual sees themselves and has a skewed perception of their own body. They have an extreme preoccupation with food, dieting and losing weight. This is a serious psychiatric condition that causes those effected to have a distorted body image. Those who suffer from anorexia have almost a neurotic fear of gaining weight, although they are often fixated with food. They will go to dangerous extents to lose weight, including eliminate food they have already eaten by any means possible. They are obsessed with a desire to remain thin, regardless of how it effects their health. They ignore the ramifications of what such severe starvation has on their body, including the possibility of death.   

Who Suffers From Anorexia?

According to the National Association of Anorexia Nervosa and Associated Disorders, 30 million people in the United States alone suffer from Anorexia. This disease typically arises during adolescence, usually in young women between the ages of 15-18 and is the third most common disorder in adolescents. Although women are statistically more prone to suffer from anorexia, 10-15% of anorexics are men. The cause of this disease is unknown, but it can affect anyone. Typically, those who have a profession that focuses on body perfection, such as dancers and actors, are among those who develop this disease. Although scientists are still searching for an exact cause for this disease, there is evidence that suggests individuals can have a genetic predisposition to develop the disease. Statistics also point to a family history of eating disorders, a history of physical or sexual abuse, individuals who are perfectionist, have low self-esteem, or poor social skills.

Types Of Anorexia

There are two different kinds of anorexia. Although Bulimia is often listed as its own disease, it is in fact a type of anorexia. The two types of anorexia are based on the way in which the individual starves their body of calories and deals with losing weight. The two types are restrictive anorexia and binge/purge anorexia.

Restrictive Anorexia

This type of anorexia is exactly as the name suggests, restricting and limiting the amount of food ingested. They will strive to take in as few calories in a possible. Far less than their body requires to function normally. Often times they will decline to eat in front of others, cut their food into tiny pieces or even go to the extent of hiding their food to make it appear as if they have eaten it. They might also participate in over exercising.

Binge/Purge Anorexia

This type of anorexia is defined as when the anorexic will consume a large amount of food and then as soon as possible use vomiting, laxatives, diuretics, enemas and compulsive exercise as a way to eliminate it from their body as quickly as possible.

Symptoms Of Anorexia

Anorexia has a large number of both physical and psychological symptoms. The strain that anorexics put on their bodies make many of their symptoms very obvious. However, in many cases the anorexic is completely blind to what is happening to their body as they have a complete and total fixation with weight loss. They often aren’t even aware of their own appearance and how emaciated they have become. The anorexic will see fat even where there is none. They simply cannot see how skinny they truly are. Denial is a strong component of this disease. The disease very much effects their perception of what their body looks like.

Behavioral And Psychological Symptoms

Individuals with anorexia will demonstrate an abnormal fixation with food. They will often refuse to eat in the company of others. They will try to convince those around them that they are eating and will even go to the extent of hiding their food. They might even make up excuses as to why they aren’t eating, such as feeling ill or having already eaten.
They have a concentrated preoccupation with food and will obsessively count calories and read ingredient labels. Anorexics will also sometimes keep a food diary as well as have strange eating habits such as chewing food and then spitting it out rather than swallowing it.
Other psychological issues can also manifest themselves at this time such as anxiety, depression, self-harm and addiction.

Physical Symptoms

With anorexia there is marked and dramatic weight loss. They will complain about being overweight and have a fixation about their clothing size and figure. They will often be very vocal about their dissatisfaction with their body and weight. Many will also compulsively exercise.
Although they are dangerously thin, they will complain about being fat. They will frequently be burdened by fatigue, muscle weakness and shortness of breath as they aren’t giving their bodies enough calories to function normally.

Consequences On The Body From Anorexia

Anorexia ravages the body. There are many different physical and mental complications that can occur due to starvation. By denying their body the food and fuel that it needs, organs can suffer permanent damage. Many of the physical and mental issues they experience while at an unhealthy weight can be reversed once they begin to eat healthy again.

Due to the starvation, it’s not surprising that individuals will experience low blood pressure. However, the serious problem is when the heart begins to beat irregularly, known as arrhythmia. As the starvation continues heart failure is a serious concern.

The stomach and intestines really suffer with anorexia. Especially if the individual has been using laxatives or inducing vomiting to purge their system of food. This can cause serious distress to the esophagus from repeated exposure to stomach acid. They can develop ulcers in their stomach as well as experience a great deal of diarrhea. Low motility in the intestines can cause pain as well as constipation.

Electrolyte imbalance from anorexia can severely impair kidney function. Anorexics can develop kidney stones and chronic kidney disease which can eventually lead to kidney failure.

Anorexia can cause serious liver damage. Anorexia can cause elevated liver enzymes, this can be a warning of impeding organ failure from starvation and malnourishment.

Due to the body’s undernourishment and lack of calcium, the skeletal system can be seriously affected. The bone density (bone mass) can be seriously impacted and depleted. This will make the bones more brittle and at risk to fracture easily. This can all lead to osteoporosis later in life.

Anorexics have a really hard time fighting infection because they can have a low white blood cell count. The also can suffer from anemia (low red blood cell count), which would make them extremely tired, due to the lack of iron and other vitamins that help the body make hemoglobin from being undernourished.

Anorexics may feel dizzy, tired, irritable and have a hard time thinking clearly and rationally. Due to the extensive starvation the brain will not be operating as it normally would be, and they may have a poor memory. Ironically, although they are exhausted, anorexics may also suffer from insomnia. Cognitive function will be impaired, and depression is often a common symptom of anorexia, as well as attention span and concentration. The brain can actually shrink from malnutrition.

One of the more noticeable changes the body can experience is what happens to the skin and the hair. The skin can not only appear dry and cracked but take on a yellowish tinge. It will also easily bruise. The body in some cases may try to assist itself in maintaining body temperature, due to the loss of body fat, by growing a fine layer of hair called Lanugo.
Finger nails and toe nails may become weak and fragile because the individual is not getting the nutrients to grow strong and healthy nails. The finger tips and toes can also appear blue.
Hair thinning, or loss is quite common among anorexics. Again, the anorexic isn’t getting enough nutrition to help it grow properly

Hormones in women can be deeply affected by anorexia. The levels of estrogen in the body can plummet significantly. Many times, women suffering from anorexia will cease to have their periods which can result in permanent infertility if the disease goes unchecked. Young women or men in their teens can stunt their growth cycle through malnutrition.

It is difficult for women who suffer from anorexia to conceive. Often the disease not only messes with the hormones that control their reproductive system, such as estrogen, but will cease to menstruate all together. If a woman should become pregnant, the chance of miscarriage is extremely high. The body is having a hard-enough time sustaining itself, yet alone another life. If a baby should make it full term, it is likely to be born small and underweight.

Anorexia And Addiction

There is a great deal of evidence that suggest that anorexia and drug addiction are very similar diseases. Scientist have discovered that the brain behaves in very much the same way with both disorders. The reward center is activated and stimulated in the identical way.
The correlation between substance abuse and anorexia goes beyond brain behavior. Often these two diseases take root for the same reasons, early trauma, family history and preexisting, undiagnosed mental issues.
Statistically, over 50% of individuals who are fighting an eating disorder also have a substance abuse problem. Often times the anorexic will use the substances to assist them with their weight loss. They will use amphetamines, cocaine, crack, ecstasy or prescription drugs to suppress their appetite and further weight loss.
One of the big draws for anorexic and a drug addict is control. Although it is an illusion, the abuse still gives them the feeling of being in control of something in their chaotic universe.

Anorexia And Relationship

Anorexia is like an invisible barrier between the anorexic and their loved ones. It is hard for those who don’t have the disease to sympathize or even understand what they are going through.
Anorexics are so out of touch with their bodies and disgusted with how they think they appear, that it is difficult for them to get physically close to someone. They are also often so preoccupied with their obsession with food and weight loss, their day to day life often gets ignored.

Death From Anorexia

Anorexia has the highest mortality rate of all the mental illnesses. Between 5-20% of anorexics will die from the disease. The statistics for this disease are grim. Depression goes hand in hand with this disease and suicide is another concern, with 1 in 5 deaths from anorexia being self-inflicted.
As the anorexic ravages their body through starvation, every organ is working its hardest. These organs are also at their weakest as they have been deprived of nutrients and vitamins for a prolonged period of time.
Heart failure is a big concern, as the body losses muscle mass and becomes weaker, so does the heart. Most anorexic die from heart failure or some other physical complication due to the starvation, not the starvation itself.

Treatment For Anorexia

The most important part of overcoming anorexia is admitting there is a problem. This is more difficult with this particular disease as an anorexic has a distorted view of their body and in their own mind may not even realize that they have a problem.
Anorexics are usually in denial and the first and most important step is getting them to realize that they have a serious problem in the first place. This is the hardest step in the recovery process.
Once an anorexic is willing to admit they have an issue, the healing process can begin.

How is Anorexia Diagnosed?

There is a process to diagnosing anorexia. The anorexic will have a physical exam and a psychological evaluation to determine the extent of the disease and the toll that has taken on the patient’s body. Once this process is complete, the doctors will develop a treatment plan specifically for the patient to meet their individual needs.

Psychological Exam

A mental health profession will be the one to give the diagnosis of anorexia once the patient has had a psychological evaluation. The doctor will ask questions to get a clear picture of the nature of the disorder and the patients attitude toward food, their body and their life in general.
The doctor will also try to determine any other underlying psychiatric disorders that have manifested themselves along with the eating disorder.
As stated previously, some anorexics have duel disorders, and these will be treated together, including any substance abuse issues.

Physical Exam

An anorexic seeking treatment will first undergo a thorough physical exam. This is not to diagnose anorexia but to determine the degree to which the disease has damaged the physical health of the patient and help them on the physical end of their recovery journey. They will check all the patient’s vitals as well as their heart and lungs, as these organs can be severely damaged by the disease.
They will also do blood test to check the function of the patient’s other organs, such as kidneys, liver and thyroid. They will also want a full blood count run.
In some cases, x-rays and EKG’s will also be ordered and run by the doctor to check for broken bones and irregularities in the heart.


There are many different kinds of treatments that are used to treat anorexia. The doctor who does the psychological evaluation will determine what treatment or combination of treatments they should prescribe and to what extent.

  • Inpatient

    In many cases hospitalization will be required, depending on the degree of emaciation and what effect the disease has had on the patient’s organs. They may also need a feeding tube or intravenous feeding to combat the malnourishment. The doctor will try to get the patient to safely gain a small amount of weight each week. At this point in recovery, getting the patient healthy again is the most important goal.

  • Outpatient

    Patients who are not as medically fragile can participate in outpatient. These people can participate in treatment programs while living at home and maintaining their life.

  • Interpersonal Therapy

    This therapy is designed to treat an anorexics depression and/or anxiety. They will learn how to work on their interpersonal relationships and how their social interaction affects them and bring about their disease as a response.

  • Family Therapy

    Family Therapy can be hard for an anorexic. It forces them to see how their disease not only effects them but also the people they love. It can be an emotional time for the patient and their family. It is also a time for the family to learn and understand how they have individually contributed to their loved one’s disease.
    This is also where family history comes into play and how it has helped shape the patient and their disease.
    Occasionally, the therapy is strictly for the family of the anorexic. They are taught how to support the patient and help them cope with their disease.

  • Duel Treatment

    Many times, anorexics are fighting more than one illness at a time. They are in many cases also fighting substance abuse as well as their eating disorder. Many treatment centers will offer a duel treatment plan where they not only treat the anorexia but also treat the drug addiction and try to find the underlying cause of both.

  • Medical Treatment

    In most cases, medical treatment is an absolute necessity. The patient will have most likely done significate damage to their body and internal organs. This is as important a part of the treatment program as the therapy sessions they will participate in. They need to be under a doctor’s supervision to make sure that their health is steadily improving, and they are safely gaining weight.

  • Cognitive-Behavioral Therapy

    This therapy will help the patient identify and work through troubled behaviors and negative thoughts that brought about their disease in the first place. They will be counseled on how to turn their thought process around and change their negative patterns. Doctors look for the underlying cause for their eating disorder and show the patient how they can make positive changes and learn to deal with the stresses, the need for control and perfection. They also will learn to have a more positive perception of their own body.

  • Motivational Enhancement Therapy

    This therapy is exactly as it sounds. It helps the patient try to find ways to motivate themselves to healing. This therapy requires a lot of work on the part of the patient to find a more optimistic outlook, encourage positive behavior and look for a positive relationship with food.

  • Anorexia Group Therapy

    Group therapy is a positive setting where groups of anorexics meet and are able to talk and support one another through their recovery. There are many kinds of group therapies that they can participate in. These therapies not only foster support for themselves and other anorexics but focus on an activity that they might find engaging, peaceful and healing such as pet therapy, equine (horse) therapy, dance therapy, and art therapy.

  • Medication

    There is no specific medication that is designed to treat anorexia. However, doctors may at time prescribe different medications to treat symptoms of the disease such as anxiety, depression as well as any underlying psychiatric disorder discovered during their evaluation.

Nutritional Counseling

Although an anorexic may have in-depth knowledge of the ingredients and the amount of calories food items have, they are easily overwhelmed when the recovery process begins. This is another vital part of the recovery process. A registered dietician will help guide the patient into better eating patterns, making healthy food choices and teach them about nutrition.
They can also teach the patient not only the amount they need to eat on a daily basis to maintain optimum health but how to recognize their body’s signals, such as hunger and fullness. This is something an anorexic has mentally trained themselves to ignore and have to be retrained to recognize it.
Anorexics truly need a supportive dietician who can compassionately and patiently walk them through this growing process. This is not an easy part of the recovery process for an anorexic and having someone who truly understands the fear and anxiety that this process will cause them is imperative.

Therapy Goals

In the end, the goal of treatment is not just to save the patients life from starvation and malnutrition, as well as help them reach a healthy weight. It is to change their entire outlook. It is to help them learn coping skills, to accept and love their body, to help them recognize what causes them to engage in negative patterns to begin with and boost their self-esteem. The goal is to teach them to learn to recognize the negative self-talk and be able to turn it around into positive motivation.

Relapse And Recovery

Anorexia is a difficult disease to conquer. Many people relapse after treatment. Therefore, it is vital that the anorexic and their family realize that treatment is a lifelong journey and that they need to continue to be vigilant even after treatment. Remaining in a support group can help an anorexic maintain a healthy lifestyle and offer support, should they relapse.
The good news is that with proper and thorough treatment, more than half of the people suffering from anorexia make a full recovery and continue to live a healthy life.