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All about Anorexia Nervosa- Causes, Symptoms and Treatment Update 2020

What is Anorexia Nervosa-

Also simply called by the name of anorexia, the major eating disorder anorexia nervosa is one of the many eating conditions that affect about 30 million of the total population in the U.S.

The psychological condition anorexia Nervosa can be potentially life-threating to a lot of people as well.

Most people who suffer through this disorder lose a lot of body mass and are abnormally underweight relative to their body type and height.

Patients with this eating disorder mostly develop a substantial amount of fear of putting on weight and have a distorted perception towards it.

Patients with anorexia disorder mostly have a high priority on shaping and regulating their weight to malnourished levels and they put on almost all types of efforts that largely interfere with their quality of life and eventually worsens it.

People with this condition inhibit the slightest gain in weight while continuously losing it by putting a lot of limitations on the type of food they consume.

They might also control any minor surplus of calories through vomiting post meals or with the use of diet aids, enemas, diuretics or misuse of laxatives.

Excessive over-exercising is also one of the common characteristics seen in people suffering through anorexia.

Irrespective of the amount of weight loss, the abnormal distress of weight gain is continuous in the patient.

The troublesome condition isn’t only linked to food, but the issue makes patients completely unhealthy and it becomes quite life-threatening for them to survive with emotional issues.

People who have anorexia mostly compare their thinness with their self-esteem.

Bearing a lot of similarities with various other kinds of eating habit disorders, anorexia can potentially take over life and for most sufferers, itis is quite difficult to overcome.

The general concern of anorexia isn’t limited to food. The condition can also be characterized as extremely unhealthy and sometimes life-threatening measures to overcome emotional concerns.

Classification of Anorexia Nervosa

The eating disorder anorexia nervosa has been categorized under-eating and feeding disorders in the most recent revisions of the Statistical and Diagnostic Manual of Mental Disorders (DSM 5).

Showing relation between the previous DSM version (DSM-IV-TR), the revised 2013 manual (DSM 5) discloses alterations in the specified standards for the eating disorder of anorexia nervosa.

Most notable alterations were of exclusion of amenorrhea criterion. A lot of reasons contributed to the removal of Amenorrhea as it doesn’t specifically relate to males and isn’t applicable for females prior to or post menstruation age or consuming birth control pills.

Women showing other AN symptoms still had reported menstrual cycles.

Some Common Symptoms of  Anorexia Nervosa

Anorexia can be confused with a lot of other conditions, so it’s best to look out for identical symptoms and consult at the earliest for an exact diagnosis.

Although the physical symptoms and behavior would indicate starvation, anorexia also tends to create altered behavioral issues that generally include perception changes in body weight and an abnormally intense fear of weight gain.

The signs and symptoms might quickly not get recognized as different people have different considerations for low weight, and many of these patients might not have an extremely thin appearance.

Another factor that makes anorexia difficult to diagnose is that the people suffering through it also disguise their thinness, physical issues in addition to their eating habits.

Physical symptoms

The general physical symptoms and signs for anorexia are:

  • Not having expected developmental gains in weight
  • A drastically thin posture
  • Irregular heartbeats
  • Abnormal blood counts
  • Insomnia
  • Fatigue
  • Fainting or Dizziness
  • Menstruation Absence
  • Abdominal pain and constipation
  • Yellowish and dry skin coloring
  • Intolerance to cold weather
  • Swelling in Legs and arms
  • Hair of soft and downy appearance that covers the body 
  • Thinning of hair and hair loss
  • Discoloration of fingers with the bluish appearance
  • Erosion in teeth and formation of calluses on knuckles through induced vomiting
  • Dehydration

Many people undergoing this condition also purge and binge, similar to people with bulimia.

However, people suffering through anorexia typically struggle with abnormal lower body weight, while individuals undergoing bulimia typically remain normal to the weight that is considered much above normal.

Behavioral and emotional symptoms

The symptoms associated with anorexia aren’t normally confined to abnormal changes in eating habits, but the condition also counts for many behavioral issues including attempting to lose weight through:

  • Severe restriction in food intake through fasting and dieting
  • Excessive amounts of strenuous exercise
  • Self-induced vomiting that helps in getting rid of extra food and bingeing. People generally use herbal weight loss products, laxatives, diet aids or enemas. 
  • Other behavioral or emotional symptoms include:
  • Frequent refusal to eat and skipping a lot of meals
  • Hunger denial and giving reasons to not eat.
  • Limiting daily food intake to only foods that are understood as safe. These are mostly foods having lower caloric count and fat content. 
  • Adopting abnormal rituals and rigid meals like chewing food and spitting it afterward. 
  • Mostly standing in front of the mirror for checking on perceived flaws
  • Mostly complaining about having certain body areas with higher fat or being fat as a whole
  • Wearing many layers of clothing to cover up and avoid perceived embarrassment
  • Reduced sex drive 
  • Complete withdrawal from social circles
  • Insomnia
  • Frequent irritation
  • Always having a flat mood (being emotionless)
  • Mostly avoiding situations where the patient has to eat publicly
  • Lying about the amount of food that has been consumed
  • Fear of weight gain includes repeated weight measurement and frequently measuring body stats.

Measuring the severity of the illness

The severity of patients suffering through anorexia is generally measurable by finding out their body mass index (BMI).

DSM 5 uses these measurements to indicate different stages and seriousness of anorexia nervosa disorder. The severity is classified by DSM 5 to the following levels:

  • Mild: Patients have a BMI of 17 and higher
  • Moderate: BMI range lies between 16 to 16.99
  • Severe: BMI range lies between 15 to 15.99
  • Extreme: Patients have a BMI lesser than 15

Examining the condition

Depending on your symptoms your physician would recommend one or few tests that generally include:

Complete Blood Count (CBC) - This is meant to find abnormalities in red blood cells, white blood cells, and platelets to evaluate the existence of different illnesses such as anemia, thrombocytosis, leukopenia, and leukocytosis which occurs due to malnutrition.

Chem-20 – This is a combination of twenty different chemical blood tests including electrolytes, cholesterol, chlorine, protein, sodium, potassium and tests to measure kidney and liver function.

Urinalysis – A number of tests are performed and these are useful for diagnosing different medical disorders or substance abuse.

Thyroid screen – This consists of t3, t4 and TSH tests that help in checking on thyroid gland function.

Glucose tolerance test – This is also known as the Oral glucose tolerance test (OGTT). It is required for evaluating the body’s capacity to break down glucose.

Electroencephalogram (EEG) – The test measures all electrical brain activity and impulses to the brain. The test is ideal for the detection of any irregularities, mainly for addressing pituitary tumors.

Electrocardiogram – (ECG or EKG): This test finds out all electrical impulses in the heart. This helps in finding out disorders such as hyperkalemia.

BUN-to-creatinine ratio – Doctors use this ratio for the prediction of various ailments and disorders.

Creatine Kinase Test (CK – Test) – This test is meant for measuring creatine kinase, which is a naturally occurring enzyme in skeletal muscle (CK-MM), brain (CK-BB), and the heart (CK-MB).

Blood urea nitrogen (BUN) test – urea nitrogen occurs as a result of protein metabolism. This test is used primarily for testing kidney function.

Liver function test – These are a series of tests your doctor may ask for assessing liver function

Serum Cholinesterase – Liver enzymes (pseudocholinesterase and acetylcholinesterase) are tested for assessing malnutrition effects.

When would be the right time to consult a doctor?

Most people suffering through anorexia aren’t willing to initially comply with standard treatment procedures. Their primary desire of having a thin appearance rules out all other health concerns.

If anyone of your loved one undergoes through one or more abnormal symptoms, its best to urge them to consult a doctor.

If these symptoms resemble similarity with yours, or if you’ve been worrying since long about having any kind of eating disorder, it’s always best to ask for help.

If suffering through anorexia embarrasses you and you’re not willing to share your concern with your close ones, you must try to find people whom you trust the most and can openly talk about anything.

Causes of the Anorexia Nervosa

When it comes to anorexia, there isn’t any specific cause. The main reason for this condition is still unknown. Just like many other health ailments, the issue can simply be an outcome of a combination of many factors such as psychological, environmental and biological factors.


The thin body type has been adored since long in Western culture. Often self-worth and success have also been thought to be proportional to having a thin appearance.

In a lot of cases of anorexia, peer pressure can also act as a fuel to appear thing mostly among girls in their teenage years.

Earlier theories linked out causes such as dysfunctional families and childhood sexual abuse. Loneliness, anxiety, depression, and feeling of lack of control can also cause the issue to prevail.


Obstetric complications – Further development of anorexia nervosa is also possible due to perinatal and prenatal complications, such as abnormalities in neonatal cardiac function, placental infarction, diabetes mellitus, and maternal anemia.

Harm avoidance, which is one of the commonly connected personas with AN development might also be subjective to various Neonatal issues.

Gastrointestinal diseases – Compared to the general population, people who have gastrointestinal issues are predisposed to a number of eating disorders including anorexia.

However, the link between both conditions seems quite complex. Many findings also suggest links between celiac disease and anorexia nervosa.

A few authors reported that accompanying symptoms before getting diagnosis of gastrointestinal disease can cause food aversion, with further leads to notable changes in eating habits.

Other authors reported that higher risk is associated is with developing more symptoms at the time of getting diagnosed.

Biological –Research is yet battling to clear the link between anorexia and the different genes that are involved in this condition.

The occurrence of some alterations in genes might bring some people at a high-risk state for inviting anorexia.

Also, certain people have already developed a hereditary predisposition towards perseverance, sensitivity, and perfectionism – all behaviors linked with anorexia nervosa.

Psychological – Most people who’re suffering through anorexia nervosa might also have obsessive-compulsive personality traits which make it quite simple for the patient to follow a strict diet and avoid food intake despite feeling hunger.

They might be extremely driven to achieve their ideal image of perfectionism which causes them to think that they’re not thin enough.

Also, they might develop higher anxiety levels and may mostly indulge in restrictive eating for feeling at ease.


A majority of anorexic patients are women and girls. However, the condition is also increasingly affecting a lot of boys and adult men. Such conditions are mostly linked to ever-increasing social pressures.

Anorexia has prevailed as a common issue for most teenagers. People above their 40s can rarely develop this condition.

Still, any person at any age group is a substantial risk of developing this unhealthy eating disorder. The risk is quite higher in teens due to a lot of changes occurring in the body in puberty.

Teenagers generally have a face a lot of peer pressure and they’re quite sensitive to casual comments over the body shape and weight and even casual comments.

Factors aren’t specific when it comes to developing anorexia, but the main reasons that increase risk in the development of this condition include.

Genetics – Genetics of the person largely influences the risk associated with getting anorexic. The risk becomes substantial with alterations in certain gene types.

People whose first-degree relative – a sibling, parent or child - who suffered through the disorder have higher chances of developing the same.

Uncontrollably checking on diet and starving- Often the primary culprit in inviting eating is making changes in diet. Dieting has been linked to a lot of eating disorders.

A lot of evidence clarifies that the common symptoms associated with anorexia are also symptoms linked to starvation.

Most fat loss diets are linked to starvation and minimizing caloric intake. In certain individuals being in a starved state for a long time can lead to mood changes, the decline in appetite, anxiety and thinking inflexibly.

In certain vulnerable individuals, weight loss and starvation might affect the brain function, which mostly provokes a lot of restrictive eating behaviors and also makes it quite difficult to get back to normal and healthy eating habits.

Alterations in life – the condition can be related to a lot of things such as a new job or home, illness or death of a closed one, a breakup.

All these and many other changes in life lead to higher emotional stress while maximizing the risk of certain eating disorders like anorexia.

Types of Anorexia Nervosa

Anorexia can further be classified into two main types, which are:

Purge/Binge eating type – Anyone who suffers through this eating disorder would normally purge after having a meal.

With this behavior, the sufferer develops an alleviated worry of weight gain and counterbalances a little bit of the guilt of ingesting foods that are meant to be avoided.

People who are suffering through Binge/purge type behavior mostly purge by uncontrollably exercising excessively, vomiting out extra chunks of calories and laxative abuse.

Restrictive type anorexia – This type of anorexia sufferer is often mistakenly perceived as someone with high self-discipline.

The anorexic individual mostly restricts intake of any additional amount of calories through food, most of these being foods with high sugar and fat content.

This group consumes calories that are far less compared to calories ideal for maintaining a healthy weight. In this case, people generally undergo an unhealthy and dangerous form of starvation.

Differences between Anorexia and Dieting

Although the severe patterns of restrictive eating behavior characterizing anorexia nervosa disorder bears a lot of resemblance with the general patterns of dieting, the condition is distinguished by obvious differences between these two conditions.

Compared to any other form of dieting, the drastic change in behavior and perception as a result of this disorder is highly distressing and consequential on overall physical and mental health.

The major difference between dieting to control unhealthy weight gain and anorexia nervosa is obvious with everything in excess, whether it’s limiting food intake or excessively exercising.

While dieting would help the individual to maintain a healthy weight and be in discipline, anorexia largely controls the life and emotions of a person as a whole.

These abnormal changes further shape a chaotic and dangerous environment for the individual.

The primary goal for most individuals on a diet plan is to reduce weight to a sufficient level and appear good.

However, in anorexia disorder, they diet because they’ve perceived weight loss as a form of contentment and they equate it with their self-worth.

Health complications

If someone suffers through this condition their close ones must ensure that extreme caution is being taken as a number of complications can arise due to the disorder.

Anorexia can have a number of health complications and at its severe stage, it can also be fatal. Sudden death can also occur even when someone might not seem to be abnormally underweight.

Death can be caused due to electrolyte imbalance (sodium, calcium or potassium imbalance) or from unusual heart rhythms (arrhythmias).

There are a lot of other complications associated with anorexia:

  • Abnormal muscle loss
  • Severe heart complications such as abnormal heartbeat rhythms, mitral valve prolapse and eventually death due to heart failure. 
  • The decline in testosterone hormone in males
  • Absence of period in females
  • Anemia
  • Osteoporosis (bone loss), resulting in high risk of bone fracture
  • Issues in the Kidneys
  • Imbalance in electrolytes like low blood potassium, chloride and sodium
  • Gastrointestinal issues such as bloating, nausea and constipation

It's best to get treated for anorexia at the earliest as with time the patient can severely suffer malnourishment, further leading to damage in vital organs such as kidneys, heart, and brain.

Even if at later stages the patient’s condition is kept under control, the occurred damage wouldn’t entirely be reversible.

There are a whole lot of physical complications associated with anorexia, but additionally, with all these issues, many anorexia nervosa patients also suffer through other mental abnormalities.

Some of these being:

  • Mood disorders in addition to anxiety and depression.
  • Obsessive-compulsive disorder
  • Inflicting self-injury, developing suicidal tendencies or attempts to suicide
  • Various disorders related to personality
  • Abusing alcohol and various substances

Prevention of the disorder

No specific guaranteed ways and measures have been discovered yet for the prevention of anorexia nervosa disorder.

Early anorexia indicators can be accurately diagnosed by consulting primary care physicians (internists, primary care physicians, and family physicians) and this helps in inhibiting the development of illness to a full-blown state.

For instance, while routine appointments they might ask certain questions that are mostly related to appearance satisfaction and eating habits.

If you’re skeptical about sudden changes in the behavior of a family member, specifically about their severe abnormal dieting chances and their over-emphasis on appearance, you must consider talking with them about their symptoms.

This wouldn’t sound much helpful for the prevention of any eating disorder, but it can be a first good step towards making healthy changes in their lifestyles and consulting them with beneficial treatments for the same.

Types of Treatment for Anorexia

The best treatment option for fighting the anorexic disorder and overcoming it is to look for an expert team of eating-specialists with a nutritionist, a physician and a therapist.

The most efficient and holistic treatment procedures for anorexia eating disorder consist of three main components:

Therapy – The main concern that is generally addressed with this form of treatment is to look out for all underlying eating disorder issues that the sufferer is going through, learn to cope up with healthier eating and with time developing the ability to express them and dealing with different emotions.

Nutritional – This aspect of treatment and care is primarily focused on developing healthy eating habits and restoration of normal body weight.

The anorexic individual is asked to implement a specifically tailored diet plan for him or her with the utmost supervision and care. They are further educated about normal eating behaviors and their benefits.

Medical treatment – While following standard medical procedures for the treatment of anorexia nervosa, the highest priority is to gradually reverse and eventually cure adverse health effects that are outcomes of unhealthy eating patterns.

Generally, the goal is to address and restore imbalances in electrolytes, reversing malnourishment, unstable heartbeat and amenorrhea.

Irrespective of how serious and difficult to overcome this condition would appear, there are a lot of available treatment options for the same as well.

With the right set of treatment protocols, that patient can easily gain self-consciousness and gets a much better awareness of inner self while returning back to healthier and normal eating habits.

Through these treatments, the primary concern is to reverse many serious complications caused by the condition and ultimately bring stability and normalcy to life.

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