Anorexia is an eating disorder defined by the inability to maintain one's body weight within 15% of Ideal Body Weight (IBW). The essential features of this illness include intense fear of gaining weight, a distorted body image, and denial of the seriousness of the illness.
The understanding of the cause and the treatment for anorexia has evolved rapidly from the early theory of anorexics being perfectionistic girls detailed by Hilde Bruch (1904–1984). As of 2015, anorexia was understood as a disease that involves many factors and coexists with anxiety, depression, and/or a history of abuse. Anorexia, like bulimia, has become more widespread, and new forms of the illness continue to emerge. Orthorexia, the cult of health, is anorexia under a new name. Diabexia is another form of anorexia in which diabetics manipulate their insulin and blood sugar to create weight loss. Research on female athletes reveals a dangerous triad of intensive exercise, amenorrhea, and bone fractures. Some clinics treat female athletes who are functionally anorexic.
Anorexia nervosa is a serious and life-threatening mental illness, and there is no one test than can diagnose this complex disorder. The diagnosis of anorexia can only be made when a physician or mental health professional recognizes the characteristic signs, symptoms, and patterns of thinking and behavior. Several medical conditions can cause symptoms similar to those seen in anorexia nervosa and must be ruled out before diagnosis (thyroid disease, inflammatory bowel disease, etc.). Anorexia nervosa tends to appear in adolescence but can develop at any age. The disease primarily affects adolescent girls and young women; however, anorexia can be found among boys, people undergoing transgender change, men, older women, and young girls. Athletes, wrestlers, gymnasts, dancers, and models—people for whom thinness is a professional requirement—are particularly vulnerable to developing anorexia. Depression, anxiety, and a family history of substance disorders may also be factors that place someone at risk for developing anorexia. When anorexia is increasingly harmful and cooccurs with extensive cutting behavior, the illness is often linked to a history of sexual abuse.
People with anorexia nervosa continue to think they look fat even when they have become dangerously thin. Anorexics can develop odd ritualistic eating habits, such as cutting an apple into translucent slices, refusing to eat in front of others, or baking four kinds of pies for others that they themselves do not eat. People with anorexia will do whatever is necessary to prevent caloric intake, such as using a child's knife and fork, hiding food in their clothes, lying to family and friends, or avoiding social events. Like bulimia, anorexia requires enormous secrecy.
Physical changes associated with malnutrition and starvation can be seen as anorexia progresses. The nails and hair of anorexics become brittle, and their skin looks dry, aged, and yellow. Fine hair (called lanugo) grows on parts of the body previously without hair as the body attempts to hold warmth. Typically, people with anorexia nervosa will feel cold and wear multiple layers of clothing because their body has lost the basic ability to maintain its temperature. Most anorexia patients report feeling tired, dizzy, and unable to focus at work or school. These symptoms are due to malnutrition and the hormonal changes that may occur in the body from starvation.
In addition to restricting their calorie intake, anorexics often exercise compulsively. They drink caffeine to increase urination, increase energy, and promote water loss. Anorexics often abuse laxatives as a means of weight loss. Starvation damages vital organs such as the heart, kidneys, and brain. Pulse rate and blood pressure drop, and anorexics may experience irregular heartbeat or heart failure leading to death. Nutritional deprivation in young women leads to the loss of calcium from bones. A young adult's bones can become brittle and prone to breaking. Finally, nutritional deprivation leads to decreased brain volume, affecting the person's ability to think clearly. People with anorexia can actually starve themselves to death. Anorexia nervosa has the highest mortality rate of any psychiatric illness, due to the complications of malnutrition and the high rate of suicide in this population. Infertility is a secondary serious consequence of anorexia.
Many researchers concur that anorexia is caused by a combination of genetic and environmental factors. Eating disorders tend to run in families, and female relatives are most commonly affected. Close relatives of a person with anorexia nervosa are 10 times more likely to have an eating disorder than those without the illness in their family members. Scientific studies have shown that certain chemicals in the brain, specifically the neurotransmitters norepinephrine and serotonin, are not functioning optimally in patients with anorexia nervosa, a condition that can worsen from malnutrition and starvation. Some studies suggest that anorexia may be closer to obsessive compulsive disorder (OCD) than was once believed. In long-term studies of people with this illness, about one-half fully recovered; many had intermittent periods of recovery and relapse. A small percentage of these patients continued to experience a more chronic form of anorexia nervosa with ongoing symptoms of this and other eating disorders.
Predictions regarding who will have this illness for only a brief period and who will find it chronic and debilitating remain difficult to make. People with this disorder should be diagnosed and treated as soon as possible; eating disorders are most successfully treated when intervention is early. Some people can be treated as outpatients, but others require medical hospitalization to stabilize their low weight through refeeding treatment. Refeeding may include the use of feeding tubes, intravenous fluids, and structured diets with supervised meals. Anorexia also has psychosexual effects. The sexual development of anorexic adolescents is arrested, and adults who have the disease generally lose interest in sex.
Most anorexics, about 95%, are women. Conventional risk factors for the disorder may include a history of alcoholism and/or depression, early onset of puberty, tallness, perfectionism, low self-esteem, and certain illnesses such as juvenile diabetes. Psychosocial factors associated with the disease are over-controlling parents, an upwardly mobile family, and a culture that places excessive value on female thinness. Emotionally, anorexia often involves issues of control; the typical anorexic is a strong-willed adolescent whose aversion to food is a misdirected way of exercising autonomy to compensate for a lack of control in other areas of life.
People suffering from anorexia often must be hospitalized for secondary medical effects of the condition. Sometimes anorexics are force-fed in order to be kept alive. Due to medical complications as well as emotional distress caused by the disorder, anorexia nervosa is one of the few mental disorders that can be fatal. Between 5 and 20% of people with anorexia die from it, and the longer the disease persists, the more likely it will proves fatal.
See also Body image ; Bulimia .
Rumney, Avis. Dying to Please: Anorexia, Treatment and Recovery. Jefferson, NC: McFarland, 2009.
Sandoz, Emily K., Kelly G. Wilson, and Troy DuFrene. Acceptance and Commitment Therapy for Eating Disorders: A Process-Focused Guide to Treating Anorexia and Bulimia. Oakland, CA: New Harbinger, 2011.
Shepphird, Sari Fine. 100 Questions & Answers About Anorexia Nervosa. Sudbury, MA: Jones and Bartlett Publishers, 2010.
Stryer, Stacy Beller. Anorexia. Santa Barbara, CA: Greenwood Press, 2009.
Academy of Nutrition and Dietetics, 120 South Riverside Plaza, Ste. 2000, Chicago, IL, 60606-6995, (312) 8990040, (800) 877-1600
American Anorexia and Bulimia Association (AABA), 418 E. 78th St., New York, NY, 10021, (212) 734-1114, firstname.lastname@example.org, www.anad.org .
National Anorexic Aid Society, 445 E. Dublin-Granville Rd., Columbus, OH, 43229, (614) 436-1112.
National Association of Anorexia Nervosa and Associated Disorders, PO Box 7, Highland Park, IL, 60035, (708) 831-3438