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Anorexia signs and symptoms


Anorexia nervosa - Symptoms and causes

Overview

Anorexia (an-o-REK-see-uh) nervosa — often simply called anorexia — is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives.

To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively. No matter how much weight is lost, the person continues to fear weight gain.

Anorexia isn't really about food. It's an extremely unhealthy and sometimes life-threatening way to try to cope with emotional problems. When you have anorexia, you often equate thinness with self-worth.

Anorexia, like other eating disorders, can take over your life and can be very difficult to overcome. But with treatment, you can gain a better sense of who you are, return to healthier eating habits and reverse some of anorexia's serious complications.

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Symptoms

The physical signs and symptoms of anorexia nervosa are related to starvation. Anorexia also includes emotional and behavioral issues involving an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat.

It may be difficult to notice signs and symptoms because what is considered a low body weight is different for each person, and some individuals may not appear extremely thin. Also, people with anorexia often disguise their thinness, eating habits or physical problems.

Physical symptoms

Physical signs and symptoms of anorexia may include:

  • Extreme weight loss or not making expected developmental weight gains
  • Thin appearance
  • Abnormal blood counts
  • Fatigue
  • Insomnia
  • Dizziness or fainting
  • Bluish discoloration of the fingers
  • Hair that thins, breaks or falls out
  • Soft, downy hair covering the body
  • Absence of menstruation
  • Constipation and abdominal pain
  • Dry or yellowish skin
  • Intolerance of cold
  • Irregular heart rhythms
  • Low blood pressure
  • Dehydration
  • Swelling of arms or legs
  • Eroded teeth and calluses on the knuckles from induced vomiting

Some people who have anorexia binge and purge, similar to individuals who have bulimia. But people with anorexia generally struggle with an abnormally low body weight, while individuals with bulimia typically are normal to above normal weight.

Emotional and behavioral symptoms

Behavioral symptoms of anorexia may include attempts to lose weight by:

  • Severely restricting food intake through dieting or fasting
  • Exercising excessively
  • Bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products

Emotional and behavioral signs and symptoms may include:

  • Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them
  • Frequently skipping meals or refusing to eat
  • Denial of hunger or making excuses for not eating
  • Eating only a few certain "safe" foods, usually those low in fat and calories
  • Adopting rigid meal or eating rituals, such as spitting food out after chewing
  • Not wanting to eat in public
  • Lying about how much food has been eaten
  • Fear of gaining weight that may include repeated weighing or measuring the body
  • Frequent checking in the mirror for perceived flaws
  • Complaining about being fat or having parts of the body that are fat
  • Covering up in layers of clothing
  • Flat mood (lack of emotion)
  • Social withdrawal
  • Irritability
  • Insomnia
  • Reduced interest in sex

When to see a doctor

Unfortunately, many people with anorexia don't want treatment, at least initially. Their desire to remain thin overrides concerns about their health. If you have a loved one you're worried about, urge her or him to talk to a doctor.

If you're experiencing any of the problems listed above, or if you think you may have an eating disorder, get help. If you're hiding your anorexia from loved ones, try to find a person you trust to talk to about what's going on.

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Causes

The exact cause of anorexia is unknown. As with many diseases, it's probably a combination of biological, psychological and environmental factors.

  • Biological. Although it's not yet clear which genes are involved, there may be genetic changes that make some people at higher risk of developing anorexia. Some people may have a genetic tendency toward perfectionism, sensitivity and perseverance — all traits associated with anorexia.
  • Psychological. Some people with anorexia may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. They may have an extreme drive for perfectionism, which causes them to think they're never thin enough. And they may have high levels of anxiety and engage in restrictive eating to reduce it.
  • Environmental. Modern Western culture emphasizes thinness. Success and worth are often equated with being thin. Peer pressure may help fuel the desire to be thin, particularly among young girls.

Risk factors

Anorexia is more common in girls and women. However, boys and men have increasingly developed eating disorders, possibly related to growing social pressures.

Anorexia is also more common among teenagers. Still, people of any age can develop this eating disorder, though it's rare in those over 40. Teens may be more at risk because of all the changes their bodies go through during puberty. They may also face increased peer pressure and be more sensitive to criticism or even casual comments about weight or body shape.

Certain factors increase the risk of anorexia, including:

  • Genetics. Changes in specific genes may put certain people at higher risk of anorexia. Those with a first-degree relative — a parent, sibling or child — who had the disorder have a much higher risk of anorexia.
  • Dieting and starvation. Dieting is a risk factor for developing an eating disorder. There is strong evidence that many of the symptoms of anorexia are actually symptoms of starvation. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.
  • Transitions. Whether it's a new school, home or job; a relationship breakup; or the death or illness of a loved one, change can bring emotional stress and increase the risk of anorexia.

Complications

Anorexia can have numerous complications. At its most severe, it can be fatal. Death may occur suddenly — even when someone is not severely underweight. This may result from abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body.

Other complications of anorexia include:

  • Anemia
  • Heart problems, such as mitral valve prolapse, abnormal heart rhythms or heart failure
  • Bone loss (osteoporosis), increasing the risk of fractures
  • Loss of muscle
  • In females, absence of a period
  • In males, decreased testosterone
  • Gastrointestinal problems, such as constipation, bloating or nausea
  • Electrolyte abnormalities, such as low blood potassium, sodium and chloride
  • Kidney problems

If a person with anorexia becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. This damage may not be fully reversible, even when the anorexia is under control.

In addition to the host of physical complications, people with anorexia also commonly have other mental health disorders as well. They may include:

  • Depression, anxiety and other mood disorders
  • Personality disorders
  • Obsessive-compulsive disorders
  • Alcohol and substance misuse
  • Self-injury, suicidal thoughts or suicide attempts

Prevention

There's no guaranteed way to prevent anorexia nervosa. Primary care physicians (pediatricians, family physicians and internists) may be in a good position to identify early indicators of anorexia and prevent the development of full-blown illness. For instance, they can ask questions about eating habits and satisfaction with appearance during routine medical appointments.

If you notice that a family member or friend has low self-esteem, severe dieting habits and dissatisfaction with appearance, consider talking to him or her about these issues. Although you may not be able to prevent an eating disorder from developing, you can talk about healthier behavior or treatment options.

By Mayo Clinic Staff

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What It Is, Symptoms, Diagnosis & Treatment

Overview

What is anorexia nervosa?

Anorexia, formally known as anorexia nervosa, is an eating disorder. People with anorexia limit the number of calories and the types of food they eat. Eventually, they lose weight or cannot maintain an appropriate body weight based on their height, age, stature and physical health. They may exercise compulsively and/or purge the food they eat through intentional vomiting and/or misuse of laxatives.

Individuals with anorexia also have a distorted self-image of their body and have an intense fear of gaining weight.

Anorexia is a serious condition that requires treatment. Extreme weight loss in people with anorexia can lead to malnutrition, dangerous health problems and even death.

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 and Causes

What are the signs and symptoms of anorexia?

You cannot tell if a person has anorexia just by their appearance because anorexia also involves mental and behavioral components — not just physical. A person does not need to be underweight to have anorexia. Larger-bodied individuals can also have anorexia. However, they may be less likely to be diagnosed due to cultural stigma against fat and obesity. In addition, someone can be underweight without having anorexia. Remember, anorexia also includes psychological and behavioral components as well as physical.

There are several emotional, behavioral and physical signs and symptoms of anorexia. If you or someone you know experiences the signs and symptoms of anorexia below, it’s important to seek help.

Emotional and mental signs of anorexia

Emotional and mental signs of anorexia include:

  • Having an intense fear of gaining weight.
  • Being unable to realistically assess your body weight and shape (having a distorted self-image).
  • Having an obsessive interest in food, calories and dieting.
  • Feeling overweight or “fat,” even if you’re underweight.
  • Fear of certain foods or food groups.
  • Being very self-critical.
  • Denying the seriousness of your low body weight and/or food restriction.
  • Feeling a strong desire to be in control.
  • Feeling irritable and/or depressed.
  • Experiencing thoughts of self-harm or suicide.
Behavioral signs of anorexia

Behavioral signs of anorexia include:

  • Changes in eating habits or routines, such as eating foods in a certain order or rearranging foods on a plate.
  • A sudden change in dietary preferences, such as eliminating certain food types or food groups.
  • Making frequent comments about feeling “fat” or overweight despite weight loss.
  • Purging through intentional vomiting and/or misusing laxatives or diuretics
  • Going to the bathroom right after eating.
  • Using diet pills or appetite suppressants.
  • Compulsive and excessive exercising or extreme physical training.
  • Continuing to diet even when your weight is low for your sex, height and stature.
  • Making meals for others but not yourself.
  • Wearing loose clothing and/or wearing layers to hide weight loss and stay warm.
  • Withdrawing from friends and social events.
Physical signs and symptoms of anorexia

The most well-known physical sign of anorexia is low body weight for a person’s height, sex and stature. However, it’s important to remember that someone can have anorexia without being underweight. In addition to weight-related signs of anorexia, there are also physical symptoms that are actually side effects of starvation and malnutrition.

Physical signs of anorexia include:

  • Significant weight loss over several weeks or months.
  • Not maintaining an appropriate body weight based on your height, age, sex, stature and physical health.
  • Unexplained change in growth curve or body mass index (BMI) in children and still growing adolescents.

Physical symptoms of anorexia that are side effects of starvation and malnutrition include:

  • Dizziness and/or fainting.
  • Feeling tired.
  • Slow heartbeat (bradycardia) or irregular heartbeat (arrhythmia).
  • Low blood pressure (hypotension).
  • Poor concentration and focus.
  • Feeling cold all the time.
  • Absent periods (amenorrhea) or irregular menstrual periods.
  • Shortness of breath.
  • Bloating and/or abdominal pain.
  • Muscle weakness and loss of muscle mass.
  • Dry skin, brittle nails and/or thinning hair.
  • Poor wound healing and frequent illness.
  • Bluish or purple coloring of the hands and feet.

What causes anorexia?

Anorexia and all eating disorders are complex conditions. For this reason, the exact cause of anorexia is unknown, but research suggests that a combination of certain genetic factors, psychological traits and environmental factors, especially sociocultural factors, might be responsible.

Factors that may be involved in developing anorexia include:

  • Genetics: Research suggests that approximately 50% to 80% of the risk of developing an eating disorder is genetic. People with first-degree relatives (siblings or parents) with an eating disorder are 10 times more likely to develop an eating disorder, which suggests a genetic link. Changes in brain chemistry may also play a role, particularly changes to the brain reward system and neurotransmitters, such as serotonin and dopamine, which can affect appetite, mood and impulse control.
  • Trauma: Many experts believe that eating disorders, including anorexia, are caused by people attempting to cope with overwhelming feelings and painful emotions by controlling food. Physical abuse or sexual assault, for example, can contribute to some people developing an eating disorder.
  • Environment and culture: Cultures that idealize a particular body type — usually “thin” bodies — can place unnecessary pressure on people to achieve unrealistic body standards. Popular culture and images in media and advertising often link thinness to popularity, success, beauty and happiness. This may contribute to someone developing anorexia.
  • Peer pressure: Particularly for children and adolescents, peer pressure can be a very powerful force. Experiencing teasing, bullying or ridiculing because of appearance or weight can contribute to the development of anorexia.
  • Emotional health: Perfectionism, impulsive behavior and difficult relationships can all play a role in lowering a person’s self-esteem and perceived self-worth. This can make them vulnerable to developing anorexia.

It’s important to note that there’s no single path to an eating disorder or anorexia. For many people, irregular eating behaviors (also called “disordered eating”) represent an inappropriate coping strategy that becomes permanent over time. This pathway to disordered eating is true for some, but not all, who develop anorexia.

Diagnosis and Tests

How is anorexia diagnosed?

A healthcare provider can diagnose a person with anorexia based on the criteria for anorexia nervosa listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association. The three criteria for anorexia nervosa under the DSM-5 include:

  • Restriction of calorie consumption leading to weight loss or a failure to gain weight resulting in a significantly low body weight based on that person’s age, sex, height and stage of growth.
  • Intense fear of gaining weight or becoming “fat.”
  • Having a distorted view of themselves and their condition. In other words, the individual is unable to realistically assess their body weight and shape believes their appearance has a strong influence on their self-worth and denies the medical seriousness of their current low body weight and/or food restriction.

Even if all of the DSM-5 criteria for anorexia aren’t met, a person can still have a serious eating disorder. DSM-5 criteria classifies the severity of anorexia according to body mass index (BMI). Individuals who meet the criteria for anorexia but who aren’t underweight despite significant weight loss have what’s known as atypical anorexia.

Diagnostic guidelines in the DSM-5 also allow healthcare providers to determine if a person is in partial remission (recovery) or full remission as well as to specify the current severity of the condition based on body mass index (BMI).

If signs and symptoms of anorexia are present, a healthcare provider will begin an evaluation by performing a complete medical history and physical examination. The provider or a mental health professional will likely ask questions about the following topics:

  • Dietary history (attitudes about food, dietary restriction).
  • Exercise history.
  • Psychological history.
  • Body image (this includes behaviors such as how often you weigh yourself).
  • Bingeing and purging frequency and elimination habits (use of diet pills, laxatives and supplements).
  • Family history of eating disorders.
  • Menstrual status (if your periods are regular or irregular).
  • Medication history.
  • Prior treatment.

It’s important to remember that a person with anorexia or any eating disorder will have the best recovery outcome if they receive an early diagnosis. If you or someone you know is experiencing signs and symptoms of anorexia, be sure to talk to a healthcare provider as soon as possible.

What tests are used to diagnose or assess anorexia?

Although there are no laboratory tests to specifically diagnose anorexia, a healthcare provider may use various diagnostic tests, such as blood tests, to rule out any medical conditions that could cause weight loss and to evaluate the physical damage weight loss and starvation may have caused.

Tests to rule out weight-loss causing illness or to assess anorexia side effects may include:

  • Complete blood count to assess overall health.
  • An electrolyte blood panel to check for dehydration and your blood’s acid-base balance.
  • Albumin blood test to check for liver health and nutrient deficiency.
  • Electrocardiogram (EKG) to check heart health.
  • Urinalysis to check for a wide range of conditions.
  • Bone density test to check for weak bones (osteoporosis).
  • Kidney function tests.
  • Liver function tests.
  • Thyroid function tests.
  • Vitamin D levels.
  • A pregnancy test in people assigned female at birth who are of childbearing age.
  • Hormone tests if evidence of menstrual problems in people assigned female at birth (to rule out other causes) and measuring testosterone in people assigned male at birth.

Management and Treatment

How is anorexia treated?

The biggest challenge in treating anorexia is helping the person recognize and accept that they have an illness. Many people with anorexia deny that they have an eating disorder. They often seek medical treatment only when their condition is serious or life-threatening. This is why it’s important to diagnose and treat anorexia in its beginning stages.

The goals of treatment for anorexia include:

  • Stabilizing weight loss.
  • Beginning nutrition rehabilitation to restore weight.
  • Eliminating binge eating and/or purging behaviors and other problematic eating patterns.
  • Treating psychological issues such as low self-esteem and distorted thinking patterns.
  • Developing long-term behavioral changes.

People with eating disorders, including anorexia, often have additional mental health conditions, including:

  • Depression.
  • Anxiety disorders.
  • Borderline personality disorder.
  • Obsessive-compulsive disorder.
  • Substance use disorders.

These conditions can further complicate anorexia, so if an individual has one or more of these conditions, their healthcare team will likely recommend treatment for the condition(s) as well.

Treatment options will vary depending on the individual’s needs. A person may receive treatment through residential care (outpatient care) or hospitalization depending on their current medical and mental health state. Treatment for anorexia most often involves a combination of the following strategies:

  • Psychotherapy.
  • Medication.
  • Nutrition counseling.
  • Group and/or family therapy.
  • Hospitalization.
Psychotherapy

Psychotherapy is a type of individual counseling that focuses on changing the thinking (cognitive therapy) and behavior (behavioral therapy) of a person with an eating disorder. Treatment includes practical techniques for developing healthy attitudes toward food and weight, as well as approaches for changing the way the person responds to difficult situations. There are several types of psychotherapy, including:

  • Acceptance and commitment therapy: This therapy’s goal is to develop motivation to change actions rather than your thoughts and feelings.
  • Cognitive behavioral therapy (CBT): This therapy’s goal is to address distorted views and attitudes about weight, shape and appearance and to practice behavioral modification (if “X” happens, I can do “Y” instead of “Z”).
  • Cognitive remediation therapy: This therapy uses reflection and guided supervision to develop the capability of focusing on more than one thing at a time.
  • Dialectical behavior therapy (DBT): This therapy helps you not just develop new skills to handle negative triggers but also helps you develop insight to recognize triggers or situations where a non-useful behavior might occur. Specific skills include building mindfulness, improving relationships through interpersonal effectiveness, managing emotions and tolerating stress.
  • Family-based therapy (also called the Maudsley Method): This therapy involves family-based refeeding, which means putting the parents and family in charge of getting the appropriate nutritional intake consumed by the person with anorexia. It’s the most evidence-based method to physiologically restore health to an individual with anorexia who is under 18 years of age.
  • Interpersonal psychotherapy: This therapy is aimed at resolving an interpersonal problem area. Improving relationships and communications and resolving identified problems may reduce eating disorder symptoms.
  • Psychodynamic psychotherapy: This therapy involves looking at the root causes of anorexia as the key to recovery.
Medication

Some healthcare providers may prescribe medication to help manage anxiety and depression that are often associated with anorexia. The antipsychotic medication olanzapine (Zyprexa®) may be helpful for weight gain. Sometimes, providers prescribe medications to help with period regulation.

Nutrition counseling

Nutrition counseling is a strategy to help treat anorexia that involves the following:

  • Teaching a healthy approach to food and weight.
  • Helping restore normal eating patterns.
  • Teaching the importance of nutrition and a balanced diet.
  • Restoring a healthy relationship with food and eating.
Group and/or family therapy

Family support is very important to anorexia treatment success. Family members must understand the eating disorder and recognize its signs and symptoms.

People with eating disorders might also benefit from group therapy, where they can find support and openly discuss their feelings and concerns with others who share common experiences.

Hospitalization

Hospitalization might be needed to treat severe weight loss that has resulted in malnutrition and other serious mental or physical health complications, such as heart disorders, serious depression and suicidal thoughts or behaviors.

The most serious complication of treating anorexia is a condition called refeeding syndrome. This life-threatening condition can occur when a seriously malnourished person begins to receive nutrition again. Basically, their body cannot properly restart the metabolism process.

People experiencing refeeding syndrome can develop the following conditions:

  • Whole-body swelling (edema).
  • Heart failure and/or lung failure.
  • Gastrointestinal problems.
  • Extensive muscle weakness.
  • Delirium.
  • Death.

Since refeeding syndrome can have serious and life-threatening side effects, it’s essential for people with anorexia to receive medical treatment and/or guidance.

People who have one or more of the following risk factors for developing refeeding syndrome may need to be treated in a hospital:

  • Are severely malnourished (less than 70% median BMI in adolescents; a BMI of less than 15 in adults).
  • Have had little or no calorie intake for more than 10 days.
  • Have a history of refeeding syndrome.
  • Have lost a lot of weight in a very short period of time (10% to 15% of total body mass within three to six months).
  • Drink significant amounts of alcohol.
  • Have a history of misusing laxatives, diet pills, diuretics, or insulin (if they have diabetes).
  • Have abnormal electrolyte levels before starting refeeding.

How long does it take to recover from anorexia?

Every person’s anorexia recovery journey is different. The important thing to remember is that it is possible to recover from anorexia. Treatment for anorexia often involves many components, such as psychological therapy, nutritional counseling and addressing the cause of the person’s anorexia, if possible, and each of these components can take different amounts of time.

No matter where you or a loved one are in their journey of recovery, it’s essential to continue working toward recovery.

Prevention

What are the risk factors for developing anorexia?

Anorexia can affect anyone, no matter their gender, age or race. However, certain factors put some people at greater risk for developing anorexia, including:

  • Age: Eating disorders, including anorexia, are more common in adolescents and young adults, but young children and older adults can still develop anorexia.
  • Gender: Women and girls are more likely to be diagnosed with anorexia. However, it’s important to know that men and boys can have anorexia and may be under-diagnosed due to differences in seeking treatment.
  • Family history: Having a parent or sibling (first-degree relative) with an eating disorder increases your risk of developing an eating disorder, such as anorexia.
  • Dieting: Dieting taken too far can develop into anorexia.
  • Changes and trauma: Big changes in your life, such as going to college, starting a new job or going through a divorce, and/or trauma, such as sexual assault or physical abuse, may trigger the development of anorexia.
  • Certain careers and sports: Eating disorders are especially common amongst models, gymnasts, runners, wrestlers and dancers.

Can anorexia be prevented?

Although it might not be possible to prevent all cases of anorexia, it’s helpful to start treatment as soon as someone begins to have symptoms.

In addition, teaching and encouraging healthy eating habits and realistic attitudes about food and body image also might help prevent the development or worsening of eating disorders. If your child or family member decides to become vegetarian or vegan, for instance, it’s worth seeing a dietitian versed in eating disorders and touching base with your pediatrician or healthcare provider to make sure that this change occurs without a loss in nutrients.

Outlook / Prognosis

What is the outlook (prognosis) for people with anorexia?

The prognosis for anorexia varies depending on certain factors, including:

  • How long the person has had anorexia.
  • The severity of the condition.
  • The type of treatment and adherence to treatment.

Anorexia, like other eating disorders, gets worse the longer it’s left untreated. The sooner the disorder is diagnosed and treated, the better the outcome. However, people with anorexia often will not admit they have a problem and might resist treatment or refuse to follow the treatment plan.

Anorexia is a serious and potentially life-threatening eating disorder if it’s left untreated. Eating disorders, including anorexia, are among the deadliest mental health conditions, second only to opioid addiction. Individuals with anorexia are 5 times more likely to die prematurely and 18 times more likely to die by suicide.

The good news is that anorexia can be treated, and someone with anorexia can return to a healthy weight and healthy eating patterns. Unfortunately, the risk of relapse is high, so recovery from anorexia usually requires long-term treatment as well as a strong commitment by the individual. Support of family members and friends can help ensure that the person receives and adheres to their needed treatment.

What are the complications of anorexia?

The medical complications and health risks of malnutrition and starvation, which are common in people who have anorexia, can affect nearly every organ in your body. In severe cases, vital organs such as your brain, heart and kidneys can sustain damage. This damage may be irreversible even after a person has recovered from anorexia.

Severe medical complications that can happen from untreated anorexia include:

  • Irregular heartbeats (arrhythmia).
  • Loss of bone mass (osteoporosis) and tooth enamel erosion.
  • Kidney and liver damage.
  • Fatty liver disease (steatosis).
  • Seizures caused by extremely low blood sugar (hypoglycemia).
  • Rhabdomyolysis (rapid breakdown of skeletal muscle) due to loss of water and electrolyte/acid-base imbalances.
  • Delayed puberty and physical growth.
  • Infertility and menstrual problems.
  • Insomnia.
  • Anemia.
  • Ventricular arrhythmia, a heart rhythm disorder.
  • Mitral valve prolapse (caused by loss of heart muscle mass).
  • Cardiac arrest.
  • Death.

In addition to physical complications, people with anorexia also commonly have other mental health conditions, including:

  • Depression, anxiety and other mood disorders.
  • Personality disorders.
  • Obsessive-compulsive disorders.
  • Alcohol use disorder and substance misuse.

If these mental health conditions are left untreated, they could lead to self-injury, suicidal thoughts or suicide attempts.

If you’re having suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-8255. Someone will be available to talk with you 24/7.

Living With

How do I take care of myself if I have anorexia?

It can be uncomfortable and scary, but it’s important to tell a loved one and/or your healthcare provider if you have anorexia.

If you have already been diagnosed with anorexia, there are some things you can do to manage your condition and stay committed to recovery, including:

  • Get enough sleep.
  • Don’t abuse alcohol or drugs.
  • If you take prescribed medication, be sure to take it regularly and do not miss doses.
  • If you are participating in talk therapy to treat your anorexia, be sure to see your therapist regularly.
  • Reach out to family and friends for support.
  • Consider joining a support group for people who have anorexia.
  • See your healthcare provider regularly.

How can I care for a loved one who has anorexia?

There are multiple things you can do to help and support someone with anorexia, including:

  • Learn about anorexia: Educate yourself about anorexia to better understand what they are going through. Don’t assume you know what they are experiencing.
  • Be empathetic: Don’t downplay or dismiss their feelings and experiences. Let them know that you are there to listen and support them. Try to put yourself in their shoes.
  • Encourage them to seek help and/or treatment: While having an understanding and supportive friend or family member is helpful to a person with anorexia, anorexia is a medical condition. Because of this, people with anorexia need treatment such as therapy and nutritional counseling to manage their condition. Encourage them to talk to their healthcare provider if they are experiencing the signs and symptoms of anorexia.
  • Be patient: It can take a while for someone with anorexia to get better once they’ve started treatment. Know that it is a long and complex process and that their symptoms and behaviors will eventually improve.

When should I see my healthcare provider?

If you or someone you know is experiencing signs and symptoms of anorexia, be sure to talk to a healthcare provider as soon as possible.

When should a person with anorexia go to the emergency room?

Someone with anorexia should go to the emergency room (ER) if they’re experiencing any of the following physical symptoms:

  • Unusually low blood pressure.
  • Decreased heart rate or irregular heartbeat.
  • Chest pain.
  • Seizures (due to extremely low blood sugar levels).

If you’re having thoughts of harming yourself, get to the nearest hospital as soon as possible or call the National Suicide Prevention Lifeline at 1-800-273-8255. Someone will be available to talk with you 24/7.

If you recognize suicidal behaviors in someone with anorexia, get them care as soon as possible.

A note from Cleveland Clinic

Anorexia is a serious and potentially life-threatening condition. The good news is that recovery is definitely possible. If you or someone you know is experiencing signs and symptoms of anorexia, it’s essential to seek help and care as soon as possible. It’s never too late to seek treatment, but getting help early improves the chance of a lasting recovery.

Anorexia - symptoms (signs), diagnosis and treatment of a mental disorder in Moscow

Anorexia - a nervous disorder in which there is a partial or complete refusal to eat, there is no appetite when food is needed. This is the main symptom of the disease, which is accompanied by problems in the functioning of the nervous system, metabolism, and other ailments.

The article will discuss the stages, symptoms and treatment of anorexia. You will learn what anorexia means, how to recognize and overcome it.

Seek medical attention if symptoms occur. The information on the page is for reference only and cannot be used for self-diagnosis and self-treatment.

Article content:

  • Signs of anorexia
  • Symptoms of anorexia
  • Diagnosis of anorexia
  • Treatment of anorexia
  • "Non-specific" step
  • "Specific" stage
  • Recovery period
  • How to overcome anorexia

Consequences of anorexia

Diagnosis and treatment is complicated by the fact that people do not seek help until the situation becomes life-threatening:

  • according to statistics, 20% of people die due to serious changes in internal organs, exhaustion;
  • Due to psychological problems, many patients resort to suicide.

Mental disorder - anorexia

Anorexia is more likely to become noticeable due to a person's underweight. How does anorexia manifest itself? Main features:

  • the patient is terribly afraid of gaining weight, which comes to the point of absurdity - for example, some people count rice grains before eating;
  • scales become your best friend - regular weighings are made several times a day;
  • free time is devoted to weight loss - counting calories, getting acquainted with information about new diets;
  • a person is dissatisfied with his appearance, complains of fat even with severe thinness - a symptom confirms that anorexia is a problem that seriously affects thinking and self-perception;
  • when it is impossible to resist hunger, laxatives, diuretics are used after lunch or dinner;
  • even with severe weakness, sports training occurs regularly;
  • is characterized by the rejection of fatty foods, meat in favor of vegetables and fruits.
What should I do if I have one or more symptoms? Do not self-medicate, consult a specialist.

Anorexia often occurs in patients from 12 to 20 years old, when a person begins to build relationships with society. During this period, parents should pay attention to the teenager. There is dissatisfaction with appearance - and without objective reasons, which leads to the study of information about diets, fear of obesity.

An alarm if a relative with a good appetite switches to low-fat yoghurts and other low-calorie foods. Don't ignore strange eating habits: eating small plates, chopping food, swallowing food without chewing.

Watch for early symptoms of anorexia and watch for unusual behaviors such as loss of social circle, secrecy, sleep problems, irritability, baggy clothing, hormonal imbalances, thinness. Do not put pressure on the child by talking, especially since self-diagnosis is impossible. If a teenager avoids communication, try to persuade him to visit a psychologist.

Causes of the development of the disorder

In the course of diagnosis, groups of symptoms are distinguished:

  • innate personality traits — increased emotional sensitivity, anxiety, tendency to perfectionism, behavioral rigidity;
  • psychological factors - self-doubt, dissatisfaction with the body, a feeling of inability to control one's life, lack of skills to regulate intense painful emotions;
  • physiological disorders - hormonal imbalance and features of the release of the hormone ghrelin, which is responsible for the feeling of hunger, satiety;
  • neurophysiological reasons - features of the functioning of the brain areas responsible for obtaining pleasure and satisfaction, feeling full, taste perception;
  • increased activity of the zone, which is responsible for the formation, strengthening of habits;
  • hypersensitivity to sensations from internal organs;
  • hereditary factors - a number of studies show the relationship between the presence of genes and the risk of developing ED.

Symptoms of anorexia arise from a lack of acceptance of one's own body. If at the same time conflicts, resentments occur in the family, or unpleasant remarks about appearance are used, then an alarming concern about weight appears.

Other factors cause rapid weight loss and impaired hunger. Appetite problems are a relatively common symptom when taking medications. Sometimes this property of drugs is used intentionally to cope with excess weight, which is the abuse of drugs.

The development of exhaustion while taking antidepressants should be considered separately. This type of loss of appetite and weight loss is not anorexia nervosa. The treatment of psychological problems should be supervised by a physician to monitor the side effects of therapy. In the case of depression, the detected loss of appetite may not even be noticed by the patient. Changes in appetite and weight loss are common symptoms of this disease. The patient may hide part of the information from the doctor, which will complicate the diagnosis.

Symptoms and treatment of anorexia

In addition to obsession with weight loss, diagnostics reveals other destructive symptoms of the disease. Patients experience worsening sleep, muscle cramps, dry hair, pale skin, bad mood, dizziness, muscle atrophy, sunken eyes, age spots appear. In advanced cases, teeth and hair begin to fall out, menstruation in women disappears, fainting often occurs.

The person does not think about the treatment of anorexia due to the gradual development of the disease. At first, there is only dissatisfaction with the appearance associated with being overweight. But soon it turns into a struggle with the body, which is accompanied by an unhealthy refusal to eat. The first results of weight loss improve mood, but dissatisfaction soon returns. a new weight loss cycle begins. A person may not notice a symptom that manifests itself in weakness or feeling unwell. On average, after a year, anorexia becomes visible from the side, then urgent treatment in a hospital is required.

An eating disorder is not limited to dissatisfaction with oneself and appearance. Even in the absence of a fatal outcome, an untimely visit to a doctor threatens with problems. The brain is undernourished, so concentration is reduced. In the list of symptoms of anorexia, you can add memory impairment, the appearance of mood swings. A person avoids communication, depression develops, alcohol abuse begins. Immunity is rapidly declining, which can cause complications, exacerbate chronic pathologies.

Osteoporosis develops due to mineral metabolism disorders, respectively, the risk of fractures increases, pain occurs in the vertebral zone, growth decreases. The amount of sugar in the blood decreases, cerebral edema, a feeling of fear, convulsions, hallucinations, and even coma may appear. There are problems with the heart, the hormonal background is disturbed, tantrums appear, menstruation disappears in women, there is a risk of infertility, and other disorders.

Diagnosis of anorexia

Interview with the patient is an important part of the diagnosis of the disease:

  • compared to the recommended body weight, the weight is permanently reduced by 15%;
  • the desire to lose weight with drugs, vomiting or deliberate refusal to eat;
  • fear of fullness constantly appears in the conversation, a distorted perception of the body is noticed;
  • for adolescents, a serious symptom is a cessation of growth and a cessation of natural development.

After the interview, the diagnosis of physiological parameters begins. For this, blood tests for sugar, thyroid hormones are prescribed. The Center for the Study of Eating Disorders recommends a CT scan of the brain. Girls need to consult a gynecologist to determine or exclude the symptoms of the disease in this profile.

Treatment

Anorexia nervosa also affects the human psyche. Therefore, treatment at the Center for the Study of Eating Disorders is built taking into account this factor. First, the stage of the disease, the degree of physiological changes are identified. A thorough diagnosis of the patient's condition is carried out - each symptom is important, affects the overall clinical picture and treatment methods.

Doctors strive to solve the following problems:

  • exclude serious weight loss, the onset of irreversible dystrophy;
  • stop large water losses, as it is life-threatening;
  • to restore the correct ratio of electrolytes in the blood.

Treatment of anorexia involves the involvement of psychologists and psychiatrists in the process. At the first stage of the disease, the patient needs psychological help. If the diagnosis revealed a different stage, then an integrated approach is needed here, since there is a direct threat to life. Hospitalization is often required.

“Non-specific” stage of treatment

The main symptom of this stage of anorexia is eating problems. Treatment lasts about three weeks and includes:

  • Bed rest - the patient rests and refuses physical activity.
  • Meals - a balanced diet, which is selected by a nutritionist.
  • The diet consists of those products that do not provoke additional irritation of the gastrointestinal tract. Salt, seasonings are excluded, heat treatment of food is used: cooking, steaming. Products that provoke gas formation in the intestines, fresh fruits and vegetables are excluded.
  • Complete physical examination of the patient.
  • Administering Parenteral Nutrition—Volume and rate of administration are calculated from the results of a complete examination.
  • Appointment of a course of vitamins and microelements necessary for recovery, drugs that help the gastrointestinal tract function normally.
  • Appointment of drug therapy aimed at reducing depressive symptoms, anxiety, aggression, tearfulness.
  • Monitoring that the patient does not get rid of food - antiemetics are used, constant supervision of the nurse.
  • Calorie control - in case of refusal of food, the patient is prescribed additional replacement medical nutrition in the form of a drink with a nutrient mixture. In case of complete refusal of food, enteral nutrition can be used as a temporary measure.
  • Gradual increase in calorie intake - the goal is to gain two or three kilograms.

"Special" stage

When it is possible to partially overcome the symptom of lack of appetite, to cope with vomiting, rejection of food, the doctors of the Center for the Study of Eating Disorders proceed to the next stage. The treatment lasts up to 9 weeks, during which the patient begins to move, refuse bed rest, gradually return to a normal lifestyle.

Anorexia is difficult, so tranquilizers may be prescribed to relieve symptoms and signs of anxiety. Treatment includes:

  • Individual psychotherapy - the patient must be aware of the consequences of fasting, learn to regulate their emotions in healthy ways.
  • Group psychotherapy - they renew the socialization of the patient, help to see understanding from other people, to hear new opinions about the disorder.
  • Conducting family therapy - the participation of loved ones in the treatment of anorexia is a significant factor in recovery. During therapy, new communication skills are formed.
  • Transition to a normal diet - complete restoration of body weight to normal.

To make sure that there are no pathologies, a repeated diagnosis is carried out, additional treatment of concomitant diseases is prescribed. Even with a normal diet, preventive psychotherapy is required, which will eliminate the return of fears and anxiety in relation to food.

Recovery period

If the diagnosis has revealed anorexia, then there is a long way to a healthy perception of yourself and your body. To recover from prolonged exhaustion, it is important to observe bed rest at first. You should not start activity even with a feeling of relief - it can be deceiving.

During this period, it is especially important to monitor food intake. It is better to eat many times a day in small portions. Typically, treatment involves six meals a day. It is not recommended to replace high-calorie meals with their counterparts, as the body needs nutrients.

Anorexia causes fear of the weight gain needed to save a life. Group therapy helps, where you can talk with people who are on the mend, or even coped with the disease.

Individual consultations with a psychologist are also important, because the symptom of self-hatred does not appear without a reason. If internal conflicts are not resolved, then treatment will be useless. It is important to diagnose other psychological problems - depression, trauma.

How to avoid a recurrence

The symptoms and treatment of anorexia are such that there is a risk that the problem will recur. Building healthy relationships with loved ones, getting rid of self-doubt is impossible in one day. Some people need years of communication with a psychologist to gain complete control over their relationship with the body.

Therefore, the preventive therapy of anorexia at the Center for the Study of Eating Disorders is to restore self-confidence, a healthy lifestyle. If one of your relatives is unsuccessfully struggling with being overweight or obsessed with a figure, then send him to a nutritionist and psychologist. During consultations, a person normalizes the attitude towards the body and receives a balanced nutrition plan that will not harm health.

It is worth treating yourself kindly, paying attention to your own successes. If you want to feel better, try spending more time on activities that bring you pleasure: socializing with loved ones, drawing, reading, playing music, walking and playing with pets.

It is important to develop the right relationship with food - do not evaluate your personality on the basis of how much or how little, right or wrong you eat. Do not praise yourself for giving up sweets or scold yourself for a good appetite, do not use food as a reward for success or consolation for failure.

You can make an appointment with us by calling +7(499) 703-20-51.

Author: Korshunova Anna Alexandrovna,

Member of the AED International Academy,

psychiatrist, psychotherapist, head of the CIRPP.

Anorexia: what it is, symptoms, causes, types, how to treat

Together with an RBC expert Style tells what are its causes and consequences, and how the disease can be cured.

  • What is
  • Species
  • Stages
  • Symptoms
  • Causes
  • Consequences
  • How to treat
  • Expert commentary

The material was checked and commented by Elmira Gereeva, psychologist, consultant in weight management and eating behavior, nutritionist, head of the educational department of the School of Emotional Intelligence

Advertising on RBC www. adv.rbc.ru

What is anorexia

Many people strive to normalize weight, watch their diet, go on diets and limit harmful foods on the menu. But sometimes these processes turn into an obsessive state. Anorexia nervosa is an eating disorder that can lead to severe weight loss. A person with this disease is preoccupied with what and how much he eats, often keeps a strict calorie count, adheres to an extremely meager diet. The decreasing number on the scales is the main aspiration and the only achievement that brings joy. Often, a reduction in food intake is complemented by increased training.

Anorexia is most common in girls between the ages of 14 and 25, but it is also diagnosed in older women and men. At different times, she was moved by Angelina Jolie, Demi Moore, Victoria Beckham, Mary-Kate Olsen, Yulia Lipnitskaya. At the same time, it is almost impossible to determine anorexia only by external signs.

Types of anorexia

Anorexia is not necessarily a psychological illness. It may be temporary, independent of the patient's desire to normalize weight and pass as soon as possible (for example, the recovery period after poisoning).

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In clinical practice, there are several types of eating disorder:

  1. Primary anorexia. It often occurs against the background of other health pathologies, expressed in a lack of appetite, disorders of the gastrointestinal tract.
  2. Neuropsychiatric anorexia. It is typical to refuse any food for no apparent reason, but against the background of mental problems, such as paranoia or depression.
  3. Mental morbid anorexia. Complete loss of the need for food with relatively normal physical and mental well-being.
  4. Drug anorexia. Occurs as a side effect of taking drugs designed to solve other health problems, such as antidepressants or stimulants.
  5. Anorexia nervosa. A conscious refusal to eat due to the all-consuming idea of ​​getting rid of excess weight.

Stages of anorexia

Only a doctor can diagnose anorexia. Do not rush to labeling and diagnosing if you met with an old friend and think that she has lost a lot of weight. This may be due to another illness or prolonged stress. Or maybe - the result of proper nutrition and sports in accordance with the doctor's recommendations. To make a diagnosis, many criteria are taken into account, including heart rate, tests, and a conversation with a psychotherapist.

Gereeva Elmira:

The stages of development of anorexia nervosa can be divided into several stages:

The first stage. A person decides to lose weight. This stage is characterized by pronounced dysmorphophobia - delusional or overvalued ideas of dissatisfaction with one's own appearance, which trigger mechanisms to prevent this shortcoming. Now the number of diagnosed cases of anorexia nervosa has significantly decreased, but the age threshold is also lowering. Children and teenagers are at risk.

In modern society, the boundaries of a healthy lifestyle have been erased. Due to the lack of knowledge, it is very difficult for people to determine whether now their loved one has simply begun to monitor their diet or is developing an eating disorder. Therefore, most often the first stage of the development of the disease is skipped. After all, improving nutrition and exercising is great. Only no one says what is hidden behind this "idea fix".

Second stage. Characterized by deliberate actions. And it ends at the moment when the weight is reduced by 20-50% of the initial indicators. It all starts with a reduction in daily calorie content, restrictions in a particular food group, or excessive physical activity.

Further ways to reduce weight depend only on its subjective "severity". Induction of vomiting and use of diuretics or laxatives entail secondary somatoendocrine disorders. This happens about 1-2 years after the person started to lose weight. For example, girls begin amenorrhea.

At this point, the idea of ​​weight loss absorbs a person completely, he thinks only about food and indicators on the scales. The fear of gaining weight back causes disturbing thoughts about every bite eaten. The lower the numbers, the more pronounced somatic disorders: from prolapse of organs, constipation, pain in the stomach to cachexia - an extreme degree of exhaustion of the body.

Third stage. The resulting pathologies become more pronounced. Thermoregulation is disturbed, hair falls out, teeth are destroyed, the level of physical activity decreases. In addition, a person does not notice objective problems and a decrease in the quality of life. He still continues to go to the "ideal" because of the disturbed perception of his own body. Even at this stage, it is possible to correct the consequences. But the risk of recurrence of the condition, which requires hospital observation, remains for another two years.

Symptoms of anorexia

People with anorexia nervosa constantly lose weight and appear emaciated. In addition to external manifestations, there are a number of symptoms in the patient's health and lifestyle:

  • inability to maintain optimal weight;
  • fatigue and insomnia;
  • yellowish skin tone, dark or pale patches;
  • thinning and hair loss;
  • absence of menstruation for several cycles;
  • dry skin;
  • low pressure;
  • problems with the gastrointestinal tract, lack of stool.

If you notice the following symptoms in your loved ones, they most likely need specialist help.

Constantly cold

Anorexia affects the production of thyroid hormones, which regulate metabolic processes and are responsible for the normal functioning of the immune system. One of the consequences of such an imbalance is a violation of the temperature regime of the body. Due to poor microcirculation and a drop in internal temperature, patients with anorexia are constantly cold [1]. They are given out by multi-layered baggy clothes, which they are forced to wear even in the warm season.

For the same reason, the body begins to be covered with a layer of thin fluffy hairs - this is how the body tries to keep warm. In addition, due to a weakened immune system, people with this eating disorder are more likely to get colds than others. For example, a common runny nose can easily turn into chronic sinusitis or tonsillitis.

Begins to get involved in cooking

Passion for cooking and the desire to feed everyone around is one of the main symptoms of anorexia. You can recognize the disease by a sudden desire to watch cooking shows, talk a lot about food, collect recipes, read cookbooks and cook sumptuous meals for the family. True, the patient himself is unlikely to touch the prepared dishes. Food begins to occupy all thoughts, but it is no longer associated with what can be taken orally.

Some people think that interest in cooking is an attempt by the brain to remind the body to eat. Others are sure that anorexics get indirect joy and pleasure by watching how others eat. If you notice that a friend is giving her lunch to a pet, throwing away food, or shifting it to other people's plates, this is cause for concern.

Often sad and easily pissed off

Extreme diets lead to nutritional deficiencies [2] and imbalances in certain hormones: serotonin, dopamine, oxytocin, leptin, and cortisol, the stress hormone [3]. Therefore, in patients with anorexia, there are sharp mood swings, and obsessive behavior in relation to food intensifies. For example, some of them begin to wash their hands after each contact with food.

In addition, endocrine changes cause an increased sense of anxiety and prolonged depression, according to the staff of the Harvard Medical School [4]. The fact is that estrogen and oxytocin help fight fear, reduce stress and anxiety. And the low level of these hormones, which is typical for people with anorexia, makes it difficult to overcome the fear of food. At the same time, pressure from relatives only increases anxiety.

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Tired quickly

Lack of proper nutrition and poor appetite lead to increased fatigue. Since protein-energy deficiency occurs with anorexia, this negatively affects the work of all organs and systems of the body. To maintain life, he is forced to use internal resources, which are far from unlimited.

As a result, anorexic patients experience a decrease in muscle strength. They begin to tire faster, experience weakness, drowsiness and frequent dizziness [5]. In addition, fainting and malfunctions of the heart (weak pulse, arrhythmia) are possible. The faster the girl loses weight, the more pronounced the unpleasant consequences.

Rapidly loses weight and is afraid to gain weight

The mere thought of the possibility of gaining weight causes a panic attack in patients with anorexia. At the same time, it is almost impossible to feed them. To keep the number of calories consumed to a minimum, not all girls refuse food.

They use different methods to reduce body weight. According to a study by American psychologists [6], 86% of people with eating disorders artificially induce vomiting, 56% abuse laxatives, and another 49% use diuretics.

In addition to changes in behavior, over time, external signs of the disease begin to appear. Among them are a sharp weight loss, sunken cheeks and stomach, blue bags under the eyes, protruding collarbones, pointed knees and elbows. At the same time, the skin becomes dry and pale, and the hair becomes brittle and dull.

Becomes withdrawn and uncommunicative

When the desire to lose weight becomes an obsession, the circle of interests narrows. A patient with anorexia becomes withdrawn and uncommunicative, gradually losing contact with relatives and friends. Since at this moment a person is left alone with his problem, he begins to seek support in the circle of like-minded people who are losing weight.

As a rule, people with anorexia find each other in special communities that promote the disease. There they share daily reports and life hacks that help them on their way to the “perfect body”. System administrators do not keep track of such malicious content, so these groups continue to exist [7]. According to Canadian researchers [8], social media is one of the main catalysts for the development of eating disorders.

Constantly counting calories

Strict calorie counting is another rule that anorexics follow. They register every food they eat. As a rule, such girls reduce the calorie intake to 400–700 per day [9].

At the same time, many keep so-called "food diaries". They are published in social networks using the hashtag #anorexiadnevnik. For some, the disease begins with a harmless rejection of sweets and starchy foods, while others decide to give up meat or become a vegan. From the outside, it may seem that everything happens within the framework of the concept of a healthy diet, so relatives perceive these restrictions as a teenage whim. But soon the diet is reduced to a few “safe” low-fat foods, and mood begins to depend on the number on the scale.

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Exercising and walking a lot

Extreme dieting is often accompanied by strenuous exercise in anorexics. In this way, patients punish themselves for eating and burn calories that have entered the body. According to the results of a study [10] conducted by Italian doctors, 45% of patients with eating disorders resorted to heavy physical exertion.

This phenomenon is more common in women than in men, according to scientists from La Trobe University in Australia [11]. With anorexia, thoughts about training become obsessive: when, for some reason, patients miss classes, they experience a strong sense of guilt [12].

If a friend starts walking a lot and torturing herself with prolonged physical activity, she most likely needs help, psychiatrists warn [13].

Complains of menstrual irregularities

Reducing the size of portions and number of meals negatively affects the synthesis of leptin and insulin, hormones that regulate appetite. Their deficiency leads to various metabolic and neuroendocrine disorders. For example, the patient's bones become looser and more fragile, and therefore the risk of fractures increases significantly.

In addition, with anorexia, the production of sex hormones decreases, which slows down sexual growth, disrupts the reproductive function of the body and loses sexual desire. As a rule, along with the loss of kilograms in patients with anorexia, the menstrual cycle is interrupted.

And with a lack of leptin, the brain ceases to control the process of losing weight. As a result, the body begins to quickly lose weight and reject incoming food at the cellular level.

Considers himself fat

Anorexics cannot objectively assess their figure. They spend a lot of time in front of the mirror and consider themselves fat [14], even when everyone around them says that they are exhausted. This is a feature of the disease: the perception of the body is distorted [15], so the ideal weight for such girls is unattainable.

French researchers conducted an interesting experiment [16]. They invited 50 participants, half of whom suffered from anorexia. The girls were asked to visually assess whether they could pass through a narrow doorway.

The results of the study showed that participants with eating disorders overestimate body size. They feel bigger than they really are. Scientists believe this is due to disorders of the central nervous system. Girls saw themselves the same as they were before anorexia.

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Causes of anorexia

The exact cause of the diagnosis is unknown. People who develop anorexia may suffer from perfectionism and constantly strive for an unattainable ideal or be characterized by excessive anxiety and look for ways to control their lives. Doctors identify several main factors prone to eating disorders:

  1. Biological. Genetics and hormones can lead to the development of anorexia nervosa. It is especially associated with low levels of serotonin.
  2. Social. Intrusive images of thin people broadcast in magazines, social networks and videos can affect how a person perceives himself. We inevitably compare ourselves with others, especially if they are beautiful and successful.
  3. Psychological. People with obsessive-compulsive disorder (OCD) tend to diet and exercise rigorously due to obsessions and compulsions.

Consequences of anorexia

Eating disorders cause many serious complications. Sometimes they lead to death, and often suddenly, without prior excessive weight loss. This is due to an abnormal heart rhythm or an imbalance of electrolytes—vital minerals—sodium, calcium, and potassium.

Other complications of anorexia can be cardiovascular problems such as mitral valve prolapse and heart failure. Often, the disease is accompanied by loss of muscle and bone mass, leading to an increased risk of fractures. Anorexia leads to hormonal disorders and diseases of the stomach, chronic renal failure.

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How to Treat Anorexia

One of the biggest challenges in treating anorexic patients is their lack of desire to change. Sometimes a person does not agree to the help of a doctor, even when it becomes obvious that the quality of life is suffering. Lack of energy and strength, physical and nervous exhaustion, depression, inability to eat for a long time are already the extreme stages of an eating disorder. The main goal of treatment is to return the body to normal weight and develop proper eating habits without strict restrictions and hunger strikes. Therefore, a nutritionist works together with a therapist and a psychiatrist, who will help to create a menu and gradually return the patient to the joy of eating. Comprehensive treatment includes:

  1. Individual therapy. Cognitive-behavioral methods help to change the vector of thinking, learn to cope with strong emotions and increase self-esteem.
  2. Family therapy. It is good if not only anorexia sufferer participates in therapeutic sessions with a psychiatrist, but also his relatives and friends. To create a favorable atmosphere for all participants in the process, it is important to learn how to resolve conflicts, as well as adhere to a healthy lifestyle.
  3. Group therapy. These sessions allow people with identical problems to communicate with each other. All conversations are held with the participation and under the supervision of a doctor, otherwise they can turn into competitions between those who want to lose weight even more.
  4. Medical treatment. There is currently no cure for anorexia, but doctors can prescribe pills to combat the disease's symptoms of depression and anxiety.
  5. Hospitalization. Depending on the degree of weight loss, the patient can be treated as an outpatient or inpatient. In some cases, a feeding tube and droppers are indicated to keep the body alive, especially with severe dehydration.

Many people cope with anorexia and return to a full life. However, there are patients who cannot be saved. Usually this happens due to untimely access to specialists, when the body is exhausted to such an extent that there are irreversible malfunctions in the work of internal organs. Some people require lifelong support from a psychologist and work with groups of patients suffering from eating disorders.

There is no proven method to prevent anorexia nervosa, it can occur unpredictably as a result of severe psychological shocks. But observing the symptoms of the disorder helps in rapid diagnosis, subsequent treatment, and recovery. Do not hesitate to seek professional help from doctors if you suspect violations in yourself and your loved ones.

Expert comment

Elmira Gereeva. Psychologist, consultant in weight management and eating behavior, nutritionist, head of the educational department of the School of Emotional Intelligence

Anorexia nervosa is one of the most terrible mental disorders. It is diagnosed based on a low BMI (body mass index). This line is outlined in the diagnostic criteria (according to ICD-10 below 17.5). In people with ED, the highest risk of death is observed precisely in connection with this disease [17]. Anorexia nervosa is characterized by a deliberate reduction in body weight, which (which is very important) is caused by the person himself. Conventionally, there are two types of anorexia nervosa: purgative and restrictive.

Restrictive anorexia nervosa proceeds without episodes of body cleansing. And catastrophic weight loss is due to hunger strikes and excessive physical exertion. Cleansing anorexia nervosa is characterized by episodes of inducing vomiting after an attack of overeating, as well as the use of medications (laxatives, diuretics).

Dehydration in anorexia is due to a general tendency to starvation. At some point, in order to reduce the feeling of hunger, a person can increase the consumption of zero-calorie liquids. It is in this case that the risk of mortality increases. Recovery from anorexia is a very complex process. A good indicator is when a person has returned to his optimal BMI. The disease is often corrected in the hospital. Based on the clinical picture, a panel of specialists decides which diet is best for the patient. Most often, in addition to increasing the daily calorie content, droppers and Nutrizone are attached to it - feeding through a tube.

In order not to come to critical numbers on the scales and restore health, it is enough to adhere to standard principles of healthy eating, for example, Dietary Guidelines for Americans [18]. Remember to follow the WHO recommendations for physical activity. This will be enough. No need to chase the ideal and bring yourself to anorexia, which is impossible to get sick for a long time - the body will not stand it. If you cannot cope on your own, be sure to contact the experts. You should not deny the existence of a problem, as it will declare itself in any case.

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