What are the other Names for this Condition? (Also known as/Synonyms)

• Eating Disorder - Anorexia
• AN (Anorexia Nervosa)

What is Anorexia Nervosa? (Definition/Background Information)

• Anorexia Nervosa (Anorexia or AN) is a serious eating disorder characterized by loss of body weight disproportional to an individual’s age and height. It is reported predominantly in females. The symptoms of the condition typically begin to appear during adolescence and young adulthood
• Anorexia Nervosa is of 2 types:
  • Restrictive Anorexia Nervosa; a condition resulting in reduced intake of food
  • Binge eating and purging; a condition where eating excess food is followed by self-induced vomiting
• A history of the disorder amongst immediate family members, age (adolescence or young adulthood), changes in circumstances (such as death of a loved one, or changes in school, job, or a relationship), certain personality types, being involved in sports or being a dancer, are some risk factors for developing Anorexia Nervosa
• The causes of Anorexia Nervosa may be genetic, psychological, and environmental. It is possible that more than one factor contributes to this disorder
• The main symptom of this disorder is weight loss that is not proportional to an individual’s age or height. Other signs include an obsession with appearance, anxiety, depression, low blood pressure, constipation, dehydration, and decrease in bone density. Those affected by this disorder are often unable to comprehend the seriousness of their illness
• An accurate diagnosis of Anorexia Nervosa is made by a thorough physical examination, an assessment of symptoms, and evaluation of personal and family medical history. Other tests may include blood and urine analyses, X-ray scans to check for changes in bone density, and electrocardiography to assess heart function. An affected individual may be referred to a psychiatrist for further examination and assessment
• The potential complications of Anorexia Nervosa can be life-threatening, and may include anemia, severe electrolyte imbalance, kidney malfunction, thyroid problems, loss of bone density, seizures, depression, substance abuse, and thoughts of suicide
• A cooperative effort from professionals from various medical fields, as well as support from family members, is often required for an effective treatment of Anorexia. The options for treatment may include eating healthy with the guidance of a dietician, medications (for depression and anxiety), psychiatric counseling and adopting a hobby to generate/cultivate positive self-esteem. In some cases, hospitalization may be required to monitor the affected individual if life-threatening complications are noted
• Presently, there are no available methods towards preventing Anorexia Nervosa. However, recognizing the symptoms early on and seeking prompt medical attention may prevent serious physical and emotional health issues from developing in the individual
• An emphasis on being healthy (and not thin), healthy physical activity (and not excessive), having a supportive environment at home, veering away from social pressures, and cultivating habits that can increase assertiveness and self-esteem, may help the affected individuals cope with or recover from this condition
• A complete recovery from Anorexia is possible, with individual effort and family/group support. However, there is a possibility of the condition becoming chronic; therefore, long-term management of the condition may be necessary. It has been reported that the mortality rate in individuals with psychiatric disorders is highest for those with Anorexia Nervosa (at about 6%)

Who gets Anorexia Nervosa? (Age and Sex Distribution)

• Anorexia Nervosa occurs predominantly in the Western countries (such as US and Europe), although the numbers are reported to be on the rise in non-Western countries as well
• Individuals may develop AN at any age; however, teenagers and young adults are more at risk
• The disorder can affect both male and female genders, although 90% of those affected are females

What are the Risk Factors for Anorexia Nervosa? (Predisposing Factors)

The following are some risk factors that may predispose one to Anorexia Nervosa:

• Female gender
• Teenagers or young adults
• Having a close family member (sibling or mother) with the condition
• Certain professions that include athletics, modeling, acting, or dancing (such as ballet)
• Constant worry about body weight and shape
• Having certain set ideas or notions about health and beauty, resulting in a feeling of inadequacy 
• Personality traits, such as perfectionism
• Anxiety disorders
• Low self-esteem and self-worth
• Social or peer pressure
• High parental expectations
• Weight gain
• A recent bereavement
• Switching schools or jobs
• Change in relationship status
• Change in parents’ relationship, such as due to separation or divorce

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Anorexia Nervosa? (Etiology)

The causes of Anorexia Nervosa may be genetic, psychological, or environmental. In many cases, a combination of these factors may result in this eating disorder.

Genetic factors:

• Based on research on families, in which the condition is reported in more than one member, a genetic predisposition to AN may be a factor for development of this disorder
• Although the gene(s) responsible for the disorder have not yet been identified, research has shown that certain loci on chromosomes 1, 2, and 13 may be involved in the development of Anorexia

Psychological factors:

• An obsessive-compulsive personality in individuals may contribute to this disorder. Such personality types may force them stick to rules, schedules, and calorie counts, even when such behavior may otherwise be harmful to them
• High expectations from parents, such as to achieve academic or sport excellence
• Parental separation or divorce
• Anxiety and depression can contribute to Anorexia. Conversely, AN can exacerbate anxiety and cause depression in the affected individuals, causing a kind of negative feedback loop

Environmental factors:

• The idea of equating ‘being thin’ to ‘being attractive’ may have a bearing on the development of this condition. This idea is more prevalent among the Western societies, particularly among young women
• Social or peer pressure is reported to contribute to Anorexia as well. A need to “belong” and not appear different from peers, may be the trigger for developing certain habits which can lead to Anorexia Nervosa

What are the Signs and Symptoms of Anorexia Nervosa?

The signs and symptoms of Anorexia Nervosa may be categorized as being physical or behavioral. 

The physical signs and symptoms may include:

• Extreme weight loss; tiredness
• Thinning and breaking of hair
• Dry skin covered with fine hair
• Pale appearance; dry mouth
• Dehydration, constipation
• Low blood pressure
• Anemia
• Sensitivity to cold, experiencing chills
• Hormonal disturbances
• Absence of menstruation
• Confusion, memory problems
• Muscle wasting; loss of bone density
• Swelling of hands and feet

The behavioral signs and symptoms may include:

• Dread of weight gain; not eating enough food
• Over-exercising with little regard for discomfort to self
• Using the bathroom right after a meal; inducing self to vomit
• Taking medication to induce bowel movement to get rid of ingested food
• Using water pills to induce urination
• Using diet pills to keep hunger at bay
• Not eating in the presence of others
• Obsession with food
• Lying about food ingestion
• Irritability, anxiety, and depression
• Reduced desire for sex
• Reduced social interactions
• Nurturing suicidal thoughts

How is Anorexia Nervosa Diagnosed?

The diagnosis of Anorexia Nervosa is made by the following tests and exams:

• A thorough physical examination and an assessment of symptoms
• An evaluation of family medical history
• Psychological examination and assessment
• Blood tests to check for different blood cell types (anemia)
• Urine test for checking kidney function
• Tests to check liver function
• Thyroid function tests
• Electrocardiography for assessing heart function
• X-rays to determine if there is a loss of bone density

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Anorexia Nervosa?

Some known complications of Anorexia Nervosa include:

• Arrhythmia or irregular heartbeats
• Severe dehydration and/or malnutrition
• Kidney failure due to dehydration
• Severe anemia
• Increased risk of infections
• Fainting episodes
• Osteoporosis
• Seizures
• Clinical depression
• Difficulties getting pregnant
• Loss of friends
• Contemplating or attempting suicide

How is Anorexia Nervosa Treated?

The treatment for Anorexia Nervosa involves a multi-pronged approach. A coordinated effort from professionals belonging to different disciplines is often required to assist the affected individual in recovery.

The treatment options include:

• Nutritional therapy, to enable weight gain in a gradual manner; maintenance of healthy body weight (the diet is carefully planned with scheduled eating times)
• Psychotherapy, to help an individual comprehend that he/she has an illness. This may often be the most difficult part, especially if the individual believes that he/she is not sick and treatment is unnecessary
• Counseling to help cope with stress
• Behavioral therapies, to assist the affected individual modulate their behavior and improve self-esteem. Such therapies may include:
  • Curbing excessive physical activity
  • Cultivating new habits or hobbies
  • Increased family/social interactions 
• Medication for anxiety and depression

Hospitalization may be necessary if severe complications develop, before seeking appropriate medical treatment. Following hospitalization, the affected individual may be:

• Treated with anti-psychotic and anti-depressant medications
• Fed through a tube (nasogastric tube)
• Given electrolytes
• Monitored for vital signs periodically
• Medicated or treated for any complication that may be present at the time (including arrhythmia, infection, and seizures)

How can Anorexia Nervosa be Prevented?

Currently, there are no available methods for preventing Anorexia Nervosa.

• However, recognizing the symptoms of the disorder and seeking prompt medical attention early may get an individual onto the path of recovery and avoid complications
• If a close relative, such as a parent or sibling, has the condition; then getting educated to recognize the symptoms of Anorexia can be helpful in preventing progression of symptoms
• Supportive family and friends can help individuals with AN cope better with stress

What is the Prognosis of Anorexia Nervosa? (Outcomes/Resolutions)

• The prognosis of Anorexia Nervosa depends on an early diagnosis, timely treatment, as well as the overall physical and psychological health status of the affected individual
• It is possible to achieve a complete recovery. However, there is a likelihood of relapse and the condition can become chronic
• For sustained wellbeing, an individual has to continue to work on the following:
  • Improving their self-esteem
  • Coping mechanism for stress
• If treatment is delayed or refused, serious and life-threatening complications may ensue. These complications can be fatal; Anorexia Nervosa has a mortality rate between 5-13%

Additional and Relevant Useful Information for Anorexia Nervosa:

Binge-eating disorder is an eating disorder, which involves recurrent episodes of eating large portions of food even when one is not hungry. It may be described as a form of compulsive behavior.