Anorexia

Anorexia

Anorexia Nervosa, commonly referred to as anorexia, is an eating disorder rooted in the act of limiting nutrient intake to avoid gaining weight. It is a common eating disorder as individuals experience a distorted body image causing obsessions over the potential of gaining weight.  

It is important to remember the condition can affect any individual regardless of gender, race, age, sexual orientation or body type. Anorexia is a potentially life threatening disorder which should not be taken lightly or ignored. Often individuals with anorexia are fearful to admit the severity of the problem, leaving close family and friends to communicate with health professionals about potential concerns. Below are examples of possible habits and tendencies attributed to anorexia:

✅ binge-eating or purging                                         ✅ self-harm
✅ restricting food intake                                             ✅ fear of gaining weight
✅ distorted self image or body dysphoria              ✅ long periods of fasting
✅ inability to visualize weight loss                             ✅ menstrual irregularities 
✅ misuse of diuretics, laxatives, or enemas            
✅ obsessive measurement of body parts         
✅ inability to recognize severity of low body weight

✅ binge-eating or purging
✅ restricting food intake 
✅ fear of gaining weight
✅ distorted self image or body dysphoria 
✅ inability to visualize weight loss
✅ inability to recognize severity of low body weight
✅ obsessive measurement of body parts
✅ menstrual irregularities 
✅ long periods of fasting
✅ self-harm
✅ misuse of diuretics, laxatives, or enemas

Causes of Anorexia

Anorexia is commonly linked to how one views themselves or their self-image. Research has shown genetic factors can increase the potential risk of developing anorexia while other social and behavioral factors can trigger the onset. Children are at a high risk of sustaining this condition due to their developing brains adapting to new behaviors. 

The many misconceptions have led to the creation of more misconceptions within our society of what causes or leads patients to anorexia. Some of these “fake causes” of anorexia may actually stem from genetic predispositions to anorexia. The assumed correlation between these misconceptions and the causation of anorexia has allowed people to accept fake information as true causal factors of the disorder. If we remember the old saying about assuming, it is when we assume without listening deeper, we miss the true source of the problem. 

Here is a list of that may and may not be contributing factors:

💡 distorted self-image/body dysphoria        assigned biological sex
💡 environmental settings                                  gender
💡 culture                                                               sexual orientation 
💡 other restrictive eating diets                          race
💡 trauma causes a need for control                ethnicity 
💡 societal pressures                                             religion
💡 family values or norms                                    socioeconomic status 
💡 stigma and shame                                           an individual’s choice
                                                                                   
  a conscientious decision to not eat

💡 distorted self-image/body dysphoria 
💡 environmental settings
💡 culture 
💡 other restrictive eating diets
💡 trauma causes a need for control
💡 societal pressures
💡 family values or norms
💡 stigma and shame  

assigned biological sex
gender
sexual orientation 
  race
  ethnicity 
  religion
  socioeconomic status 
  an individual’s choice
  a conscientious decision to not eat

Misconceptions About Anorexia

The many misconceptions of anorexia have led to the current societal stigmas around eating disorders. They have created a barrier to seeking out professional help due to the fear of judgment and biases. These stigmas prevent people from having conversations about the potentially threatening condition and needs for successful treatment. These pressures create discomfort when sharing struggles or experiences causing individuals to believe they will always be misunderstood. Some of these stigmas/misconceptions include:

🚫  attention-seeking
🚫  something to ignore
🚫  uncommon
🚫  adolescent phase
🚫  affecting women only
🚫  does not affect men
🚫  “skinny person’s disorder”  
🚫  shameful
🚫  due to social media

Signs and Symptoms of Anorexia

There are many behavioral signs connected to an anorexia diagnosis. However each individual experiences their own behavioral patterns. Symptoms altering behavioral patterns are not an accurate diagnosis of anorexia, though act as a key identifier and guideline singling one is struggling. Keeping in mind, signs vary based on the individual experiences of a person living with anorexia. Here is a list of some common signs:

Obsession of Body Image
🚩  frequent comments about looking “fat”
🚩  dressing in multiple layers or wearing baggy clothes to hide body
🚩  maintaining a strict exercise routine
🚩  obsession with calories or counting calories

Social
🚩  low drive to interact socially
🚩  concerns about eating in public
🚩  isolating from friends and family
🚩  denial of feeling hungry

Eating
🚩  restrictive towards certain foods
🚩  a strong feeling of needing to gain control
🚩  feeling cold all of the time
🚩  cooking meals for others without actually eating them
🚩  avoiding meal times

Physical
🚩  lack of menstruation
🚩  self harm

Diagnosing Anorexia

There are three diagnostic parts when assessing patients with potential anorexia symptoms. The diagnostic process is completed with the assistance and guidelines created by the Diagnostic and Statistical Manual of Mental Disorders, which aims to explain mental disorders. To clarify, the DSM-5 creates and defines labels to categorize people, however we must remember that everyone is different and no two cases are quite the same. 

It is also important to note, having some identifying or similar symptoms does not mean one has a condition. In the case of anorexia nervosa, there are three pieces of diagnosis criteria used by psychiatrist  and mental health professionals specializing in eating disorders. These medical professionals are to be consulted for a proper diagnosis. The simplified DSM-5 criteria is as follows:

⚠️ The limitation of food eaten in proportion to body size, which leads to a significantly low body weight for an individual person’s body type.
⚠️ Extreme fear of gaining weight or becoming fat even while at a significantly low body weight. 
⚠️ Disturbance of an individual’s body image including severe criticism of one’s body weight upon self-evaluation or persistent lack of recognition of the severity of current low body weight.

Conditions Commonly Mistaken for Anorexia

Misdiagnosis of eating disorders is frighteningly common, and treatment may be delayed for years because the patient was advised to simply “eat more.” Similar symptoms to other eating disorders also frequently causes confusion and misdiagnoses. The following are some diagnoses often mistaken for anorexia:

✳️ Obsessive-compulsive: strange eating rituals and similar behavioral patterns
✳️ Bulimia nervosa: binging and purging
✳️  Esophageal achalasia: induced/spontaneous vomiting, avoidance of food, and significantly low body weight
✳️ Constitutional thinness: significantly low body mass index (BMI)

Treating Anorexia

Anorexia is a challenging condition to treat, as many people living with the disease are unaware of the drastic effect the eating habits have had on their health. Treatment options for those suffering from anorexia vary depending on severity. 

More severe cases of anorexia in which patients have progressed further into the stages of malnutrition may require immediate hospitalization. Concerns related to dehydration, electrolyte imbalances, and low blood sugar levels can be life threatening especially in individuals with chronic illnesses such as diabetes. 

The most successful approach to recovery are treatments involving a multidisciplinary approach of coordinated care between multiple doctors or health professionals working together with their client. This approach supports all environments linked to the client’s world for a personalized and supportive recovery. The treatment team creates a plan together with the same goal of supporting the client on the road to recovery. This integrative approach may include referral for the following treatments:

🧬 dietician
🧬 residential programs
🧬 psychotherapy
🧬 inpatient hospitalization 
🧬 integrative therapy
🧬 family therapy
🧬 therapeutic support groups
🧬 nutritional counseling
🧬 cannabis 

Support from family, friends, and peers play an important role in the engagement with treatment. With the moral support needed to succeed and a multidisciplinary approach towards successful treatment has shown to be an effective way to treat those with anorexia.

Healthcare Professionals Who Treat Anorexia

For the best results in a successful treatment of anorexia, seek providers that have specialities in the assessment, treatment, diagnosis, and continuing support of patients diagnosed with anorexia. 

Many medical and mental health providers are familiar with the diagnosis of anorexia.  However if your chosen provider is not, they should always provide a knowledgeable referral source. Specialized providers will have the capabilities to diagnose using various testing methods to decrease the likelihood of misdiagnoses and unnecessary treatments. 

If you choose to utilize medication, psychotherapy should always be incorporated in treatment planning. 

The following are professionals involved in the treatment of anorexia:

🧠 psychiatrists
🧠 family physician  
🧠 psychologist
🧠 nutritionist
🧠 counselors and therapists
🧠 occupational therapist
🧠 social worker
🧠 advance practice nurse
🧠 dietitian

Recognizing Immediate Need for Anorexia Treatment

Asking for help is nothing to feel ashamed of, and warning signs of anorexia are important to catch in the early stages of the disease in order to fully recover and avoid permanent health problems or even death. 

For loved ones and outside supporters, sometimes there is a need to make a challenging 

decision of requiring treatment even though there is potential for conflict. Remember, health is wealth, and taking the first steps in finding or receiving treatment is crucial in the preservation of an individual’s physical and mental health. 

You should seek treatment or assistance if you are experiencing: 

🚨 obsessive behaviors towards food
🚨 skin discoloration
🚨 change in relationship with food
🚨 change in mood 
🚨 uncontrolled emotions or behaviors
🚨 decreased socialization 
🚨 difficulty maintaining relationships
🚨 disengagement in hobbies
🚨neglecting grooming and hygiene
🚨 lack of menstruation
🚨 loss of hair 

Anorexia Professional Organizations

Provided are some resources to help the start of seeking support for anorexia. Though these are national links, consider narrowing options down by searching in your current location. 

https://dsm-psychiatryonline-org.libproxy.temple.edu/doi/full/10.1176/appi.books.9780890425596.dsm10#CIHFFIAE

https://www.nationaleatingdisorders.org/warning-signs-and-symptoms

https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia/warning-signs-symptoms

https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/eating-disorder-myths

https://centerfordiscovery.com/blog/five-common-misconceptions-anorexia-nervosa/

https://www.urmc.rochester.edu/childrens-hospital/adolescent/eating-disorders/myths.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3479631/

https://www.nationaleatingdisorders.org/learn/general-information/research-on-males

https://psycnet.apa.org/search/display?id=e7df0649-b880-9215-bc05-4abb77cecb6d&recordId=9&tab=PA&page=1&display=25&sort=PublicationYearMSSort%20desc,AuthorSort%20asc&sr=1

https://centerfordiscovery.com/blog/five-disorders-mimic-anorexia-nervosa/

https://www.mayoclinic.org/diseases-conditions/eating-disorders/in-depth/eating-disorder-treatment/art-20046234

https://www.verywellmind.com/leading-eating-disorder-charities-and-organizations-4145389

https://www.nami.org/About-Mental-Illness/Treatments/Psychosocial-Treatments

https://www.psychiatry.org/patients-families/eating-disorders

 

Scholarly Articles:

The neurobiology of anorexia nervosa: A systematic review // Andrea Phillipou, Susan Lee Rossell and David Jonathan Castle2,6

https://journals-sagepub-com.libproxy.temple.edu/doi/pdf/10.1177/0004867413509693

Researchers at King’s College Report New Data on Eating Disorders (Anorexia nervosa: aetiology, assessment, and treatment). (2016, January 16). Psychology & Psychiatry Journal, 551. https://link.gale.com/apps/doc/A439485721/AONE?u=temple_main&sid=AONE&xid=958e8197

ANOREXIA NERVOSA: A MULTIDISCIPLINARY TREATMENT PROGRAM FOR PATIENT AND FAMILY

https://www-tandfonline-com.libproxy.temple.edu/doi/pdf/10.1300/J010v07n01_07?needAccess=true

Oesophageal achalasia in adolescent women mistaken for anorexia nervosa.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1882482/?page=1

Constitutional thinness and anorexia nervosa: a possible misdiagnosis?

https://www.frontiersin.org/articles/10.3389/fendo.2014.00175/full

Anorexia nervosa: Obsessive–compulsive disorder, obsessive–compulsive personality disorder, or neither?

https://www-sciencedirect-com.libproxy.temple.edu/science/article/pii/S027273580100112X