Anorexia nervosa, often simply called “anorexia,” is an eating disorder characterized by distorted body image and an intense fear of gaining weight. Those who suffer typically display extremely restrictive behavior regarding food intake and are often visibly underweight (below a body mass index of 18.5). In addition to restriction, compulsive purging behavior is also common, including excessive exercise, laxative use, or self-induced vomiting.
Eating disorders co-occur with substance use disorders at a rate five times higher than the general population, reports the National Eating Disorder Association. Commonly abused substances include alcohol, amphetamines, cocaine, laxatives and diuretics.
Diagnosing Anorexia Nervosa
According to the American Psychiatric Association, an anorexia diagnosis involves the following criteria:
- Restrictive intake of energy sources resulting in low body weight with regard to that person’s age, sex, development, and physical health
- An overwhelming fear of weight gain, even if already underweight
- Denial of the seriousness of that person’s low body weight
- Strong connection of self-worth to physical appearance, or a dysfunctional experience with one’s own perceived physical appearance
Who is at Risk for Anorexia?
About 30 million people in the United States suffer from an eating disorder. Although researchers have identified no single, identifiable cause for developing the disorder, some groups are more at risk than others. For example, individuals with the following personality traits may be more susceptible to eating disorders:
- An inclination toward perfectionism
- Impulsive behavior
- Competitive nature
- Prone to avoid conflict
- “Type A” approach to achievement
- Low self-esteem
More women are currently diagnosed than men, although the proportion of boys and men reporting symptoms is rising. Some studies show that 50-80% of the risk is genetic, and nearly half of those who are diagnosed will also have a co-occurring mood and anxiety disorder. For individuals who become hospitalized from an eating disorder, the co-occurrence of mood or anxiety disorders jumps to 94%.
Short-Term and Long-Term Effects of Anorexia
In the short term, food restriction causes include dehydration, upset stomach, constipation, dizziness, fainting, loss of energy, and irregular sleep patterns. Side effects also include mood swings, difficulty concentrating, poor performance in work or school, and stressed personal relationships.
As continued restriction deprives the body of essential macro and micronutrients, more noticeable side effects develop, including weight and muscle loss, hair loss and tooth decay. A fine “down” called lanugo may grow on the body. Individuals may also experience anemia, seizures, amenorrhea, thyroid dysfunction and low white blood cell count, which hinders the body’s ability to fight infection. As starvation continues, heart and kidney damage occur.
Clients who seek treatment will recover from most of these health issues, but some damage, such as bone loss, is permanent. This leads to a greater likelihood of developing osteoporosis later in life. Without treatment, anorexia is fatal. In some cases, users may develop bulimia or binge eating disorder in response to ongoing starvation.
Signs of Anorexia
Aside from the physical side effects listed above, those who suffer from anorexia may also exhibit behavioral signs that can help loved ones identify when a problem exists. These include:
- Strict adherence to eating rituals, such as only eating certain times of day, or only eating food in a certain order
- Compulsive, ritualistic behavior, such as needing to walk a specific number of steps in a day or perform specific tasks before eating
- Taking an unusually long time to eat small quantities of food
- Excessively using spices or condiments
It is important to remember that those who suffer from anorexia may go to considerable lengths to hide their disorder, making it difficult for friends and family to identify a problem. They may dress in layers to distract from significant weight loss, avoid social settings involving food, or explain away their weight loss with stress or recent illness.
Treatment for Anorexia
Long-term recovery from anorexia nervosa requires comprehensive treatment with doctors, mental health professionals and dietitians who have experience with eating disorders. Since many anorexia clients also suffer from co-occurring disorders, such as depression, personality disorders or substance use, an assessment to determine what further psychological treatment may be needed is important.
The primary focus as treatment begins is to address immediate medical concerns, which may require hospitalization. But lifelong recovery requires more than simply helping a client return to a healthy body weight. Psychotherapy is also required to help treat co-occurring mental illnesses, restore self-confidence and build a healthy body image. The primary forms of psychotherapy used to treat anorexia are cognitive behavioral therapy (CBT) and family-based treatment (FBT).
Cognitive behavioral therapy, a cornerstone of our treatment at Sprout Health Group, helps clients identify what leads them to restrict and develop strategies to work through their triggers in a healthy way.
Family-based treatment is another important part of anorexia recover, particularly for teens and adolescents. This approach incorporates parents into treatment, creating a greater sense of understanding for the illness among all family members, and a stronger support network for the client.
Anorexia and Substance Use Disorders
When anorexia nervosa occurs alongside substance use, it is important to seek help at a facility certified in treating co-occurring disorders. Personalized treatment plans that address anorexia and addiction recovery separately typically lead to the best outcomes.
It is also important to seek a facility with a comprehensive aftercare program. Aftercare refers to the transition process from treatment to ongoing recovery in everyday life. It may include medical checkups to ensure physical recovery continues, as well as ongoing therapy sessions, nutritional education and addiction recovery support. Group therapy with others in recovery is also beneficial. The best combination of treatments is unique to each individual.
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