Characteristics Of Anorexia Nervosa

What is Anorexia nervosa?

Anorexia nervosa is an eating disorder associated with food restriction and self-starvation. It is characterized by a preoccupation with food, dieting, and body size that leads to restrictive eating habits. It can be very dangerous, even lethal, if not treated. While anorexia is often associated with teenagers, especially teenage girls, it can occur at any age and can affect individuals of any age, gender, or background.

People with AN may have an intense fear of gaining weight and a severely distorted body image [1]. The actions caused by these issues can lead to significant psychological and physical consequences, including organ damage, nutritional deficiencies, heart problems, and gastrointestinal issues. This eating disorder requires a comprehensive treatment approach, including psychotherapy, nutritional counseling, and medical monitoring.

Recognizing Anorexia Nervosa

There are two subtypes of anorexia nervosa: restrictive anorexia nervosa and binge eating/purging type of anorexia [1],[2]. Diagnosis of anorexia nervosa requires professional assessment using specific criteria according to The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5).

Identifying Restrictive Anorexia

The restricting type of anorexia involves eating very little food and losing weight through self-starvation or excessive exercise. The number of calories consumed by someone who is restricted is insufficient to support bodily functions and normal activities. Individuals might also work out more than once per day or exercise with the sole purpose of weight loss at the expense of friendships, homework, and other responsibilities [2].

Symptoms of anorexia nervosa include:

• Severely restricted food consumption
• Extreme thinness
• A tireless pursuit of thinness
• Unwillingness to maintain a healthy weight
• Intense fear of gaining weight
• Self-esteem influenced by weight or shape
• Distorted body image

Other symptoms and signs, which may develop over time, include:

• Osteopenia or osteoporosis
• Anemia and muscle wasting
• Weakness
• Brittle nails and hair
• Yellow, dry skin
• Fine hair growth all over the body
• Severe constipation
• Low blood pressure
• Slowed pulse
• Slowed breathing
• Heart damage
• Brain damage
• Hypothermia
• Lethargy
• Infertility

Identifying Binge Eating/Purging Type of Anorexia

While binging is often thought of as a bulimic symptom, there is also a binge eating/purging type of anorexia. Those with this type of anorexia engage in calorie and food restriction but also may experience binge eating and purging episodes. These involve eating large amounts of food and then purging by using laxatives, diuretics, enemas, or vomiting.

Someone with this subtype of anorexia may have the above symptoms associated with the restrictive type, as well as binge and purge episodes. Symptoms of a binging episode include: 

• Consuming massive amounts of food in a short time 
• Eating when not hungry or already full
• Eating extremely quickly 
• Eating alone to avoid embarrassment or humiliation
• Feeling guilty or ashamed about eating patterns

Diagnostic Criteria for Anorexia Nervosa

The DSM-5 outlines three major criteria for diagnosing anorexia nervosa:

• Restricting food intake relative to requirements, leading to significant weight loss and low body weight for sex, age, development, and physical health
• Having an intense fear of gaining weight or becoming fat, so much so that this fear interferes with weight gain despite the person’s significantly low weight
• The major influence of body shape or weight on self-evaluation and self-worth or consistent lack of recognition of the severity of their low body weight.

Dr. Brindusa Vanta, MD, notes, “Even if not all the criteria from the DSM-5 for anorexia are met, a severe eating disorder may still be present. There are cases of so-called atypical anorexia that don’t fit the typical description of anorexia.”

The Prevalence of Anorexia

Girls and women have a much higher prevalence of anorexia compared to boys and men, but it’s a misconception that anorexia only affects certain types of females.

Some research indicates that cisgender men make up about one-quarter of all anorexia nervosa diagnoses[3]. Research also found that transgender and nonbinary people are significantly affected by this eating disorder, with trans college students four times more likely to report disordered eating, including AN [4]. However, larger studies are needed to confirm these findings.

Research suggests that about 1% of female adolescents have anorexia. Furthermore, the prevalence of anorexia in Western countries increases at the rate of approximately 11 new cases per 100,000 every year. The rates in non-Western countries are increasing as well and currently range from 0.46% to 3.2%.

Anorexia Mortality Rates

Anorexia has one of the highest mortality rates of all mental disorders.  Eating disorders have the second highest mortality rate of any psychiatric illness behind opiate addiction. Over 3.3 million healthy life years worldwide are lost annually because of eating disorders. Getting treatment significantly improves the outcomes and survival rate.

Understanding the Causes and Risk Factors

Anorexia nervosa isn’t caused by a single factor—rather, its development is influenced by many interacting and intersecting factors, including genetic, psychological, environmental, and demographic risk factors[1],[2],[5],[6]. 

Genetic Causes

• Family history: Individuals with a family history of eating disorders, including anorexia nervosa, may have learned behaviors that make them at risk for this disorder.
• Heritability: Studies suggest a genetic component in the development of anorexia, with a higher concordance rate among identical twins compared to fraternal twins.

Psychological Causes

• Perfectionism: High levels of perfectionism and a desire for control are common psychological traits associated with anorexia nervosa.
• Body image distortion: A distorted image of your body, often driven by societal pressures and media influence, can contribute to the development of anorexia.
• Low self-esteem: Individuals with low self-esteem may use body weight and shape as a means of gaining a sense of control and self-worth.

Environmental Causes

• Cultural pressures: Societal emphasis on thinness and beauty standards can contribute to the development of body dissatisfaction and drive disordered eating behaviors.
• Peer influence: Pressure from peers, especially in environments where appearance is highly valued, may contribute to the onset of anorexia nervosa.
• Traumatic events: Traumatic experiences, such as childhood abuse or bullying, can be environmental factors that contribute to the development of anorexia.

Other Risk Factors

• Gender: Anorexia nervosa is more prevalent in females.
• Age: Onset often occurs during adolescence, but anorexia can develop at any age.
• Occupation or activities: Certain professions or activities that emphasize thinness, such as modeling or competitive sports, may create higher risk.
• Personality traits: Traits such as anxiety, obsessive-compulsiveness, and neuroticism may increase susceptibility to anorexia nervosa.

Understanding the interplay of these genetic, psychological, and environmental factors is crucial for developing effective prevention and treatment strategies for anorexia nervosa.

How Social Media Influences Anorexia

While there is research exploring the potential association between social media use and eating disorders like AN, the relationship is complex and not yet fully understood. The following points provide insights into the potential impact of social media on anorexia nervosa:[7],[8],[9]

• Exposure to idealized body images on social media platforms may contribute to body dissatisfaction and the internalization of unrealistic beauty standards, increasing the risk of disordered eating.
• Social media platforms facilitate comparison with peers, influencers, and celebrities, potentially causing feelings of inadequacy as well as pressure to conform to perceived societal norms, such as a thin waist.
• Cyberbullying and body shaming on social media may contribute to increased anxiety, stress, and the development of eating disorders like anorexia.
• Exposure to online content promoting fasting, excessive exercise, and extreme dieting may influence vulnerable individuals to adopt unhealthy weight-loss behaviors.
• Social media algorithms may create “echo chambers” in which users are exposed to content that reinforces their existing beliefs and behaviors, potentially perpetuating and exacerbating disordered eating. 

Dr. Vanta says, “Individuals diagnosed with anorexia nervosa can greatly benefit from reducing the amount of time spent on social media and from removing triggering content from their feeds.”

Secrecy Is a Common Trait of Those With Anorexia

Secrecy is very common in girls who are struggling with anorexia nervosa because they don’t want their weight loss to be interrupted if they are found out. They may also be ashamed and embarrassed about their behavior. 

They may skip meals by saying they forgot to eat, appearing to be too busy, or falling asleep at mealtimes. People with anorexia often make many excuses about why they are not hungry. They also avoid social occasions during which food will be readily available or spend lots of time making meals for others without eating the food they’ve prepared. 

Individuals with this condition may wear baggy or oversized clothing to hide their thin bodies. In order to lose more weight and give the impression to others that they are eating, they often restrict their intake to fluids and low-calorie food choices such as plain lettuce. Individuals who have anorexia may also use laxatives, diet pills, and excessive exercise in secret to continue shedding pounds.