Most people have an idea of what anorexia is, but did you know that 9% of Americans will experience an eating disorder in their lifetime? Anorexia, one of the most well-known eating disorders, occurs when individuals severely restrict their food intake, consuming significantly less than what is needed to maintain a healthy body mass index (BMI).
The unfortunate fact is that this self-imposed starvation leads to extreme weight loss and can have serious physical and psychological consequences. Despite some of the common misconceptions, anorexia is not just about food; it is a complex psychological issue. Understanding the seriousness of anorexia is crucial for seeking appropriate treatment and support.
The big why
The term anorexia comes from ancient Greek and means a loss of appetite. This may sum it up on the surface, but if you dig a little deeper, it’s a bit more complicated. There is no certain answer as to the exact cause of anorexia, but it is believed to result from a combination of genetic, neurochemical, and environmental factors. Genetic predispositions may involve changes in brain chemistry and hormone levels.
For a long time, it was thought that environmental influences, like the societal images that idealize thinness, could drive anorexia; newer theories put less focus on this pressure and more on the desire to control the environment. This perceived control is often a belief or feeling that even if we can not control everything, at least one can control some biological processes, specifically food intake and body weight.
This sense of control often arises as a response to feeling out of control in other areas of life and is a reason for comorbidities like obsessive-compulsive disorder (OCD) and anxiety. When stressful and unpredictable situations occur, they can feel overwhelming, whereas the ability to influence what, when, and how much one eats or exercises provides a sense of order and predictability. The real problem is this control is illusory, as the disorder eventually controls the individual through strict and all-consuming rules and rituals around food and exercise, leading to serious physical and psychological health problems.
Symptoms
We have an idea of why anorexia happens, but how exactly do doctors diagnose it? The process is complex and relies on physical, psychological, and behavioral signs and symptoms.
A doctor will typically conduct a thorough physical examination to check for signs of malnutrition or complications from insufficient food. This is where frontline healthcare workers and those who have completed courses like family nurse practitioner online programs make such a massive difference.
Healthcare workers would check vital signs, body mass index (BMI), skin and hair health, and heart function. If a doctor suspects anorexia, they are trained to diagnose but will often refer the patient to a mental health worker with more expertise.
In a psychological evaluation, the therapist tries to get as full a picture as possible of the patient’s situation, discussing eating habits, body image perception, and feelings of self-worth.
There are a variety of psychological self-report questionnaires that can be deployed to get a quantitative sense of the situation. Behavioral observations focus on identifying extreme dieting, refusal to eat, denial of hunger, fear of gaining weight, and dissatisfaction with body size and shape. It is usual for the GP or psychologist to order laboratory tests to rule out other medical conditions that might cause weight loss or to check for complications related to anorexia.
Common treatments
Since anorexia is a psychological disorder with extreme physical consequences, the approach to treatment needs to address both, usually with some form of supervised weight gain and talk therapy:
Supervised weight gain for anorexia
To get the patient back up to a healthy weight there are a range of nutritional programmes. The approach depends on each patient and is different if they are an inpatient. You will hopefully receive expert nutritional advice so that a diet plan can be made that helps you achieve a healthy weight. However, nutritional advice alone is not enough for a full recovery. Doctors will often recommend specific vitamin and mineral supplements to ensure you get the necessary nutrients or build levels back up if you are deficient. For those staying in the hospital, regular check-ins will monitor your progress and adjust your treatment plan as necessary.
Psychotherapy
Cognitive behavioral therapy (CBT) is a common form of therapy used for a range of issues. For anorexia, CBT can help to change distorted thinking patterns and behaviors related to food, body image, and self-worth. A CBT therapist would likely look at the underlying thought patterns that are driving anorexic behaviors.
Family-based therapy (FBT) can be effective for young people as it involves family members in the treatment process; when the family is included and supportive, they can significantly improve the treatment process. Other forms of individual therapy, like psychodynamic or interpersonal therapy can also be beneficial.
In severe cases, hospitalization or residential treatment may be necessary to stabilize the patient’s health until they are safe to be treated at home. intensive care offers support in a structured and safe environment.
Support groups offer a sense of community and understanding, with encouragement and shared experiences from others in recovery. Treatment for anorexia typically involves a team approach, including doctors, mental health professionals, and dietitians experienced in eating disorders, with ongoing therapy and nutrition education crucial for continued recovery.
Co-occurring conditions
Alongside anorexia, it is common to find other mental health conditions like anxiety, depression, or substance use. For this reason, a proper diagnosis is vital before treatment can begin.
About 49.5% of people with anorexia experience major depressive disorder (MDD) at some point, which can compound the effect of both conditions. Generalized anxiety disorder, which essentially involves excessive worry, affects about 21.9% of people with anorexia. 22.7% of people with anorexia experience post-traumatic stress disorder (PTSD) following some form of traumatic event. Some personality disorders like Borderline personality disorder (BPD), which is characterized by unstable moods, behavior, and relationships, affect about 25% of individuals with anorexia.
These co-occurring disorders can create a more complex situation to unravel; they can be comorbid, meaning they share symptoms or have different symptoms that exacerbate each other.
**Please note this article should not serve as medical advice; if you or someone you care about is struggling, contact one of the many helplines, your GP, counselor, or psychologist.
