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Anorexia

Anorexia nervosa: symptoms , causes and treatment

Anorexia Nervosa – Often just called anorexia, this disorder refers specifically to the practice of self-starvation or living on an extremely restricted diet. Patients who suffer from anorexia are not able to see that they are a normal body weight, and even when they are underweight, they “feel fat.”

You would likely be suffering from anorexia if you are experiencing the following:

  • Severely restricting food intake leading to significantly low body weight for the person’s age, gender, and height
  • Failure to gain weight resulting in significant low body weight for the person’s age, gender and height
  • Fear of weight gain or becoming fat
  • Having a distorted body image, eg. believing you are overweight or fat when you are actually underweight
  • Having distorted thoughts relating to weight and food, eg., thinking you would gain weight by eating a small portion of food
Anorexia nervosa: symptoms , causes and treatment
Types of Anorexia

Types of Anorexia

There are two different types of anorexia and these are referred to as the restricting type and the purging type.

People who suffer from the restricting type will restrict calories to an unrealistic level and may also exercise to an excessive degree in an attempt to continually lose weight.
The purging type presents in a similar manner to bulimia nervosa in that people tend to binge on foods and then purge by different means, including vomiting, taking laxatives, or using diuretics. (Purging anorexia is different from bulimia in that anorexics tend to be underweight while bulimics tend to maintain a normal or above average body weight.)

Atypical Presentations

While there are common types of anorexia, there are atypical presentations as well. These include the following:

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Presentation in Children

Anorexia has appeared in children under the age of 12 and as young as age seven. In this younger group, the vast majority of the patients are male. Of course, young children cannot explain their condition, so physicians must look for signs and symptoms, such as: low fat reserves, ischaemic changes in toes (causing gangrene in the toes and feet), and peripheral circulatory failure.

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Presentation in Women over the Age of 30

At times, women over the age of 30 may develop anorexia. It is usually coupled with strong signs of depression. Most commonly, women of this type develop the condition as a result of extreme stress, trauma or loss of a beloved family member. Since this type of atypical anorexia can look very much like depression, a physician will need to differentiate between the two.

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Presentation in Males

For the most part, anorexia presents in young women. However, there are cases when males will begin losing weight due to extreme food restriction. Often, the male patients will indicate they are exercising more or working to become fit, and they may restrict their food to such a level that they develop anorexia.

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Atypical Anorexic Presentations

There are also some atypical anorexic presentations where individuals appear to have no fear of weight gain or issues with body image. In fact, because this type of presentation has become more well-known, studies indicate that body image issues should not be a deciding factor when diagnosing anorexia.

The Impact on Patients

The impact of anorexia contains both physical and psychological elements for an individual. This serious illness can bring about equally serious repercussions. The common complications or effects can include:

  • Higher risk of anxiety and depression
  • Higher risk of suicidal behaviour
  • Higher risk of alcohol and drug abuse
  • Hormonal changes include loss of reproductive hormones (resulting in infertility)
  • Lower levels of thyroid and growth hormones
  • Bone loss
  • Slow heart rhythms (sinus bradycardia)
  • Low blood pressure
  • Weakness in the heart muscle
  • Seizures
  • Confused or disrupted thought processes
  • Odd nerve sensations in extremities (peripheral neuropathy)
  • Anaemia
  • Bloating and constipation
  • Multiple organ failure
People who suffer from severe, untreated anorexia could also be at risk of death. The condition causes psychological symptoms such as depression and anxiety, and it increases the symptoms of pre-existing psychological problems such as depression, bipolar disorder, anxiety, and obsessive compulsive disorder. Additionally, it is responsible for numerous physical issues.
Impact of Anorexia on patients

What is the treatment for anorexia?

The National Institute for Health and Care Excellence (NICE, 2017) guidelines recommend that outpatient psychological treatment for anorexia should normally be of at least six months duration. Treatment recommended involves reducing physiological risks and enhancing psychological mental health.
Treatment therefore includes both physiological risk monitoring in addition to psychological and is designed to assist recovery through establishing healthier coping strategies for current emotional and cognitive difficulties. These include the following:
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Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy addresses current eating disordered behaviours and the underlying emotional and cognitive processes informing the behaviours. CBT is often recommended for the treatment for different kinds of eating disorders.

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Cognitive analytic therapy (CAT)

Cognitive analytic therapy explores how past experiences contribute to development of anorexia and focuses on identifying alternative, more effective coping strategies. Target problems are identified as well as other issues maintaining the eating disorder.

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Interpersonal therapy (IPT)

Interpersonal therapy is a time-limited therapy focussed on improving an individual’s relationships with others by helping to understand problem areas and developing strategies for dealing with these domains.

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Focal psychodynamic therapy (FPT)

Focal psychodynamic therapy explores how past unresolved conflicts, particularly from childhood, influence current thoughts, feelings and behaviour.