Anorexia Nervosa

Anorexia nervosa symptoms differ from person to person. The most prominent and visible symptoms are excessive weight loss and physiological changes. Some of the common signs and symptoms of anorexia nervosa include:

1. Physical Symptoms

Restricting the necessary calorie intake over time can have a devastating effect on your mind and body. If the adverse effects of starvation are left untreated and unnoticed over time, it can cause a permanent loss in the functioning of vital organs. Some of the most common physical signs and symptoms of anorexia include:

• Extreme tiredness/fatigue
• Dry skin
• Insomnia or sleep disorder
• Thinning of hair
• Low blood pressure
• Discoloration of skin or pale skin
• Severe loss of muscle and weight
• Osteoporosis or loss of bone density
• Discoloration and brittleness of nails
• Constipation
• Emaciation or extreme thinness
• Lanugo or growth of soft hair all over the body
• Irregular heartbeats
• Infertility

2. Emotional and Behavioral Symptoms

Constant hunger can trigger unpleasant emotions such as anger and depression. Some of the warning signs of emotional and behavioral anorexia symptoms include:

• Low self-esteem
• Irritability
• Aversion to food
• Anxiety
• Depression
• Difficulty concentrating
• Suicidal thoughts
• Lack of interest or emotional flat-lining
• Mood swings
• Obsessive thoughts and social anxiety
• Exercising extensively
• Avoidance of social gatherings
• Denial of hunger
• Withdrawal from regular activities
• Feeling stressed

3. Cognitive Symptoms

Not many people know that anorexia nervosa can also lead to cognitive symptoms such as:

• An obsession with counting calories and monitoring fat contents of food.
• Preoccupation with food, recipes, or cooking; may cook elaborate dinners for others, but not eat the food themselves or consume a very small portion.
• Admiration of thinner people.
• Thoughts of being fat or not thin enough.
• An altered mental representation of one's body.
• Difficulty in abstract thinking and problem solving.
• Rigid and inflexible thinking.
• Poor self-esteem.
• Hypercriticism and clinical perfectionism.

4. Perceptual Symptoms

This condition can also affect how you perceive your body and can lead to self-criticism with respect to your weight and body. It causes:

• Perception of self as overweight, in contradiction to an underweight reality (namely "body image disturbance").
• Intolerance to cold and frequent complaints of being cold; body temperature may lower (hypothermia) in an effort to conserve energy due to malnutrition.
• Altered body schema (i.e., an implicit representation of the body evoked by acting).

Here are signs that you or anyone you know may be suffering from an eating disorder. Find out here!

The specific reasons that cause anorexia nervosa are still unclear, but it is believed to arise from multifactorial biological, environmental, and psychological factors. Some of the factors that increase a person’s risk of developing anorexia nervosa include:

1. Psychological Factors

Anorexia nervosa is often associated with an overwhelming phobia of being at a normal weight and is linked to specific personality and behavioral traits. Individuals with anorexia frequently seek perfection in their appearance and body image, which can lead them to restrict their diet to the point of starvation to achieve unrealistic goals. Other psychological factors that can contribute to the development of anorexia include:

• Excessive fear and uncertainty
• Medical history of depression and anxiety
• Painful or traumatic childhood experiences
• Reduced ability to regulate and adapt behavior to different situations
• Feelings of inadequacy and loneliness
• Stressful life events, such as accidents or the loss of a loved one

2. Environmental Factors

The current culture emphasizes an unrealistically thin body as a beauty standard. This external pressure and competitiveness to achieve unhealthy body goals can increase the obsession with restricting vital food intake.

3. Social Media Effects

Social media pressure and high-risk environments, such as sports, modeling, and acting, can contribute to the development of anorexia nervosa. Persistent exposure to media that promotes body ideals may pose a risk for body dissatisfaction and anorexia nervosa. The cultural ideal for body shape differs for men and women, favoring slender women and athletic, V-shaped muscular men. A 2002 review found that magazines popular among individuals aged 18 to 24 featured more ads and articles on body shape in those read by men compared to those read by women. Body dissatisfaction and internalization of body ideals are risk factors for anorexia nervosa that threaten the health of both male and female populations. Websites that emphasize the importance of achieving body ideals often promote anorexia nervosa through the use of religious metaphors, lifestyle descriptions, and "thinspiration" or "fitspiration," which include motivational photo galleries and quotes. Pro-anorexia websites reinforce the internalization of body ideals and their importance. The media often portray a distorted view of reality, as most actors and models are digitally altered in various ways. Consequently, people strive to emulate these "perfect" role models, despite the fact that they are not representative of true perfection.

4. Biological Factors

The correlation between biological factors and anorexia is not clearly understood. However, a family history of anorexia, drug abuse, and coexisting health issues increases the risk of developing anorexia. Abnormalities in the structure or function of the hypothalamus, a part of the brain, can also alter eating behaviors.

5. Genetic Factors

Genetic or inherited predisposition plays a role in anorexia, although the mechanisms behind the responsible genes are not well understood. Research is ongoing to enhance the understanding of the genetic factors involved in anorexia. Anorexia nervosa is highly heritable, with twin studies showing a heritability rate between 28% and 58%. First-degree relatives of individuals with anorexia have approximately 12 times the risk of developing the disorder. A 2019 study found a genetic relationship with mental disorders such as schizophrenia, obsessive-compulsive disorder, anxiety disorder, and depression, as well as metabolic functioning negatively correlated with fat mass, type 2 diabetes, and leptin. One gene of particular interest codes for a protein called the estrogen-related receptor alpha (ERRalpha). This gene influences how estrogen and estrogen receptors interact with DNA, affecting cell function. Since estrogen has significant effects on appetite and feeding, any genetic abnormalities in the estrogen signaling pathway could contribute to the symptoms of anorexia, explaining why anorexia typically manifests in young women shortly after the onset of puberty.

Several factors can increase your risk of anorexia nervosa, ranging from psychological issues, such as relationship breakups and life transitions, to medical conditions like type 1 diabetes. Anorexia nervosa can occur in both men and women, but it is more prevalent in women, who are more likely to develop negative body perceptions. Anorexia nervosa is a complex psychological disorder. Like many other eating disorders, several risk factors, including biological, sociocultural issues, and psychological triggers, can increase the risk of developing it. Some of the most common risk factors associated with anorexia nervosa include:

• Having a family history of an eating disorder.
• Diabulimia, an eating disorder in individuals with diabetes, where the person purposefully restricts insulin therapy to lose weight.
• Extreme dieting and starvation, which can alter the thinking patterns of vulnerable individuals and lead to the perpetuation of restrictive eating behaviors.
• Loneliness and boredom, which can cause psychological stress and increase the risk of developing anorexia nervosa.
• Age, as anorexia can occur in any age group but is most commonly seen during adolescence and puberty.

If you are experiencing any symptoms of anorexia nervosa, such as weight loss, increased obsession with body image, extreme dietary restriction, psychological stress, or increased fear of gaining weight, it is wise to consult a psychiatrist or nutritionist. Early diagnosis and prompt treatment for anorexia reduce the associated risks. Based on the severity and duration of your condition, your doctor might perform physical exams and analyze your medical history to rule out other mimicking health conditions. If the signs and symptoms are unclear, your physician may recommend one or more tests to diagnose your condition.

1. Physical Examination

Physical examination for anorexia nervosa may include:

• Evaluation of physical appearances, such as dry skin, sunken eyes, and growth of smooth hair over the body.
• Calculation of body mass index (less than 17.5 in adults, or less than 85% of expected weight in children).
• Checking vitals such as heart rate, blood pressure, body temperature, and other signs of malnutrition.
• Examination of the abdomen for stretch marks and liver palpation.

2. Psychological Evaluation

Psychological evaluation for anorexia may include:

• Analysis of behavioral pattern changes such as substance abuse, self-harming, or suicide attempts.
• Review of family or medical history related to other psychological disorders.
• Evaluation of attitudes toward eating, appearance, and exercise.

DSM-5 Guidelines

Anorexia nervosa is classified under Feeding and Eating Disorders in the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There is no specific BMI cut-off that defines low weight required for the diagnosis of anorexia nervosa. The diagnostic criteria for anorexia nervosa (all of which must be met for diagnosis) are:

• Restriction of energy intake relative to requirements leading to a low body weight. (Criterion A)
• Intense fear of gaining weight or persistent behaviors that interfere with gaining weight. (Criterion B)
• Disturbance in the way a person's weight or body shape is experienced, or a lack of recognition about the risks of low body weight. (Criterion C)

Relative to the previous version of the DSM (DSM-IV-TR), the 2013 revision (DSM-5) reflects changes in the criteria for anorexia nervosa. Most notably, the amenorrhea (absent period) criterion was removed for several reasons: it does not apply to males, it is not applicable for females before or after the age of menstruation or taking birth control pills, and some women who meet the other criteria for anorexia nervosa still report some menstrual activity.

Levels of Severity

Body mass index (BMI) is used by the DSM-5 as an indicator of the severity of anorexia nervosa. The DSM-5 states the following levels:

• Mild: BMI greater than 17
• Moderate: BMI 16–16.99
• Severe: BMI 15–15.99
• Extreme: BMI less than 15

3. Laboratory Tests

Although there is no specific confirmatory test for anorexia, assessment of blood work may provide clues to determine any underlying health issues. Some common lab tests used to diagnose anorexia include:

• Blood sugar test: Diabetic patients, particularly those with type 1 diabetes mellitus, have an increased risk of developing anorexia.
• Electrolyte level test: This test determines the severity and effects of anorexia on health.
• Complete blood count (CBC): This test may help your physician determine the underlying cause of your anorexic condition.
• Comprehensive metabolic profile (CMP): This test measures 14 different parameters in the blood, providing a picture of overall body chemical balance and metabolism.
• Urine routine analysis: Medical evaluation of urine samples can determine a wide range of underlying disorders causing anorexia and provide clues to hydration and fluid intake levels.
• Electrocardiogram studies: These assess cardiac patterns and other related ailments.
• Liver function test: A series of tests used to assess liver function; some tests are also used in the assessment of malnutrition and protein deficiency.
• Luteinizing hormone (LH) response to gonadotropin-releasing hormone (GnRH): This tests the pituitary gland's response to GnRH, a hormone produced in the hypothalamus. Hypogonadism is often seen in cases of anorexia nervosa.

Although there are no specific proven methods to prevent anorexia, the following measures can help manage the symptoms associated with anorexia nervosa:

1. Early detection of anorexia: Anorexia has a multifactorial etiology and shares similar symptoms with other psychological disorders, making identification challenging. However, recognizing symptoms early can reduce the risk of complications and mortality.
2. Follow healthy eating habits: The malnutrition that accompanies anorexia can severely damage the body. Consuming nutrient-rich foods in small, frequent meals can help mitigate the risk of internal organ damage. Consulting a dietitian or nutritionist for an optimal diet plan can meet your nutritional requirements.
3. Avoid alcohol: "Drunkorexia" refers to the behavior of replacing food consumption with excessive alcohol. Studies have reported the association between alcohol and the onset of anorexia nervosa. The combination of alcohol and anorexia can lead to serious health complications, so avoiding alcohol can reduce the risk of alcohol-related injuries.
4. Stop judging yourself: Individuals with anorexia often strive for perfection, which can create unwanted pressure and stress. Working on accepting your current body, weight, and appearance can help prevent negative self-perception.
5. Avoid body shaming: Allowing others to criticize your body can damage your self-esteem. Body shaming is prevalent on social media and can severely impact mental health. Try not to let negative comments affect you and practice self-love affirmations.
6. Be aware of anorexia and related eating disorders: Anorexia nervosa has the highest death rate among mental illnesses. Understanding the risk factors and triggers associated with anorexia can help combat dissatisfaction with your self-image.
7. Seek professional help: If you experience signs of anorexia or suspect you may have it, schedule an appointment with a doctor for a better understanding of your condition. Early detection of the underlying causes of anorexia allows for quicker intervention and recovery.

Do you know what foods to eat and what to avoid for anorexia? Are you aware of common home remedies for anorexia? Do you have ideas about lifestyle changes that can improve eating disorders?

The treatment of anorexia aims at restoring the body to normal weight and psychological and mental well-being. There are several therapies available to treat anorexia nervosa. However, the choice of treatment is determined based on the individual's age, complications, and health factors. In most cases, a combination of therapies is recommended to address emotional issues such as low self-esteem, anxiety, and other related mental health problems. Some common strategies to treat anorexia nervosa include:

1. Psychotherapy

   Psychotherapy can help individuals with anorexia cope with their mental health challenges. It aids patients in understanding their issues better and developing coping strategies. Various forms of psychotherapy used to treat anorexia include:

   • Family-based therapy (FBT): Also known as the Maudsley method, this therapy engages parents and family members in the process of restoring their child to a healthy weight at home. The family is encouraged to work together to ensure proper nutrition and weight gain.
   • Cognitive behavior therapy (CBT): This therapy focuses on improving mental health by addressing distorted views of body image.
   • Dialectical behavior therapy (DBT): DBT helps individuals recognize triggers and develop strategies to manage factors contributing to anorexia nervosa. It also assists patients in maintaining mental health balance.
   • Acceptance and commitment therapy: This therapy promotes self-motivation rather than attempting to change thoughts and feelings.
   • Interpersonal therapy (IPT): IPT helps patients identify and resolve problems in their relationships, which can improve mental health and reduce eating disorder symptoms.
   • Nutrition counseling: Consulting with a nutritionist can help individuals understand the importance of diet and restore normal eating patterns.
2. Medications

   There are no specific medications approved to treat anorexia, as none have been found to be highly effective. However, antidepressants or other psychiatric medications may help manage associated mental health disorders. Commonly prescribed antidepressants for anorexia include:

   • Cyproheptadine: An antihistamine that blocks chemical messengers responsible for allergic reactions and stimulates appetite through increased growth hormone secretion.
   • Marinol: A cannabinoid that may improve appetite and overall quality of life when used regularly.
   • Megestrol: A manufactured version of the hormone progesterone that can increase appetite.
   • Olanzapine: An atypical antipsychotic that affects dopamine and serotonin levels to improve mood, thoughts, and behavior.
3. Diet

   Diet is a crucial factor in the treatment of anorexia nervosa and must be tailored to each individual's needs. A variety of foods, particularly those higher in energy density, should be included in meal plans. Individuals must consume adequate calories, starting slowly and gradually increasing intake. The role of zinc supplementation during refeeding remains unclear.

Recovery from anorexia nervosa can be challenging. However, with some nutritional and dietary changes, it is possible to reverse the effects caused by anorexia. Here are some do’s and don’ts you can follow at home to manage your anorexia:

Do’s

• The use of micro nutritional supplements, including whole grains, citrus fruits, leafy greens, and more, is recommended for individuals with severe anorexia.
• Refeeding for significantly underweight individuals is essential. It is a process where a person is given food after starvation or malnourishment. However, refeeding should be gradual and progressive.
• Take fresh juices to replenish your mineral and vitamin deficiency.
• Stay hydrated. Aim to consume at least 2-3 liters of water every day.
• Include fiber-rich foods such as beans, lentils, broccoli, berries, and avocados.
• Incorporate herbs such as cardamom, asafoetida, trikatu, quality-rich spices, and ginger into your diet.

Don’ts

• Avoid aerated drinks and alcohol.
• Steer clear of caffeinated beverages such as coffee and tea.
• Say no to refined food items like pasta, noodles, polished rice, and sugar.
• Avoid eating food from unhygienic places.
• Do not overeat ready-made food items like canned or preserved food.
• Avoid foods high in sodium and salt content, such as pickled meat, highly salted breakfast cereals, buns, cakes, packed soups, and sauces.

The medical complications associated with anorexia are as follows:

• Increased risk of cardiovascular problems, such as cardiac valve complications, mitral valve prolapse, arrhythmia (abnormal heart rhythms), or heart failure.
• Kidney problems, including issues with digestion.
• Osteoporosis, in which the bones gradually decrease in density due to the development of pores.
• Electrolyte imbalance, such as decreased levels of sodium, potassium, and chloride in the body.
• Eye problems, such as lagophthalmos, a condition wherein the eyelids do not cover the eye during sleep, which can irritate and cause mild discomfort to the cornea.
• Metabolic and endocrine complications, such as thyroid abnormalities and infertility.
• Amenorrhea, which refers to the absence of menstruation.
• Gastrointestinal problems, including nausea, bloating, constipation, or slowed gastric emptying.
• Hematological disorders, such as anemia (low RBC in the blood) or leucopenia (low WBC in the blood).
• A neurological complication of anorexia includes brain atrophy changes, resulting in mild mood disturbances to permanent memory loss.

Other psychological complications of anorexia nervosa include:

• Obsessive-compulsive disorder (OCD), characterized by repetitive or excessive thoughts.
• Anxiety.
• Personality disorder.
• Drug or substance abuse.

Ayurvedic Remedies For Anorexia

Here are a few herbal and natural methods that may help with anorexia nervosa:

• Ginger (Adrak): Ginger is loaded with antioxidant, antibacterial, antiviral, and anti-inflammatory properties. Add a pinch of lime juice and rock salt to ginger juice to stimulate your taste buds and neutralize excess gastric secretion.
• Tamarind (Imli) and Salt: A mixture of tamarind and saltwater juice can be used to stimulate the taste receptors in the tongue, which can trick your mind and increase your appetite.
• Black Cardamom (Badi Elaichi): Black cardamom is rich in antioxidant and antispasmodic properties, which can help relieve the stress associated with anorexia.
• Trikatu: Trikatu comprises three powerful herbs: black pepper (Kali Mirch), ginger (Adhrakh), and long pepper (Pippali). This combination helps in secreting gastric juices, easing indigestion and gas. You can take trikatu powder with water or with a tablespoon of honey.

Living with anorexia nervosa can make you feel dissatisfied with your body, leading to limited calorie intake, excessive exercise, or overuse of medication to achieve unrealistic fitness goals. If left untreated, the persistent fear of weight gain can cause serious physiological problems such as depression, suicidal thoughts, anxiety, and social aggression. Fortunately, early diagnosis and prompt treatment for anorexia can reduce its risks and complications in most cases.

Here are a few tips that can help you manage anorexia:

• Understand and recognize your triggers
• Check your vitals regularly
• Practice meditation or yoga
• Keep yourself engaged
• Stay hydrated
• Seek professional help if needed
• Participate in support groups