Anorexia nervosa: What is it? What are the symptoms?

What Is the Definition of Anorexia Nervosa?

Anorexia nervosa is an eating disorder that causes the purposeful restriction of food intake in order to achieve a lower weight and fulfill a certain body image. It can be classified as mild, moderate, or severe using a body weight indicator of severity. There are two specific types of anorexia: binge/purging or restricting type.

In a person with the restricting type, their food intake is restricted, and they don’t participate in binge eating or purging. Binge eating/purging type is when an individual eats large quantities of food and then self-induces vomiting or misuses laxatives, diuretics, or enemas. 

Are Anorexia and Anorexia Nervosa the Same Thing?

Yes, anorexia and anorexia nervosa are the same thing. Anorexia nervosa is the formal name given to the disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), but a common term used is “anorexia.” 

“Anorexia nervosa” often will be used to refer to the specific, diagnosable illness while “anorexia” has been used in popular culture to describe someone who engages in restrictive eating patterns but might not meet full criteria. Again, one can argue that they are used interchangeably, but the only true, definitive term for the condition is anorexia nervosa.

What Is One of the Main Signs of Anorexia?

Some common anorexia nervosa symptoms and signs include: 

• Significant weight loss
• Restriction of food intake
• Fears of certain types of food or food groups
• An intense fear of gaining weight
• Hyperfocus on body weight and physical appearance
• Significant change in eating habits and patterns

In addition, one sign that often goes ignored by others involves an intense preoccupation with food, such as with planning food, thinking about food, or hyperfocusing on food. If this sounds like something you struggle with, the best thing to do is seek help from a mental health professional. They’ll be able to set you up with an individualized treatment plan and help you get connected to doctors and psychiatric professionals that can help you break these cycles as well.

How Can I Tell If I Have Anorexia?

The only true way to tell whether you have anorexia, or any other disorder, is to seek a diagnosis from a trained mental health professional. However, there are still common signs that may signal a need for testing. Here are some warning signs that you might have disordered eating patterns and/or anorexia:

• Significant, sudden weight loss that is not better explained by a physical illness
• An intense preoccupation with gaining weight; taking extreme measures to not gain weight
• Exercising more than once a day
• Thinking about ways to purge after consuming a large meal 
• Thinking of ways to restrict calorie intake
• An intense preoccupation with food and food groups, as well as labeling foods/food groups as “bad”

Though each of these are common signs that someone might have anorexia, some symptoms are more likely to be occurring alongside each other than others due to the two types of anorexia listed above: restricting and binge eating/purging. Each of these subtypes have their own unique sets of symptoms.

Anorexia Nervosa, Restricting Type: What Are the Symptoms?

People with anorexia nervosa, restricting type seriously cut their calories and eat very little. The most obvious sign of anorexia nervosa, restricting type is a person’s underweight appearance. The goal of people with this eating disorder is to quickly lose weight or maintain a dangerously low weight. According to the DSM-5, the following are criteria for diagnosis:

• Restriction of food intake leading to a significantly low body weight in the context of age, sex, development and physical health. The weight is less than minimally normal or, for children and adolescents, less than minimally expected.
• Intense fear of gaining weight or of becoming fat; continuous behavior that disrupts weight gain even though the weight is significantly low.
• A disturbance in body image (self-perceived weight or shape), undue influence of body weight or shape on self-evaluation, or continuous lack of realization of the seriousness of the low body weight.

Aside from these general traits, people with anorexia nervosa, restricting type also show specific  physical, psychological, and behavioral symptoms. Below are signs for each area:

Physical Signs:

• Rapid or sudden weight loss.
• Dizziness, fainting, and/or fatigue.
• Sensitivity to the cold.
• Lanugo (fine, soft hair) on the face and back.
• Dry skin.
• Hair loss.
• Dry, brittle hair, skin, nails.
• Gastrointestinal problems, such as constipation, cramps, pain, indigestion and bloating.
• Reduced ability for concentration and memory.
• Edema (retaining body fluid; puffy appearance).
• Reduction in metabolic rate.
• Lower heart rate.
• Lower blood pressure.
• Reduced body temperature.
• Dehydration.
• Hypoglycemia—low blood glucose levels—causing confusion, illogical thinking, shakiness and irritability.
• Easily bruised.

Psychological Signs:

• Preoccupation with body shape, weight and/or appearance.
• Serious fear of gaining weight.
• Preoccupation with food or food-related activities/events.
• Negative body image.
• Distorted body image.
• Feeling or perception of being fat when at a healthy weight.
• Low self-esteem (feelings of guilt, self-criticism and worthlessness).
• Thinking is rigid—“good or bad” foods.
• Feeling out of control when around food.
• Increased changes in mood; irritability.
• Anxiety or depression.
• Anxiety around meals is increased.
• Increased sensitivity to comments or criticism about body shape, weight, appearance, eating and exercise habits.
• Suicidal thoughts or behaviors.
• Obsessive behaviors.

Behavioral Signs:

• Constant dieting, restriction of food, rigid eating patterns.
• Changes in style of clothing.
• Exercising excessively.
• School or work performance is impaired.
• Obsessive rituals when dealing with food.
• Food preferences have changed.
• Frequently avoid eating or make up excuses not to eat.
• Withdrawal from social network and events, especially where there’s food included.
• Repeatedly checking body.
• Eating is done slowly.
• Focus is around planning and preparing food.
• Dishonest behavior in regard to food.

Binge Eating/Purging Type: Definition and Symptoms

Binge eating/purging is when a person eats large amounts of food, overeating well beyond the point of fullness, and feels out of control while doing so. The sense of being out of control is what separates binge eating from regular overeating. As a way to offset the bingeing, the person then follows the eating with self-induced vomiting, the misuse of laxatives, enemas, diuretics, or excessive exercise.

People who binge eat are severely preoccupied with their body shape and weight, especially because that’s where they base their feelings of self-worth. The criteria to diagnose a person with binge eating/purging is that they engage in the inappropriate behavior at least twice a week for at least three months. Some people don’t binge eat, but regularly purge after eating small amounts of food.

People who struggle with binge eating may show the following signs:

Behavioral:

• Hiding or hoarding food.
• Eating a larger quantity of food in one instance than in a normal meal or snack.
• Feeling that eating can’t be controlled when bingeing begins.
• Eating until the point of discomfort or pain.
• Exercise for hours on end.
• Makes excuses to cover up their behavior or periods when they’re absent from work, school or events.
• Empty boxes from laxatives, diuretics or enemas hidden in a person’s trash.
• Makes up excuses for food that goes missing or money that’s taken to pay for food.

Physical:

• Vomiting (the most prevalent sign of purging).
• Habit of using the bathroom after eating or during meals.
• Swollen salivary glands in the cheeks.
• Damaged teeth and gums.
• Sores, scars or calluses on knuckles and hands because of self-induced vomiting.
• Continuous sores in the throat and mouth.
• Scratchy voice.

However, it’s important to keep in mind that bingeing traits are also present in those with binge eating disorder. This disorder involves the same criteria as bingeing with anorexia, but does not involve purging afterward. Because of this, it’s best to let a mental health professional perform and assessment and reach a diagnosis before any decisions surrounding treatment are made.

Is an ED a Coping Mechanism?

An eating disorder can become a maladaptive coping mechanism as a result of a desire to cope with perceived lack of control, as the origins of eating disorders can largely trace back to a significant stressor(s) in a client’s environment. 

However, it also can be a form of learned behavior. For example, those with parents or close interpersonal relationships that have an eating disorder are significantly at risk to develop one themselves due to observational learning and modeling of that behavior as normal.

What Factors Make Someone Vulnerable to Anorexia Nervosa?

Here are some risk factors that increase someone’s propensity to develop anorexia nervosa:

• Engaging in dieting of any form
• Having a parent/relative/sibling/proximal person that has anorexia nervosa
• A significant life stressor or trauma
• A significant grief event
• Having a deep desire for control
• Having disorders such as generalized anxiety disorder and obsessive-compulsive disorder
• Being raised in a home environment that focuses on unhealthy weight practices
• Females in their early 20s are the group at highest risk for developing this disorder, but it is not limited to age, gender, race, sexuality, etc.
• Restricting certain food groups and labeling food as “healthy” and ‘unhealthy”
• Individuals engaging in professional athletics/vocations which require consistent body performance

What Is the Difference Between Anorexia and Bulimia?

While sharing many similarities, anorexia and bulimia are different disorders. Anorexia is a disorder that is primarily categorized by restriction of food intake, but can also be characterized by the binge/purge subtype, which can seemingly overlap with the purge behaviors of bulimia. 

Bulimia, by definition, includes engaging in frequent overeating (binge) patterns and subsequent purge behaviors. In order to have bulimia, by definition, one must engage in multiple binge eating episodes and subsequent purges. To be diagnosed with anorexia, on the other hand, you do not have to meet binge eating and purge behavioral requirements. 

However, if you are diagnosed with an anorexia binge/purging subtype, the diagnoses between this and bulimia are differentiated by looking at the primary motivations. 

Essentially, bulimic individuals are purging to remove the calories just eaten from their body, while anorexics restrict in order to eliminate their overall global calorie intake.

Treatment for Anorexia Nervosa

There are many treatment options for anorexia, but most of them are primarily psychotherapeutic. These are example of common treatment approaches used to for anorexia:

1. Cognitive behavioral therapy (CBT): If someone isn’t in immediate danger or experiencing medical complications due to the disorder, cognitive behavioral therapy (CBT) is one of the most popular treatments. The therapy focuses on issues of self-image and self-evaluation. The issue of distorted body image is the most common among people with the disorder and is the focus of the beginning stages of treatment. CBT will teach the individual how to spot the negative thought patterns and triggers that lead to this behavior and help them learn how to replace them with healthy and helpful patterns.
2. Family therapy: Someone may have problems with negative self-image because of traumatic events or memories that occurred during the developmental stages of childhood. In addition, parents may inadvertently play a role in the individual’s negative self-image. Family therapy is ideal to identify the “reinforcers” that significant people in the person’s life are conveying about being or staying thin that need to be reworked. Family therapy can also be helpful in educating the family about the disorder and how they can help their loved one in the treatment process.
3. Group therapy: Group therapy is helpful because it offers the individual a strong support system. The individuals in the group can share their personal experiences with their eating disorder, and everyone can work together to recover. Furthermore, group therapy helps one realize they are not alone in this fight.

Each of these are common and effective anorexia nervosa treatments, but with eating disorders, it’s important to receive medical help as well as mental health care. These disorders can do a serious amount of damage to one’s body, and health issues and bodily complications due to anorexia are extremely common. Because of this, physical treatment and guidance are just as necessary to regaining one’s health after struggling with an eating disorder as any therapy approaches that assist with healing the mental roots of the issue.