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Anorexia Nervosa: Causes, Symptoms, Risk Factors, Diagnosis And Treatment

Anorexia Nervosa (AN) is a psychological eating disorder in which a person restricts their calories intake in extreme fear of gaining weight, considering the fact that they are already underweight. Such individuals are extensively concerned about their weight and have a strong fear of becoming fat. This is because they usually equate their weight with their self-worth. [1]


They think that their fat body image might decrease their self-worth among others and people may start judging them in negative ways. Such mentality develops a huge fear in those people and causes them to make a life-threatening lifestyle choice by avoiding foods, skipping meals, starving for long and even purging all the food out after a meal. To mention, AN is named as a mental condition which has the highest mortality rate [2] .

The effort of people with AN is not limited to avoiding foods. They perform excessive exercises in a fear of not gaining weight which directly interferes with their health. AN is basically an act of self-starvation [3] and a body-obsessed disorder. Some people with AN also develops a habit of counting the calories in foods without any known intention of eating them.

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According to the National Eating Disorder Association, there are around 70 million people worldwide who are suffering from AN and among these, the count of women is ten times more than a man as the prior is more sensitive to criticism related to their body shape. Also, one out of every 200 women is diagnosed with this eating disorder and, sadly, the symptoms among females usually develops when they are just teenagers. [4]

Types Of Anorexia Nervosa

Ther are two types of AN.

  • Restricting subtype:It is one of the types of AN in which people are highly self-disciplined. They restrict the consumption of food followed by skipping meals, counting calories before eating certain food and performing excessive exercise to prevent themselves from gaining those extra pounds. [5]
  • Purging subtype or binge eating:It is another type of AN in which people often get involved in binge-eating and later feel the guilt of eating more accompanied by the fear of gaining weight. So, they usually self-induce the vomiting to clear all the foods from their stomach and also opt for the laxative to keep their weight in check. [5]

Causes Of Anorexia Nervosa

The three main causes of AN are as follows:

1. Environmental:In the present scenario, modern western culture is given very high importance. This culture often equates thinness with the self-worth and demotivates people who don't fit in their 'good body' criteria. Due to such social and cultural pressures, people often lose their self-esteem and develop AN. Other social factors contributing to AN are as follows:

  • Differences in family relationships [6]
  • Occupation in which thinness is a must like acting, dancing, etc.
  • Physical or sexual abuse due to body image [7]
  • A traumatic life event like breakup or negligence by employees due to body image.
  • Bullying at school due to heavy body weight, especially in teenage girls.

2. Psychological:Low self-esteem is the main cause of psychological AN [8] . Such people often feel that they are worthless among others and thus, try to lose their body weight extensively to make their place among the crowd. Losing weight actually gives them a feeling of achievement and they think that being appreciated by others due to their good body shape will improve their self-worth. Other psychological factors adding up to the cause of AN are as follows:

  • Controlling emotions or own's behaviour due to social boundaries
  • Difficulty in coping with stress
  • Wanting to become a perfectionist by staying on a strict diet and setting goals for eating due to social demand. [9]
  • Obsession towards thinness [10]
  • Killing the urge to eat in fear of becoming fat
  • Worrying excessively about the future

3. Biological:There are several studies going on to find out which gene is involved for developing AN but it is believed that people who have a family history of eating disorders and depression are more prone to developing AN. Due to unknown changes in their gene, their brain functions and hormone levels are affected which are responsible for causing anxiety, controlling appetite, giving out sense to be a perfectionist and perseverance, all traits being associated with AN. [11]

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Symptoms Of Anorexia Nervosa

There's a combination of symptoms associated with AN. They are either physical, psychological/emotional or behavioural. [12]

1. Physical

  • Irregular menstruation in women [13]
  • Bodyweight lower than the normal
  • Dizziness [12]
  • Fatigue
  • Pale coloured face and sunken eyes
  • Insomnia [14]
  • Constipation
  • Hair loss
  • Dry skin and brittle nails
  • Hypotension [15]
  • Irregular palpitation of the heart
  • Swollen of arms and legs
  • Abnormal blood counts
  • Dehydration

2. Emotional or Psychological

  • Low self-esteem [8]
  • Increased anxiety [1]
  • Feeling they are overweight in spite of being underweight
  • Feeling of dissatisfaction with their body image
  • Crave for perfectionism by restricting food [9]
  • Unable to focus or concentrate on things
  • High sensitivity to comments associated with body shape or food
  • Mood irritation
  • Excessive exercise [16]
  • Reduced sex drive
  • Self-starvation or self-denial of food though feeling hungry
  • Obsessive-compulsive behaviour [10]

3. Behavioural

  • Skipping meals frequently [5]
  • Avoiding eating in public
  • Preoccupation with food, meaning seeing food-related videos or cooking meals but avoiding eating it [17]
  • Self-inducing vomiting after a meal to clear the stomach
  • Making excuses for not eating
  • Counting calories or fasting [18]
  • Lying about not eating
  • Binge eating and then feeling guilty about it [19]
  • Doing self-harm by eating laxative or other medications to reduce weight.

Risk Factors For Anorexia Nervosa

A proper diet is key to prevent all diseases but when people start avoiding food to stay thin, a lot of health issues develop. Several risk factors develop later due to AN. They are as follows:

  • Weak immune system [20]
  • Several gastrointestinal problems like diarrhoea, constipation etc
  • Anaemia [21]
  • Osteoporosis
  • Kidney failure
  • Cardiovascular diseases [15]
  • Severe mental disorders like anxiety and depression
  • Irregular periods in women and loss of libido in men
  • Suicide attempt or death [22]

Diagnosis Of Anorexia Nervosa

AN is diagnosed through the following.

  • Psychological examination:To understand the patient's mentality related to their body shape, weight and vomiting habit
  • Physical examination:To examine the patient's height, weight, blood pressure, heart rate, abdomen and other body parts
  • Blood tests:Tests are done to determine the level of minerals (like potassium and sodium) in the body. They are also carried out to determine the fluid level in the body. [23]

Other tests include ECG to check for the irregularity in heartbeats and CT scan to check for signs of kidney and stomach abnormalities.

Treatment Of Anorexia Nervosa

Treatment of AN does not take place in a single go. It requires a team of medical experts; doctors, psychologists and dieticians who are experts in treating this food disorder by therapy, as the treatment for AN is only available for the risks associated with the condition like kidney failure, irregular heartbeat, etc. To mention, people with AN can recover but the therapy is time-taking as it requires a medical expert to completely change their belief on foods which they had for a long period.

1. Psychological treatment:It involves the following:

  • Involving parents to understand their child's mentality and guide them to make a healthy lifestyle habit and help in restoring their weight. [24]
  • Cognitive behaviour therapy, especially carried out for adults to make them understand and change their illogical belief about body shape.

2. Emergency treatments:This type of treatment takes place when the patient lands in immediate danger due to AN. For example, they may become unconscious due to low diet, dehydration, heart rhythm disturbance and electrolyte imbalances.

3. Medications:To treat some of its symptoms like antidepressants for anxiety and medications to treat abdominal pain [25]

Tips To Deal With Anorexia Nervosa

  • Don't miss your appointment with a therapist.
  • Stick to your treatment even if you don't desire to and do whatever is suggested by your therapist.
  • Talk to your medical expert and know the importance of vitamins and minerals for the body.
  • Make friends and don't isolate yourself.
  • Avoid checking your weight at regular intervals and resist seeing yourself every time in the mirror.
View Article References  
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  2. [2]   Morris, J., & Twaddle, S. (2007). Anorexia nervosa. BMJ (Clinical research ed.), 334(7599), 894–898. doi:10.1136/bmj.39171.616840.BE
  3. [3]   Bemporad, J. R. (1996). Self‐starvation through the ages: Reflections on the pre‐history of anorexia nervosa. International Journal of Eating Disorders, 19(3), 217-237.
  4. [4]   Wilson, C. P. (1982). The fear of being fat and anorexia nervosa. International Journal of psychoanalytic psychotherapy.
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  12. [12]   National Collaborating Centre for Mental Health (UK). Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. Leicester (UK): British Psychological Society (UK); 2004. (NICE Clinical Guidelines, No. 9.) 2, Eating disorders. 
  13. [13]   Kreipe, R. E., Strauss, J., Hodgman, C. H., & Ryan, R. M. (1989). Menstrual cycle abnormalities and subclinical eating disorders: a preliminary report. Psychosomatic Medicine, 51(1), 81-86.
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