Anorexia Nervosa (AN), which literally translates to “without appetite,” is an eating disorder with an etiology rooted in self-starvation, excessive dieting, severe weight loss and distorted body image with the underlying fear of gaining weight or being “fat”. Individuals with AN typically display characteristics of low self-esteem, the desire for perfection, and obsessiveness. AN has one of the highest death rates of any psychiatric disorder, so it is of utmost importance to receive a diagnosis and seek help from an interdisciplinary healthcare team in order to treat this disorder.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) an individual must meet the following criteria in order to be diagnosed with AN:
- Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, development trajectory, and physical health.
- Intense fear of gaining weight or becoming fat, even though underweight
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of seriousness of the current low body weight.
** low weight/underweight can be defined as a BMI of less than or equal to 18.5
It is important to acknowledge, however, that even if not all of the above criteria are met, and individual could still present with a serious eating disorder. There are actually two subtypes to AN: restricting type and binge-eating/purging type. Restriction relating to food intake, and purging relating to either self-induced vomiting or purging with excessive exercise to “burn off” calories.
There are specific emotional and behavior warning signs and symptoms that may be apparent in those with AN, along with physiological symptoms that are induced by the self-starvation/aggressive restriction. An individual who is struggling with AN may present with the following:
- Preoccupation with weight, food, calories
- Commenting on feeling “fat”
- Development of food rituals
- Severe and selective restriction of food intake
- Feeling the need to “burn off” food
- Making excuses to avoid mealtimes or to avoid having to eat in a social setting
- Intense fear of gaining weight
- Strong need for control
- Decreased ability to regulate internal temperature (ex. feeling cold all of the time)
- Bowel irregularities
- Cognitive impairment (ex. brain fog)
- Mood swings
- Loss of menstrual cycle
As is the case with BED, an interdisciplinary team is required in order to provide and monitor all medical, nutritional, and behavioral aspects of recovery. Treatment for AN will include the implementation of structured mealtimes, consumption of small frequent meals, and gradually increasing calories in roughly 100-200 calorie increments in order to avoid refeeding syndrome. The ultimate goal during treatment will be to increased intake while simultaneously decreasing energy output until the goal weight has been achieved.
To conclude, I will use the same statement from the BED newsletter because it is incredibly fitting across the board of all eating disorders.
“If you or anyone you know feels that this article is relatable, it is crucial to seek help from a team of professional healthcare providers. Eating disorders appear to have a low reported incidence rate not because they are not abundant in our society, (especially with the rise in social media) but because so few individuals decide to seek treatment. Just because not everyone is telling their story or making their struggles known does not mean they are not living it. It is scary to take the dive toward reversing behaviors and ways of thinking that have become so instilled, it can feel like you are losing control. The reality is that there is nothing braver than facing your inner critic head on and rewriting your story, and you have the power to do so whenever you decide.”