What is Anorexia & Anorexia Nervosa?

Anorexia – Causes, Symptoms, and Treatment

Anorexia literally means “without appetite” from the Greek “an”= without and “orexia”= appetite. Anorexia is an illness in its own right which is part of the family of eating disorders (ED).

Anorexia affects 1 in 100 adolescents and young women aged 15 to 30 each year in the UK. Anorexia has the highest suicide mortality rate of all psychiatric disorders. This disease affects mostly women, as 9 out of 10 anorexic people are female. It is important to note that everyone can be affected: men, women, children and adults. The age at which the disease occurs most often is between 12 and 20 years of age. While anorexia nervosa affects mostly adolescent girls, adults may also be affected.

Definition

Anorexia is an eating disorder of psychiatric origin. Anorexia manifests itself in a reduction or withdrawal from food through lack of appetite or refusal of food. Anorexia is a disorder of the driving behavior defined by a systematic refusal to feed. This action acting as a response to mental conflicts.

This methodically restricted feeding behavior alongside slimming, most often occurs in teenagers. Especially those who also have:

  • amenorrhea (missed periods)
  • hyperactivity associated with changes in character
  • disorders of the perception of the body

The age of onset is before the age of 25 in a teenager who justifies a diet by being very slightly overweight. Possible side effects include:

  • bulimia nervosa (see description below)
  • special interest in food
  • dietary rituals
  • vomiting
  • using laxatives and diuretics

The often spectacular weight loss reaches or exceeds 25% of the initial weight. The physical aspect is distinct, with a change of figure and muscle reduction mainly to the limbs, which are emaciated.

Amenorrhea relates to functional disorders of the HPTA (see pic) and coincides with the onset of anorexia.

the hypothalamo-pituitary axis
The hypothalamo-pituitary axis

There are no apparent mental disorders which explain the difficulties that parents and certain doctors have of accepting the psychological origin of anorexia, and the gravity of the disorders.

What earns the diagnosis is the patient’s lack of awareness of their weight loss and their lack of concern for the disease. But, they are satisfied with their weight loss and the fact they exercise total control over the shape of their body.

The obsessiveness of physical appearance remains one of the fundamental problems of anorexia. The frequent psychological profile of the anorexic person is:

  • permanent anxiety
  • self-indulgence and loneliness
  • suicidal tendencies
  • family conflicts
  • the impression of not being up to the task
  • devaluing oneself

The trigger may be a psychological shock, such as school bullying, grieving, violence, or sexual abuse.

Willingness to lose weight or fear of gaining weight, the result is the same: the patient adopts food behaviors that can lead to death. There are two main types of anorexia: restrictive and bulimic. The psychological symptoms of these two forms of anorexia nervosa are very different.

Restrictive anorexia

Restrictive anorexia is the most frequent one. The main symptoms are a weight loss phobia which shows itself as a rejection of any food. Restrictive anorexia is marked by a feeling of all power, and a desire to master its physical, emotional and relational states. This need for control over oneself and others is accompanied in the patients by a rejection of all forms of pleasure: food, sexual and affection.

Bulimia anorexia

Bulimia anorexia shows bulimic behaviors. This is marked by compulsive and massive food intake, followed by vomiting, spontaneous or induced. But, this type of anorexia is accompanied by a profound loss of self-esteem which can evolve into depressive symptoms. Disgust and self-shame may also be the cause of suicidal acts. These self-deprecating feelings often coexist with an abnormal attachment to one of the parents.

Causes

The psychological background of the anorexic patient is always marked by a strong lack of confidence and self-esteem. In anorexics, this feeling is compensated by a tenacious will to master and control everyone, starting with one’s own body. Any weight loss is felt as a new personal victory. And from victory to victory, the anorexic progressively sinks into a malnutrition which, in extreme cases lead to death.

Adult

The late appearance of anorexia is often correlated with a symbolic, traumatic or simply stressful event of adult life such as:

  • marriage
  • the death of a relative
  • the birth of a first child
  • divorce
  • loss of employment
  • sexual abuse in childhood

Imperceptible in the beginning, the classical symptoms of anorexia gradually increase:

  • phobia of food
  • refusal to eat
  • rejection of own physical appearance
  • denial of weight loss becoming more accentuated.

In most cases, the management of the adult patient reveals previous anorexic episodes that were brief or passed unnoticed.

Symptoms

The symptoms of anorexia are both psychological, physiological and behavioral. The persistent refusal to eat in a healthy way is associated with an obsessive search for weight loss or phobic fear of getting fat. Body weight drops below 85% of a healthy body weight. This is usually accompanied by a profound disturbance of the body image marked by a denial of weight loss.

A body mass index chart
Body mass index chart.

Anorexia is a psychiatric illness and manifests itself in different ways. Here are the most common, not all of which are always present:

  • Unlike anorexia during which the affected person will no longer have an appetite.
  • Anorexia is a deliberate restriction of diet. So, the person suffering from anorexia has strong dietary restrictions.
  • In anorexia nervosa, the physical goal sought is primarily the reduction of the weight. This results in weight loss going from extreme cases to more than 50% of the initial weight.
  • An increase in sports and/or intellectual activities is also possible, sometimes with sexual disorders.
  • Taking laxatives, appetite suppressants, binge eating, induced vomiting, etc.

Psychological disorders are at the forefront, with:

  • disturbances in the perception of the image of the body
  • lack of self-confidence
  • a personality often bordering on perfectionist

These symptoms are all without the person concerned wanting to acknowledge their problems. In advanced stages, symptoms related to deficiencies appear more obvious as long as the disorder persists.

Psychological symptoms

Withdrawal into oneself appears progressively as well as a rejection of any form of pleasure. Sadness or even a depression establishes. Finally, people with anorexia suffer from physical hyperactivity.

Physical symptoms

The physical manifestations of anorexia are:

  • cold to the touch
  • missed periods (amenorrhea)
  • the appearance of a thin down on the skin
  • hair loss
  • dry and brittle nails
  • hypertension

Symptoms in adults

The disorders observed in adults are generally identical to those observed in common anorexia. Hormonal dysfunction, prolonged amenorrhea, digestive and intestinal tract, highly disturbed, almost permanent hypothermia.

In adults, however, certain disorders tend to become worse; cardiac fatigue, hypertension difficult to stabilize to a normal level.

Less than 40% of patients recover from the disease.

What are the consequences of anorexia?

The physiological consequences of this progressive malnutrition are important:

  • loss of hair
  • the absence of menstruation (prolonged amenorrhea – beyond three months)
  • hemorrhagic diathesis (sudden spontaneous bleeding)
  • hypercholesterolemia (high cholesterol levels)
  • dehydration
  • bradycardia (a heart rate of under 60 bpm)
  • decalcification and osteoporosis
  • cold to the touch
  • tiredness
  • general discomfort
  • constipation

At an advanced stage, anorexia-induced undernutrition causes irreparable physiological imbalances leading to emergency hospitalization. Sometimes even the death of the patient.

Diagnosis

Only a professional can diagnose anorexia. It will avoid the confusion between anorexia nervosa and other diseases cutting hunger and causing anorexia. Anorexia nervosa affects not only the loss of weight but also the psychological mood of the individual. Weight loss is related to a deeper disorder, discomfort, anxiety, and an impaired perception of body and weight.

Several professionals can help children and adolescents with anorexia nervosa:

  • a child psychiatrist
  • a psychotherapist
  • a pediatrician with good knowledge of problems related to anorexia nervosa

Adults should contact a general practitioner specializing in eating disorders (ED), a psychiatrist or a psychotherapist.

Treatment

The main obstacle in the treatment of anorexia nervosa is the patient’s willingness to refuse any treatment. It often happens that the person with anorexia nervosa does not see themselves as ill and thus rejects any attempt to help them. The starting point of treatment will not be the same depending on the severity of the person’s condition. Hospitalization may be the first course for the most frail, while for others the first treatment will be psychotherapy, and/or the call to a dietician, or a treating physician .

The interaction of genetic factors (the heritability of anorexia is estimated to be between 50% and 70%!) And psychological, with environmental, familial and sociocultural factors, makes the treatment of anorexia extremely complex.

If some antidepressants and anxiolytics can be a one-time relief, there is no medicine to “cure” anorexia.

The use of psychiatry is unavoidable, and family therapies are strongly recommended because of the young age of many patients.

For young women who have passed adolescence, or for patients with mild symptoms, behavioral and cognitive therapy works well.

Cure rates for anorexia are mixed. If 30 to 50% of the patients recover without further complications, they are about 15% to maintain an abnormal thinness and a psychological fragility. 15% never really cure it, while nearly 10% die.

The later the anorexia is taken care of, the more the chances of a cure without physical or psychological sequelae are weak. Therapeutic treatment is mandatory by hospitalization in specialized structures where psychiatrists and nutritionists work collegially together. Therapies vary considerably from one specialized center to another, from one psychiatrist to another: individual or family psychotherapy, psychoanalysis, cognitive-behavioral therapy (CBT), psychotropic drugs in the class of serotonergic antidepressants(serotonin is indeed involved in food restriction behaviors). Whatever the strategy, the therapeutic support is long, sown with relapses and always uncertain as to the outcome of the disease.

Statistics show that after 10 years of the disease, approximately 10% of the patients die; after 20 years of illness, then 20% of patients die.

Hospitalization

Hospitalization is sometimes considered. The decision, with the exception of an emergency, is taken with the person concerned and his / her family after several interviews.

The hospitalization allows:

  • to stop the process of undernutrition and the consequences that may result
  • to motivate themselves to do everything possible to heal
  • to allow the family entourage to rest and take a break
  • to combat the phases of anxiety and depression
  • to consider setting aside the daily and family
  • to put in place a care plan adapted to each individual

Hospitalization is now a less severe trauma as the teams dealing with people with anorexia are familiar with the process and can connect the various members of the family with the utmost respect.

During the hospitalization, the nursing staff offers an adapted nutritional program, therapeutic interviews, as well as group activities, such as speaking groups, art therapy, sports or cultural activities. Therapy may be initiated or continued during hospitalization.

The close family circle is also accompanied during this hospitalization time.

Can anorexia be prevented?

There is no prevention against anorexia. The best thing is still to open the dialogue with the person who shows signs of weight loss and a refusal of food. It is important not to rush the person who is in danger of closing themselves off. However, there are reasons to suggest that anorexia nervosa can be linked to three factors:

  1. the social factor, linked to the importance given to appearance
  2. the psycho-affective factor appears when the person is anxious and does not find satisfaction in the relationships they maintain with their family and friends
  3. the last factor is related to self-confidence

4 steps  for healing anorexia

1.Awareness

The patient’s recognition of their state of weight loss and the strategies used to refuse to eat is a fundamental first step. The end of the denial of the disease is indeed essential to reach the second step.

2.Decision to heal

This decision causes the awakening of the anxieties responsible for the disease. The idea of ​​regaining weight, seeing that vomiting or compulsive food intake ceases, places the anorexic in the face of choosing healing or stalling in the disease. This choice constitutes the third step.

3.Acceptance

Accepting nourishment, dismantling the psychological “ramparts” for months, even years, accept their body. So many actions that places the patient in a healing journey. The third step begins, we must move on to the fourth, as difficult as the preceding ones, if not more.

4.Perseverance

Respecting the decisions and actions of steps two and three over the long term is the key to the success of the fight against the disease. Relapses are unfortunately frequent, and the cure rate without sequelae is less than 50%.

Three tools to cure anorexia

1.Psychotherapy

Psychotherapeutic management. This can only begin if the patient has desired it and has accepted the need for it. The cultural, social and family contexts are of paramount importance in the onset of the disease. Therefore, the goal of the therapist will be to gradually change the way the anorexic looks at themselves, others and the world around them.

2.Behavioural therapy

Behavioral management. This approach is limited, on the contrary, to the symptomatic aspects and to the thoughts generating the behaviors that sustain the disease. During the sessions, the therapist leads the patient to become aware of the path of their thought to better act on their behaviors.

3.Nutrition

Finally, the third tool is of course the nutritional aspect of therapy which has 4 objectives. Recover normal body weight, ie body mass index ( BMI ) between 18.5 and 25. The body mass index ( BMI ) is calculated by dividing its weight (in kg) by the square of its size (in meters ). Recover a normal energy and vitamin balance and finally regain a normal feeding behavior by banishing all old food phobias .

 Associations that can help people with anorexia nervosa are:

Africa – http://www.africamentalhealthfoundation.org/index.html

Australia – https://thebutterflyfoundation.org.au/

Canada – http://nedic.ca/

Ireland – https://www.bodywhys.ie/

India – http://www.mindsfoundation.org/our-purpose/

South Africa – http://www.edsa.co.za/

South America – http://aluba.org.ar/

United Kingdom – https://www.beateatingdisorders.org.uk/

USA – https://www.nationaleatingdisorders.org/

Close