An Introduction to Eating Disorders: Anorexia Nervosa

Images and definitions of perfection and beauty inundate us daily.  Even if you rarely watch television or read magazines, it is difficult to escape encountering someone’s version of ideal.  Though the beauty-ideal obsessed aspect of our culture does influence those suffering from eating disorders, these illnesses emerge from additional complex factors.  It can be tempting to want to tell someone to just eat more, exercise less, or stop throwing up.  To better understand one of the most well-known eating disorders, Anorexia Nervosa (AN), let’s take a look at its prevalence, what it is, and some of the reasons it occurs.

Eating disorders are serious and pervasive.  Consider these statistics:

  • 20% of those with an eating disorder will die, giving this category of illness the highest mortality rate or all mental illnesses
  • Anorexia Nervosa is the third most chronic illness in adolescents
  • 30 million Americans suffer from an eating disorder
  • 23 people die every day as a result of an eating disorder
  • Suicide is the second leading cause of death in Anorexia Nervosa (cardiovascular conditions are the first)

Statistics such as these are sobering.  Even so, individuals and their families can still have hope.

What are the criteria for diagnosis for this eating disorder?  According to the DSM-V, Anorexia Nervosa is characterized by three factors:

 A persistent restriction of energy intake leading to significantly low body weight (in the context of what is minimally expected for age, sex, developmental trajectory, and physical health)

  • An intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain (even though the person is at a significantly low weight).
  • Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

 In other words, the individual restricts food (energy) which leads to a lower than healthy weight; she (or he, although AN affects more women than men) feels unduly fearful of weight gain; she does not accurately evaluate her size, places extreme importance on her body shape and size, and fails to recognize the gravity of her low weight.

There are two types of Anorexia Nervosa:

Restricting Type:

During the last three months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).  Weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

Binge-Eating/ Purging Type:

During the last three months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxative, diuretics, or enemas).

Individuals suffering from AN often display multiple symptoms.  They may avoid food or skip meals.  They may engage in food rituals such as cutting their food a certain way or arranging the food methodically on the plate.  Excessive or compulsive exercise is common.  Body checking, examples of which are pinching or wrapping the hand around different parts of the body to measure size, looking in the mirror, or measuring the size of the thigh gap may occur up to a hundred times a day.  Sufferers usually have body dissatisfaction and body distortions, believing their bodies to look differently, usually heavier, than they do in reality.  Calorie counting and obsessive weighing are typically present.  Often, but not always, females with AN experience a loss of their menstrual cyclesFood group avoidance, excessive concern with body, weight, or shape, and avoidance of eating in front of others are also common symptoms.

 Anorexia Nervosa has significant damaging health risks.  Some of the most common concerns are:

  • Abnormally slow heart rate and blood pressure (which can be associated with a risk of heart failure)
  • Reduction of bone density
  • Muscle loss and weakness
  • Severe dehydration, which can lead to kidney failure. Severe headaches can be a symptom.
  • Fainting, fatigue, and overall weakness
  • Dry hair and skin (hair loss is common)
  • Growth of a downy layer of hair
  • Constipation
  • Amenorrhea

Etiology of Anorexia Nervosa

But, why?  It can be hard to understand why a person would willingly subject herself to such emotional and physical harm.  There are many factors that play into the etiology of eating disorders; thus, their existence is not due to a person’s desire to lose weight.  The factors are biological, psychological, and social.

Biological Factors

Genetics are a significant factor (50% – 80%) in eating disorders.  Gender and age play a role, with approximately 75% of AN sufferers being female.  AN most commonly arises in mid to late adolescence, though its prevalence in younger and older female populations is rising.  Physiology also plays a role, specifically the presence or absence of neurotransmitters.  One of these neurotransmitters, serotonin, provides a sense of calm and satisfaction and regulates mood, sleep, appetite, and metabolism.  Dopamine, another key neurotransmitter, is associated with pleasurable activities and also triggers a desire to eat certain foods.

Dr. Walter Kaye, the director of the eating disorders program at the UCSD School of Medicine, discusses research about neurobiology, heritability, and eating disorders:

Psychological Factors

Both a person’s hardwired temperament and softwired character influence the development of and the nature of the recovery from an eating disorder.  An example of temperament includes the characteristic of harm avoidance, that is, the individual’s anxiety inhibits his behavior and those.  Another example is being dependant on others’ responses, specifically needing to receive rewards or affirmations from others.  Character is more malleable.  An example is self-directedness, a key ability that influences an individual to live a purposeful life according to her values and to have a positive relationship with herself.  The self-directedness trait is often low among sufferers of AN.  Cooperativeness, one’s relationship with society, is another important character trait.  Other psychological characteristics of those with eating disorders are difficulty seeing the big picture, perfectionism, rigidity, and difficulty regulating emotions.

Social Factors

Cultural attitudes about weight and media influence play a role in the etiology of eating disorders.  Our culture places a premium on thinness and promotes a nearly impossible beauty ideal.  Teasing from friends or family about weight, physical or sexual abuse, problematic relationships of all types, and the objectification of women all influence eating disorders.

Eating disorders are potentially life-threatening illnesses.  Their treatment involves a collaborative team of clinicians, namely a therapist, a registered dietician, and a physician.  Regular individual and family therapy is necessary, and if an individual’s health is too compromised, a higher level of care such as inpatient treatment may be necessary.  If you or a loved one thinks you may have an eating disorder, don’t hesitate to give us a call.

Special thanks to Carolyn Jones, RN LPC CEDS CEDRN at the Eating Recovery Center of San Antonio for some of the information included in this article.