Anorexia Nervosa (Part 1)

Anorexia nervosa, often called anorexia, is a type of eating disorder. People with anorexia eat so little that they have unhealthy weight loss and become dangerously thin. They may think they are overweight or fat even when they are underweight or thin. Anorexia affects more girls and women than boys and men. Anorexia is a serious health problem that can increase the risk of early death. However, people with anorexia can get better with treatment.

What is anorexia?

Anorexia nervosa, often called anorexia, is a type of eating disorder. Eating disorders are mental health problems that cause extreme and dangerous eating behaviors. These extreme eating behaviors cause other serious health problems and sometimes death. Some eating disorders also involve extreme exercise.

Individuals with anorexia severely limit the amount of food they eat to prevent weight gain. People with anorexia usually have an intense fear of gaining weight and may think they are fat even when they are thin. Women with anorexia may also exercise too much so that they do not gain weight. Over time, eating so little food leads to serious health problems and sometimes death.

What is the difference between anorexia and other eating disorders?

People with eating disorders, such as anorexia, bulimia, and binge eating disorder, have a mental health condition that affects how they eat, and sometimes how they exercise. These eating disorders threaten their health.

Unlike those with bulimia and binge eating disorder, individuals with anorexia do not eat enough to sustain basic bodily functions. People with bulimia and binge eating disorder usually binge, or eat too much while feeling out of control.

It is possible to have more than one eating disorder in your lifetime. Regardless of what type of eating disorder you may have, you can get better with treatment.

Who is at risk for anorexia?

Anorexia is more common among girls and women than boys and men.¹

Anorexia is also more common among girls and younger women than older women. On average, girls develop anorexia at 16 or 17.² Teenage girls between 13 and 19 and young women in their early 20s are most at risk. However, eating disorders are happening more often in older women. In one recent study, 13 percent of American women over age 50 had signs of an eating disorder.³

What are the symptoms of anorexia?

Anorexia causes physical and psychological changes. A person with anorexia often looks very thin and may not act like themselves. Some other symptoms of anorexia include

• Sadness
• Moodiness
• Confused or slow thinking
• Poor memory or judgment
• Thin, brittle hair and nails
• Feeling cold all the time because of a drop in internal body temperature
• Feeling faint, dizzy, or weak
• Feeling tired or sluggish
• Irregular periods or never getting a period for a female
• Dry, blotchy, or yellow skin
• Growth of fine hair all over the body (called lanugo)
• Severe constipation or bloating
• Weak muscles or swollen joints

Individuals with anorexia may also have behavior changes, such as

• Talking about weight or food all the time
• Not eating or eating very little
• Refusing to eat in front of others
• Not wanting to go out with friends
• Making themselves throw up
• Taking laxatives or diet pills
• Exercising a lot

People with anorexia may also have other health problems, including depression, anxiety, or substance abuse.

What causes anorexia?

Researchers are not sure exactly what causes anorexia and other eating disorders. They think that eating disorders might happen because of a combination of a person's biology and life events. This combination includes having specific genes, a person's biology, body image and self-esteem, social experiences, family health history, and sometimes other mental health illnesses. Researchers are also studying unusual activity in the brain, such as changing levels of serotonin or other chemicals, to see how it may affect eating.

How does anorexia affect a woman's health?

With anorexia, your body doesn't get the energy that it needs from food, so it slows down and stops working normally. Over time, anorexia can affect your body in the following ways:⁴

• Heart problems, including low blood pressure, a slower heart rate, irregular heartbeat, heart attack, and sudden death from heart problems⁵
• Anemia (when your red blood cells do not carry enough oxygen to your body) and other blood problems
• Thinning of the bones (osteopenia or osteoporosis)
• Kidney stones or kidney failure
• Lack of periods, which can cause problems getting pregnant

During pregnancy, a higher risk for miscarriage, cesarean delivery, or having a baby with low birth weightAnorexia is a serious illness that can also lead to death. Studies have found that more women and girls die from anorexia than any other eating disorder or serious mental health problem such as depression.⁶ Many people with anorexia also have other mental health problems such as depression or anxiety.^7,8

Long-term studies of 20 years or more show that women who had an eating disorder in the past usually reach and maintain a healthy weight after treatment.⁹

References

1. Smink, F.E., van Hoeken, D., & Hoek, H.W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Reports, 14(4), 406–414.
2. National Institute for Health and Clinical Excellence (NICE), National Collaborating Centre for Mental Health (UK). (2004). Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders (NICE Clinical Guidelines, No. 9). Leicester, UK: The British Psychological Society & The Royal College of Psychiatrists.
3. Gagne, D.A., von Holle, A., Brownley, K.A., Runfola, C.D., Hofmeier, S., Branch, K.E., et al. (2012). Eating disorder symptoms and weight and shape concerns in a large web-based convenience sample of women ages 50 and above: Results of the gender and body image (GABI) study. International Journal of Eating Disorders, 45(7), 832–844.
4. Mehler, P.S., & Brown, C. (2015). Anorexia nervosa – medical complications. Journal of Eating Disorders, 3, 11.
5. Jauregui-Garrido, B., & Jauregui-Lobera, I. (2012). Sudden death in eating disorders. Vascular Health and Risk Management, 8, 91–98.
6. Arcelus, J., Mitchell, A.J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. Archives of General Psychiatry, 68(7), 724–731.
7. Bulik, C.M., Sullivan, P.F., Carter, F.A., & Joyce, P.R. (1996). Lifetime anxiety disorders in women with bulimia nervosa. Comprehensive Psychiatry, 37(5), 368–374.
8. Smith, C., & Steiner, H. (1992). Psychopathology in anorexia nervosa and depression. Journal of the American Academy of Child and Adolescent Psychiatry, 31(5), 841–843.
9. Murray, H.B., Tabri, N., Thomas, J.J., Herzog, D.B., Franko, D.L., & Eddy, K.T. (2017). Will I get fat? 22-year weight trajectories of individuals with eating disorders. International Journal of Eating Disorders, 50(7), 739–747.