Since then, the disorder has taken on new iterations, and research has learned a great deal more about its impact. Due to the complexities of disordered eating behaviors and the fact that individuals do not always engage in restricting behaviors alone, the DSM-5 has designated distinct subtypes to further understand anorexia behaviors. Restricting Type is the subtype of anorexia most commonly known. This subtype differs from a Bulimia Nervosa diagnosis in that those struggling with Bulimia Nervosa do not engage in any restrictive behaviors.
However, it is a phenomenon that is being more widely debated, as many eating disorder researchers and professionals believe its prevalence warrants an official diagnosis. Until then, the term refers to individuals that engage in excessive or compulsive exercise and do not consume the calories necessary for nourishment.
Our society has a warped perception that one must appear emaciated to struggle with anorexia. The truth is, you cannot tell by looking at someone whether or not they engage in anorexic behaviors; however, some warning signs can indicate a possible problem. Anorexia Nervosa results in severe malnourishment that can be identifiable in many ways other than weight loss, such as:. Individuals that struggle with anorexia will display specific behavioral and emotional warning signs that indicate a lack of nourishment and mental distress.
One of these include:. Although our culture is recognizing gender as less black-and-white than binary gender identification, most research is conducted based on the constructs of male and female, therefore, the impact of long-term anorexia nervosa behaviors will be summarized based on these two genders below. The statistical understanding that men experience eating disorders less than women may not be entirely accurate, as men are less likely to discuss their struggles openly.
Long-term consequences of anorexia in men include:. Reducing anorexia nervosa onset to one specific cause is impossible; however, there are various factors that can indicate increased risk. Research is working to identify specific gene variants related to anorexia nervosa development. This characteristic is manifested by restricting food intake to achieve weight loss 10 , Also, individuals with anorexia might become highly sensitive to criticism, failure and mistakes Imbalances in some hormones, such as serotonin, dopamine, oxytocin, cortisol and leptin, can explain some of these characteristics in those with anorexia 13 , Since these hormones regulate mood, appetite, motivation and behavior, abnormal levels could lead to mood swings, irregular appetite, impulsive behavior, anxiety and depression 8 , 15 , 16 , In addition, reducing food intake can lead to a deficiency of nutrients involved in mood regulation Mood swings and symptoms of anxiety, depression, perfectionism and impulsivity are commonly found in people with anorexia.
These characteristics may be caused by hormonal imbalances or nutrient deficiencies. Body shape and attractiveness are critical concerns for people with anorexia Anorexia is characterized by having a negative body image and negative feelings toward the physical self In one study, participants showed misconceptions about their body shape and appearance.
They also exhibited a high drive for thinness A classic characteristic of anorexia involves body-size overestimation, or a person thinking they are bigger than they actually are 23 [29], 24 [30]. One study investigated this concept in 25 people with anorexia by having them judge whether they were too big to pass through a door-like opening.
Those with anorexia significantly overestimated their body size, compared to the control group Repeated body checking is another characteristic of anorexia. Examples of this behavior include looking at yourself in a mirror, checking body measurements and pinching the fat on certain parts of your body Body checking can increase body dissatisfaction and anxiety, as well as promote food restriction in people with anorexia 26 , Additionally, evidence shows that sports in which weight and aesthetics are a focus can increase the risk of anorexia in vulnerable people 28 [34], 29 [35].
Anorexia involves an altered perception of the body and overestimation of body size. Additionally, the practice of body checking increases body dissatisfaction and promotes food-restrictive behaviors. Those with anorexia, especially those with the restrictive type, often exercise excessively to lose weight In teenagers with eating disorders, excessive exercise seems to be more common among women than men Some people with anorexia also experience a feeling of intense guilt when a workout is missed 33 , Walking, standing and fidgeting more frequently are other types of physical activity commonly seen in anorexia Excessive exercise is often present in combination with high levels of anxiety, depression and obsessional personalities and behaviors 35 , Lastly, it seems that low levels of leptin found in people with anorexia might increase hyperactivity and restlessness 37 , Excessive exercise is a common symptom of anorexia, and people with anorexia may feel intense guilt if they miss a workout.
The restrictive type of anorexia is characterized by a constant denial of hunger and refusal to eat. First, hormonal imbalances can provoke people with anorexia to maintain a constant fear of gaining weight, resulting in a refusal to eat. Low levels of these hormones typically found in people with anorexia can make it hard to overcome the constant fear of food and fat 39 , 40 , Irregularities in hunger and fullness hormones , such as cortisol and peptide YY, can contribute to the avoidance of eating 42 , People with anorexia can find weight loss more gratifying than eating, which can make them want to continue restricting food intake 12 , 39 , A constant fear of gaining weight can cause people with anorexia to refuse food and deny hunger.
Also, the low reward value of food can lead them to further decrease their food intake. Obsessive behavior about food and weight often triggers control-oriented eating habits Engaging in such rituals can ease anxiety, bring comfort and generate a sense of control People with anorexia can view deviation from these rituals as a failure and loss of self-control They control food as a way of controlling areas of their lives or dealing with negative emotions.
People with this type of anorexia nervosa place severe restrictions on the quantity and type of food they consume. This could include counting calories, skipping meals, restricting certain foods such as carbohydrates and following obsessive rules, such as only eating foods of a certain colour. People with this type of anorexia also place restrictions on the food they eat. But this is accompanied by binge eating and then purging.
Binge eating means someone eats a large amount of food to cope with feelings of being out of control. The person then 'compensates' for this eating by purging the food through vomiting or misusing laxatives, diuretics or enemas. The most obvious sign that someone has anorexia nervosa is that they are severely underweight, they have lost weight very quickly, or their weight fluctuates dramatically. A BMI of less than But being very thin is not the only sign of anorexia.
There are also other signs that a person may have anorexia nervosa. There may be genetic risk factors and a combination of environmental, social and cultural factors. It's likely that some people are more vulnerable to anorexia because of particular personality traits. Psychological factors , such as a high level of perfectionism or obsessive-compulsive personality traits, feeling limited control in life and low self-esteem , a tendency towards depression and anxiety and a poor reaction to stress.
Environmental factors , including the onset of puberty , stressful life events and relationship problems. Cultural pressures to be thin stemming from media and pop culture such as magazines, TV shows and movies.
Occupations that demand a thin physique may increase the risk of anorexia nervosa, such as certain sports, ballet, or the television and fashion industries. Brain chemistry , because extreme dieting can affect the balance of hormones in the body, affecting how the brain functions.
Genetic predisposition , which arises from the genes inherited from parents. Anorexia nervosa often runs in families, suggesting there may be a genetic cause. But seriously restricting calorie intake is dangerous and can have a serious impact on health.
If you have anorexia nervosa, the earlier you seek help, the better your chances of recovery. Your doctor is a good place to start, or you could talk to someone you trust like a friend, family member or teacher. They will help you take the first steps towards treatment and recovery. Use our Question Builder for general tips on what to ask your GP or specialist.
After ruling out that weight loss is caused by another condition, your doctor may refer you to a mental health professional. This health professional will diagnose anorexia nervosa based on your thoughts, feelings and eating behaviours. They will also check for any other mental or physical complications. The first step to recovery is restoring good nutrition and a healthy weight. This allows treatments to work effectively.
If the person has life threatening medical complications or is extremely low weight, they may need to spend time in hospital. A psychologist can help a person with anorexia nervosa learn behaviours that will help them to return to and maintain a healthy weight. Someone with anorexia nervosa may also see a dietitian, family therapist, psychiatrist or other members of a healthcare team. Antidepressants and other medicines are sometimes used to treat anorexia nervosa along with psychological therapy.
On average, people have anorexia nervosa for 5 to 7 years. It's common for people with the condition to relapse, so follow-up and treatment for anorexia nervosa is important.
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