Anorexia (an-o-REK-see-uh) nervosa — often simply called anorexia — is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight.

Anorexia Nervosa is a serious eating disorder that is treatable but can be life-threatening without intervention. With over 200,000 individuals in the United States impacted per year and the highest mortality rate of any mental illness, it is important to learn the signs, symptoms, and treatment options for this disorder.

Anorexia Nervosa is characterized by the National Institute of Mental Illness as individuals that have “a significant and persistent reduction in food intake leading to extremely low body weight; a relentless pursuit of thinness; a distortion of body image and intense fear of gaining weight; and extremely disturbed eating behavior [1].”

Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight, a distorted body image and an intense fear of gaining weight. The disorder compels you to become so consumed by your looks and your desire to be thin that it impacts all aspects of your life. Thoughts about going on a strict diet, food and losing weight take up most of your day. You relentlessly pursue extreme measures of losing weight.

There are two types of anorexia: restricting and purging. In the restricting type of anorexia, weight loss is achieved by restricting calories, such as dieting, fasting and constantly exercising. In the purging type of anorexia, weight loss is achieved by vomiting or using laxatives and diuretics to get rid of your food intake.

At its core, anorexia is not really about weight loss and food management. It is a much deeper emotional problem where you are using food as a way to control your life. Being thin makes you feel powerful and by losing more and more weight, you attempt to make yourself feel powerful and in control.

There is also a huge cultural and sometimes family pressure to being thin. Sometimes anorexia is even known to run in families.​​

Anorexia Facts & Statistics

The first reports of deprivation of physical needs through food go back to 300 BC, and there are many examples of these behaviors surfacing throughout history. Outside of these circumstances, Anorexia Nervosa was not officially designated as a mental health diagnosis until the DSM-3 was published in 1952. Since then, the disorder has taken on new iterations, and research has learned a great deal more about its impact.

  • Approximately 200,000 individuals in the US struggle with anorexia.
  • 1 in 200 women suffers from anorexia [3].
  • Anorexia typically begins presenting during adolescence or young adulthood [2].
  • Anorexia is the 3rd most common chronic illness in adolescents [3].
  • Anorexia is less prevalent in males than females, with an approximate ratio of 10 females to 1 males suffering [2].
  • Most individuals struggling with anorexia experience “remission” within five years of presentation of the illness if properly treated [2].
  • 20% of individuals with an anorexia diagnosis will die [3].
  • The mortality rate for anorexia is “12 times higher than the death rate of ALL causes of death for females 15 – 24 years old [3].”
  • Death from anorexia nervosa most commonly occurs due to “medical complications associated with the disorder itself or from suicide [2].”

Anorexia Nervosa Symptoms

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.

Physical Side Effects of Anorexia

Anorexia Nervosa results in severe malnourishment that can be identifiable in many ways other than weight loss, such as:

  • Loss/fluctuation of body fat and muscle.
  • Yellowing and dry skin.
  • Growing fine hair all over the body (lanugo).
  • Loss or irregularity in the menstrual cycle (amenorrhea).
  • Abdominal pain and gastrointestinal issues.
  • Reduced immune system.
  • Difficulty regulating temperature or tolerating the cold.
  • Lethargy and low energy.
  • Dental erosion.

Behavioral & Emotional Signs of Anorexia

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:

  • Reporting an intense fear of weight gain or becoming fat.
  • Emphasis on body weight, size, shape, and appearance that causes apparent distress.
  • Hyperfocused on food, including nutritional content, bodily impact, and
  • Ritualistic eating patterns such as small/large bites, pushing food around, eating in groups, avoiding certain foods, holding food in cheeks, etc.
  • Distorted body image.
  • Exercising excessively, even when weather is bad, interferes with job/school/socializing, or injury occurs.
  • Refusing to eat or be seen eating by others and avoiding eating in social situations.
  • A pattern of declining to eat, possibly stating that they have “already eaten” and/or “aren’t hungry.”
  • Mood swings and increased emotion dysregulation.
  • Difficulty thinking clearly and focusing.

Long-Term Anorexia Complications

The frightening truth is that untreated anorexia nervosa can be lethal, regardless of age, sex/gender, ethnicity, religion, socioeconomic status, etc. 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.

Female

1 in 200 women struggle with anorexia nervosa and, if left untreated, can experience long-term consequences such as:

  • Loss of menstrual cycle, difficulty conceiving, & possible infertility.
  • Damage to the vital organs could result in life-threatening issues.
  • Cardiovascular complications & increased risk of heart failure.
  • Bone and muscle loss.
  • Severe impact on career and relationship functioning.
  • Increased symptoms of other mental illnesses such as depression, anxiety, and substance use.
  • A study completed by the National Association of Anorexia Nervosa and Associated Disorders found that 5 – 10% of individuals struggling will die within ten years after the onset of the disorder [3]. These statistics vary based on gender identification.

Male

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. 15% of those struggling with anorexia nervosa identify as male. Long-term consequences of anorexia in men include:

  • Damage to the vital organs could result in life-threatening failures to function.
  • Cardiovascular complications & increase risk of heart failure.
  • Bone and muscle loss.
  • Severe impact on career and relationship functioning.
  • Increased symptoms of other mental illnesses such as depression, anxiety, and substance use.
  • Men with eating disorder diagnoses are at an increased risk of dying as they are often diagnosed later in their disorder due to assumptions that men do not struggle with disordered eating [4].

References

  1. Unknown (2017). Eating disorders. National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/statistics/eating-disorders#part_155057.
  2.  American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  3. Unknown (2006). Eating disorder statistics. South Carolina Department of Mental Health. Retrieved from https://www.state.sc.us/dmh/anorexia/statistics.htm.
  4. Mond, J.M., Mitchison, D., & Hay, P. (2014) Prevalence and implications of eating disordered behavior in men. Current Findings on Males with Eating Disorders. Philadelphia, PA: Routledge

Prevalence

The lifetime prevalence of anorexia nervosa in adults was 0.6%. Lifetime prevalence of anorexia nervosa was three times higher among females (0.9%) than males (0.3%).1

There is dearth of empirical information on eating disorders in Pakistan. A study of 180 female nursing and medical students in Karachi reported a prevalence rate of 21.7% for anorexia nervosa.2

The findings indicated that 59% of the normal-weight and 21% of the underweight women considered themselves to be overweight.Two multiple regression analyses indicated that greater exposure to Western culture and dissatisfaction with body shape were strong predictors of faulty eating attitudes, whereas unrealistic body shape perceptions could contribute to depressive affect. 3

A cross sectional survey was conducted from January to August 2018 including female students of University of Lahore, University of South Asia and Riphah International University, Lahore. Hostilities and day scholars at the age of 19 years to 30 years were included in the study. The average age of the participants in the study was 22.21±2.356. Among them 42.59% were anorexic. In day scholars, 20.37% were anorexic and in hostilities, 22.22% were anorexic4

References

  1. Hoek HW. Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Current opinion in psychiatry. 2006 Jul 1;19(4):389-94.
  2. Babar N, Alam M, Ali SS, Ansari A, Atiq M, Awais A, et al. Anorexic behaviour and attitudes among female medical and nursing students at a private university hospital. J Pak Med Assoc 2002; 52: 272-6.
  3. Suhail K. Prevalence of eating disorders in Pakistan: relationship with depression and body shape. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity. 2002 Jun;7(2):131-8.
  4. Waris M, Dawood K, Mukhtar T, Noor R, Bashir MS. Frequency of anorexia nervosa among female university students of Lahore, Pakistan. Rawal Medical Journal. 2020 Oct;45(4):780-2.