Anorexia Nervosa – Causes, Symptoms and Treatment
Anorexia nervosa is a serious eating disorder characterized by extreme underweight, an intense fear of gaining weight, and a distorted body image.
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Anorexia nervosa is a serious eating disorder characterized by extreme underweight, an intense fear of gaining weight, and a distorted body image.
What is Anorexia Nervosa?
Anorexia nervosa is a serious mental health condition classified as an eating disorder. People affected by it severely restrict their food intake, leading to dangerous levels of underweight. A defining feature is an intense fear of gaining weight alongside a distorted body image -- individuals perceive themselves as overweight even when they are objectively severely underweight. Among all psychiatric disorders, anorexia nervosa has one of the highest mortality rates.
Causes
Anorexia nervosa develops from a complex interaction of biological, psychological, and social factors:
- Biological factors: Genetic predisposition, alterations in serotonin and dopamine levels, and hormonal influences can increase the risk of developing the disorder.
- Psychological factors: Perfectionism, low self-esteem, anxiety disorders, obsessive thinking, and a strong need for control are frequently observed.
- Social and cultural factors: Societal ideals of thinness, social media pressure, family conflict, and traumatic experiences may all contribute to the development of the condition.
Symptoms
The symptoms of anorexia nervosa affect both physical and psychological well-being:
Physical Symptoms
- Significantly low body weight (Body Mass Index below 17.5)
- Absence of menstruation (amenorrhea)
- Fine downy body hair (lanugo)
- Hair loss, brittle nails, dry skin
- Low blood pressure and slow heart rate (bradycardia)
- Sensitivity to cold, dizziness, and fainting
- Electrolyte imbalances that can lead to cardiac arrhythmias
Psychological and Behavioral Symptoms
- Intense fear of weight gain despite being underweight
- Distorted perception of body shape or size
- Preoccupation with food, calories, and dieting
- Avoidance of shared meals
- Excessive exercise
- Social withdrawal and mood changes
Diagnosis
Diagnosis is made by physicians or mental health professionals based on established clinical criteria from the ICD-11 (International Classification of Diseases) or DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Common assessments include:
- Physical examination and measurement of height and weight (BMI calculation)
- Blood and urine tests to identify nutritional deficiencies and electrolyte imbalances
- Electrocardiogram (ECG) to monitor cardiac function
- Psychological interviews and standardized eating disorder questionnaires
Treatment
Treatment of anorexia nervosa requires a multidisciplinary approach and typically involves:
Psychotherapy
Cognitive Behavioral Therapy (CBT) is one of the most evidence-based psychological treatments. Other approaches include family-based treatment (especially effective in adolescents), psychodynamic therapy, and Dialectical Behavior Therapy (DBT).
Nutritional Therapy
A gradual restoration of healthy body weight under the supervision of nutrition specialists is essential. This involves a structured meal plan with a carefully increased caloric intake over time.
Medical Treatment
There is no medication specifically approved for anorexia nervosa. However, antidepressants or other psychiatric medications may be prescribed to address co-occurring conditions such as depression or anxiety.
Inpatient Treatment
Severe underweight, physical complications, or acute risk of suicide may require inpatient or day-patient care in a specialized clinic or eating disorder unit.
Prognosis and Outlook
Anorexia nervosa is a chronic condition with a variable course. With early and consistent treatment, many individuals achieve full recovery. Without treatment, however, the disorder can become life-threatening. Factors associated with a poorer prognosis include a long duration of illness, very low initial body weight, and co-occurring psychiatric conditions.
References
- World Health Organization (WHO): International Classification of Diseases, 11th Revision (ICD-11). Geneva, 2022.
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Washington D.C., 2013.
- Treasure J., Zipfel S., Micali N. et al. -- Anorexia nervosa. Nature Reviews Disease Primers, 2015. doi: 10.1038/nrdp.2015.74.
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