Definition

Anorexia nervosa, or what is often simply called anorexia, is an eating disorder characterized by abnormally low body weight, intense fear of gaining weight, and a distorted perception of weight. The term anorexia means "loss of appetite." However, this definition is misleading because people with anorexia are often hungry but refuse to eat. People with anorexia have an intense fear of getting fat and see themselves as fat even when they are skinny. These people may try to correct this perceived “deficiency” by severely restricting food intake and exercising excessively to lose weight. This disorder is diagnosed when a person weighs at least 15% less than their ideal body weight. Extreme weight loss in people with anorexia can cause dangerous health problems and even death.

In general, there are two types of anorexia, such as:

• Restricting type

People with this type of anorexia severely limit the amount and type of food they consume, including counting calories, skipping meals, limiting certain foods (such as carbohydrates), and following obsessive rules, such as only eating foods of a particular color. Excessive exercise may go along with this behavior.

• Binge eating/purging type

People with this type of anorexia also limit the food they eat. Still, in this type, it is accompanied by “binge eating” and then "purging.“Binge eating” means a person eats large amounts of food to cope with feelings of uncontrollability. The person then 'compensates' for this eating by purging through vomiting or abusing laxatives, diuretics or enemas.

Causes

The exact cause of anorexia is unknown, but like many diseases, this disorder may be the result of a combination of biological, psychological, and environmental factors:

• Biological. Although it is not yet clear which genes are involved, there may be genetic changes that put some people at higher risk of developing anorexia. Some people may have a genetic predisposition toward perfectionism, sensitivity, and perseverance (all traits associated with anorexia).
• Psychological. Some people with anorexia may have obsessive-compulsive personality traits that make it easier to follow strict diets and not eat even when hungry. They may have an extreme drive towards perfectionism, which causes them to think that they are never thin enough, and they may have high levels of anxiety.
• Environment. Modern Western culture often associates a thin body with success and reward. Peer pressure can help fuel the desire to be thin, especially among young girls.

Risk factor

Although the triggers for anorexia in a person are not yet clearly understood, several factors can increase a person's risk of experiencing anorexia, including:

• Female gender
• Higher childhood body mass index
• Genetic predisposition (eating disorders often have a familial link)
• Abnormal functioning of the chemicals and circuits in the brain that control hunger and eating
• Social pressure to be thin
• Difficulty expressing feelings
• History of being teased because of body weight or size
• History of sexual or physical abuse
• Perfectionism, or setting unrealistic goals
• Unhappiness with body image
• Limited social or family support
• Generalized social difficulties, including withdrawal from the environment
• History of mental disorders
• Premature birth, low birth weight, or being part of a multiple birth

Symptoms

The symptoms of anorexia are generally related to hunger. In addition, anorexia also includes emotional and behavioral problems involving unrealistic perceptions of body weight and an extreme fear of gaining weight or becoming fat.

Physical symptoms

Physical signs and symptoms of anorexia may include:

• Extreme weight loss or not resulting in expected weight gain
• Thin appearance
• Abnormal blood count
• Persistent fatigue
• Insomnia (difficulty sleeping)
• Episodes of dizziness or fainting
• Development of a bluish discoloration in the fingers
• Thinning, breakage, or loss of hair
• There is fine and soft hair covering the body
• No menstruation
• Experiencing Constipation and abdominal pain
• Dry or yellowish skin
• Intolerance to cold temperatures
• Irregular heart rhythm
• Low blood pressure
• Dehydration (lack of fluids)
• Swelling of the arms or legs

Emotional and behavioral symptoms

Behavioral manifestations associated with anorexia may involve efforts to achieve weight loss through: 

• Severely restricting food intake via dieting or fasting
• Engaging in excessive exercise
• Overeating, followed by self-induced vomiting to eliminate consumed food,
• Utilizing methods such as laxatives, enemas, diet aids, or herbal products

Emotional and behavioral signs and symptoms may include:

• Frequently skipping meals or actively avoiding eating
• Denying hunger or making excuses not to eat
• Eat only a few specific "safe" foods, usually those that are low in fat and calories
• Developing specific eating rituals, such as spitting out food after chewing
• Avoiding eating in public settings
• Fear of gaining weight, including weighing yourself repeatedly or having your body measured repeatedly
• Frequently check in the mirror for perceived flaws
• Complaining about being fat or having fat body parts
• Wear layers of clothing
• Flat mood (lack of emotion)
• Social withdrawal
• Irritability
• Insomnia
• Reduced interest in sex

Diagnosis

The physician will interview the patient to gather information about the symptoms being reported while also consulting the Diagnostic and Statistical Manual of Mental Disorders (DSM-%), which specifies the following as criteria for anorexia: 

• Limiting calories can cause weight loss or failure to gain weight, leading to significant weight loss depending on the person's age, gender, height, and growth stage.
• Intense worry about putting on weight or getting "fat."
• See themselves and their situation in a skewed way. People who can't honestly judge their weight and body shape think that how they look has a significant effect on their self-esteem and don't think that the health effects of being underweight and having food limits are serious.

If your doctor suspects you have anorexia, they will usually perform several tests and examinations to help determine the diagnosis, rule out medical causes for the weight loss, and check for related complications, including:

Physical examination. Including measuring your height and weight, checking vital signs, such as heart rate, blood pressure and temperature, checking for skin and nail problems, listening to your heart and lungs, and checking your stomach.

Laboratory tests, including a complete blood count and more specialized blood tests to check electrolytes and proteins and your liver, kidney, and thyroid function. A urine examination can also be done.

Psychological evaluation. Your doctor may ask about your thoughts, feelings, and eating habits. You may also be asked to complete a psychological self-assessment questionnaire.

Another Examination. X-rays may be done to check your bone density, check for fractures, or check for pneumonia (lung infection) or heart problems. An electrocardiogram (ECG) may also be done to look for heart abnormalities.

Management

Implementation of anorexia requires comprehensive plans involving several specialist teams that can help sufferers overcome the physical, emotional, social, and psychological challenges they face. Governance strategies include:

• Cognitive-behaved therapy (cognitive therapy)Cognitive Behavioral Therapy-CBT), which can help the person find new ways to think, behave, and manage stress
• Family and individual counseling
• Nutrition therapy, which includes information on how to use food to build and maintain health
• Medicines to treat depression and anxiety
• Supplement to overcome nutritional shortages
• Hospitalization, in some cases

Complications

Anorexia can pose significant health risks and lead to major complications such as:

• Having anaemia
• Problems with the heart (arrhythmia, hypotension, or heart failure)
• Reduced blood pressure
• Issues related to the kidneys
• Disproportion in electrolytes
• Period issues affecting females
• Men with low testosterone levels
• Loss of bone mass
• Death

Prevention

Although anorexia cannot be avoided, understanding the reason allows people to begin therapy as soon as symptoms appear. It may assist in avoiding anorexia if family members have positive views and behaviors toward weight, food, exercise, and attractiveness. Adults may assist children and teens in developing self-confidence in various ways, including academics, hobbies, jobs, and, most significantly, concentrating on things unrelated to one's looks.

When to see a doctor?

In most cases, anorexia is characterized by the absence of symptoms and refusal to seek treatment. Their preoccupation with maintaining a low body mass surpasses any considerations for their well-being. Consult a physician without delay if you or someone you know exhibits symptoms and signs consistent with anorexia.