Anorexia Nervosa: A Complex Eating Disorder

Anorexia nervosa (AN) is a serious and potentially life-threatening eating disorder characterized by an intense fear of gaining weight, a distorted body image, and severe food restriction leading to significantly low body weight.

Etiology:

The exact cause of AN is complex and multifactorial, involving a combination of biological, psychological, and social factors.

• Biological Factors: Genetic predisposition plays a significant role, with studies showing a higher risk for individuals with family history of eating disorders. Neurochemical imbalances, particularly in serotonin and dopamine pathways, may contribute to the distorted body image and food cravings associated with AN.

• Psychological Factors: Perfectionism, low self-esteem, a need for control, and a history of trauma or abuse can contribute to the development of AN. Individuals with AN often have a strong desire for approval and fear of rejection, making them susceptible to societal pressures regarding body image.

• Social Factors: Cultural ideals emphasizing thinness and a focus on appearance can contribute to the development of AN. Societal pressure to achieve a certain body type can be particularly intense among adolescents and young adults.

Presentation:

Individuals with AN often present with a combination of physical and psychological symptoms.

• Physical:

  • Significant weight loss: This is often the most visible symptom, leading to a BMI (body mass index) below 17.5.

  • Disturbances in menstruation: Amenorrhea (absence of periods) is common due to hormonal imbalances.

  • Cardiovascular problems: Low heart rate, low blood pressure, and heart arrhythmias can develop.

  • Gastrointestinal issues: Constipation, bloating, and abdominal pain are frequent.

  • Osteoporosis: Loss of bone density due to malnutrition.

  • Lanugo: Fine, downy hair growth on the body, particularly on the face and extremities.

• Psychological:

  • Distorted body image: Individuals with AN see themselves as overweight, even when they are severely underweight.

  • Fear of gaining weight: This fear is often irrational and intense, leading to extreme measures to avoid gaining weight.

  • Restriction of food intake: People with AN engage in restrictive eating patterns, often eliminating entire food groups or consuming very small amounts of food.

  • Excessive exercise: To compensate for food restriction and prevent weight gain, they often engage in compulsive exercise.

  • Binging and purging: Some individuals with AN may also engage in binge eating followed by purging behaviors, such as self-induced vomiting, laxative abuse, or excessive exercise.

  • Social withdrawal: Isolation and social avoidance are common due to shame and fear of judgment.

  • Depression and anxiety: These mental health conditions frequently co-occur with AN.

Prevalence:

AN is a relatively rare disorder but has a significant impact on individuals and their families. Approximately 0.5-1% of females and 0.1-0.2% of males experience AN in their lifetime. It typically begins in adolescence or early adulthood and can persist for many years if left untreated.

Symptomatology:

The defining features of AN include:

• Restriction of energy intake relative to requirements leading to significantly low body weight.

• Intense fear of gaining weight or becoming fat, even though underweight.

• Disturbance in the way one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Treatment:

Treatment for AN requires a multidisciplinary approach involving a team of professionals, including psychiatrists, psychologists, registered dietitians, and medical doctors. The primary goals of treatment are to restore healthy eating habits, address distorted body image, and manage underlying psychological issues.

Key Points:

• Anorexia nervosa is a serious eating disorder characterized by extreme food restriction, distorted body image, and an intense fear of gaining weight.

• It involves complex biological, psychological, and social factors.

• Individuals with AN present with physical symptoms like weight loss, amenorrhea, and cardiovascular problems, as well as psychological symptoms like distorted body image, fear of gaining weight, and social withdrawal.

• It is a relatively rare but significant disorder with a high risk of morbidity and mortality.

• Treatment requires a multidisciplinary approach focused on restoring healthy eating habits, addressing distorted body image, and managing underlying psychological issues.