Characteristics Of Anorexia Nervosa

Michael W. Adamowicz, LICSW Feb 2, 2007 Updated Oct 8, 2015 Bridget Engel, Psy.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D. Feb 2, 2007

Having described the causes of the various eating disorders, we now will describe each of the three major eating disorders in some detail.Anorexia Nervosa is the primary eating disorder associated with food restriction and self-starvation. It can be very dangerous, even lethal, if not treated. Anorexia is more common in teenage girls and young women, particularly among celebrities. As mentioned previously, the first well-known star associated with anorexia, Karen Carpenter, lost her life in 1983 due to cardiac complications related to her illness. Today, numerous stars are sharing their painful journeys towards recovery from anorexia, including Mary Kate Olsen, Tracey Gold, Jane Fonda, Jamie-Lynn Sigler, Sally Field, Paula Abdul, Victoria Beckham, Justine Bateman, Joan Rivers, Whitney Houston, and Carrie Otis.

Symptoms/Criteria

The Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision (DSM-IV TR), the handbook used by clinicians to diagnose an eating disorder, outlines four major criteria for diagnosis. According to the DSM, anorexics 1) refuse to maintain body weight at or above a minimally normal weight for their age and height, 2) experience intense fear of gaining weight or becoming fat, even though they are underweight, 3) misunderstand the seriousness of their weight loss, provide undue influence of body weight and shape on their self-evaluation, and demonstrate disturbances in the way their body weight and shape is experienced, and 4) (in females) experience the absence of at least three consecutive menstrual cycles (if they have already started having periods and are not pregnant).

Almost all sufferers of anorexia are girls and women – approximately 90-95%. Research suggests that about one percent (1%) of female adolescents have anorexia; so approximately one out of every one hundred young women between ten and twenty are starving themselves. Furthermore, the prevalence of anorexia in Western countries increases at the rate of approximately 11 new cases per 100,000 every year. The rates in non-Western countries are increasing as well, and currently range from 0.46% to 3.2%.

Anorexia has one of the highest mortality rates of all mental disorders. The National Eating Disorders Association indicates that 5-20% of those who have untreated anorexia nervosa will not survive the disorder. The annual death rate for females between 15 and 24 years old from anorexia is 12 times higher than the annual death rate for all other causes combined. For those who receive treatment, the mortality rate is far lower, approximately 2-3% of these people will die from this disorder.

There are two sub-types of anorexia. The restricting type of anorexia involves eating very little food and losing weight through self-starvation or excessive exercise. The number of calories consumed by restricting individuals is insufficient to support bodily functions and normal activities. The restrictive type may also work out more than once per day, or exercise with the sole purpose of weight loss at the expense of friendships, homework, and other responsibilities. While binging is often thought of as a bulimic symptom, there is also a binge eating/purging type of anorexia. The women with this type of anorexia binge by eating large amounts of food and then purge by using laxatives, diuretics, enemas, or vomiting. They engage in these behaviors in addition to restricting their diet and caloric intake.

Secrecy is very common in girls who are struggling with anorexia nervosa, because they don’t want their weight loss to be interrupted if they were found out, and also because they are typically ashamed and embarrassed about their behavior. They may skip meals by forgetting, being busy, or falling asleep at mealtimes. People with anorexia often make many excuses about why they are not hungry. They also avoid social occasions in which food will be readily available, or spend lots of time making meals for others without eating the food they’ve prepared. Anorexics may wear baggy or over-sized clothing to hide their thin bodies. In order to lose more weight and give the impression to others that they are eating, they often restrict their intake to fluids and low-calorie food choices such as plain lettuce. Anorexics may also use laxatives, diet pills, and excessive exercise in secret to continue shedding pounds.

Another common symptom of anorexia is obsessive thinking about food and weight. Their weight and body image is directly tied to their self-worth, and they experience intense fear and anxiety about gaining any weight as well as not losing enough weight. Obsessive, frequent weighing is a common behavior for individuals with anorexia, as is obsessive meal planning and counting of calories or fat grams.

Dysfunctional Thinking

A body suffering from starvation will trigger natural survival mechanisms. These biological systems stimulate intense hunger and repeated thoughts of food to remind us to eat and stay alive. Once triggered, a preoccupation with food is maintained and exaggerated by cognitive distortions (faulty and irrational thoughts or errors in thinking). For example, an individual with an eating disorder may justify a binge if they eat one cookie, since that small slip has ruined a perfect day of dieting.

Cognitive distortions can become so pervasive and ingrained that anorexics lose the ability to understand reality and the dangerousness of their behaviors. Body image distortion, mentioned previously, is particularly common and problematic for individuals with anorexia. Anorexics do not see themselves as dangerously thin (and often see themselves as fat), and this consistent misjudgment of body image interferes with their ability to acknowledge that they have a problem which requires help. Furthermore, many anorexics set unrealistic weight loss goals and believe that satisfaction will follow from meeting them. Despite dramatic weight loss, anorexics are still unhappy because they still believe they are fat and should lose more weight.

Health problems

Even after relatively short periods of anorexic behaviors, individuals with this disorder can experience serious and life threatening medical complications. Insufficient vitamins and minerals in the diet and severe weight loss cause abnormalities in electrolyte levels. As mentioned previously, electrolytes are electrically charged chemicals in your blood and cells that help to keep your heart and body functioning properly. Imbalances in electrolytes can cause fatigue, overall weakness, confusion, decreased concentration, and even seizures. Electrolyte problems and hormone imbalances can also lead to insomnia (impaired sleep). Hypokalemia is a deficiency in potassium that causes diminished reflexes, fatigue and cardiac abnormalities.

Long-term dieting and poor nutrition can decrease the level of iron in the blood, causing frequent or easy bruising, lethargy (fatigue), and anemia. Also, hypoglycemia (low levels of sugar in the blood) can lead to shakiness, anxiety, restlessness, and sometimes fainting. A condition called hypocalcemia may also occur when there is not enough calcium in the blood, resulting in muscle spasms, numbness or tingling in the hands and feet, decreased vision, and chronic tiredness. Weak or brittle bones (osteoporosis) and teeth are also significant signs of an eating disorder, as is osteopenia (low bone density).

Long-term vomiting can cause chronic bad breath, rupturing of the esophagus, bloating, distention, damage to the ling of the stomach, and gastric distress. Weak abdominal muscles caused by chronic vomiting can lead to a buildup of gastric poisons and byproducts in the stomach chamber, which eventually weakens the immune system. Gastroesophageal reflux disease (GERD) can also develop. GERD is a potentially life threatening condition in which the contents of the stomach, including acid, reflux (back up) into the esophagus causing inflammation and heartburn symptoms. Constipation, abdominal pain, bladder incontinence, and urinary tract infections are all common symptoms because of poor nutrition in the diet. A prolonged use of laxatives can also cause chronic diarrhea.

Thermoregulation (body temperature regulation) problems are common for individuals with anorexia. These individuals often complain of being cold, no matter how warm it is outside. Growth of long, downy hair on the face, arms and body (called lanugo) is a sign that an emaciated body is attempting to stay warm.

There are other symptoms as well, including delayed or permanently stunted growth. Severe dehydration is also not uncommon. This often leads to water retention (edema) and swollen hands and feet, and impaired kidney functioning. A prolonged lack of fat intake in the body causes skin to become blotchy, dry and gray or yellow in hue. Also, fingernails become brittle and hair weakens and falls out.

Many individuals who have had anorexia for long periods develop serious heart problems. A decrease in size of the heart muscle and chamber size can cause fainting, disruptions in blood pressure, and irregular or slow heartbeats (bradycardia and arrhythmia). Without appropriate medical intervention and treatment, heart problems and other organ distress can lead to serious complications and even death.