Anorexia Nervosa
A severe eating disorder characterized by persistent restriction of energy intake leading to significantly low body weight, intense fear of gaining weight, and distorted perception of body shape or size.
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Understanding Anorexia Nervosa
Anorexia Nervosa is characterized by persistent restriction of energy intake leading to significantly low body weight, intense fear of gaining weight or becoming fat, and disturbance in the way your body weight or shape is experienced. It has the highest mortality rate of any psychiatric disorder.
Individuals with anorexia nervosa have a distorted body image, often feeling overweight even when emaciated. They may engage in excessive exercise, strict dieting, or compensatory behaviors like purging. Physical signs can include dramatic weight loss, fatigue, dizziness, thinning hair, and absence of menstruation.
Psychological Features
- Ego-Syntonic Nature: Unlike most disorders, anorexia often feels consistent with your values and identity, making motivation for change complex.
- Overvaluation of Control: Control over eating and weight becomes central to self-evaluation and identity.
- Cognitive Rigidity: Dichotomous thinking, perfectionism, and difficulty with cognitive flexibility are common.
- Interoceptive Difficulties: Difficulty recognizing hunger, satiety, and emotional states creates disconnection from bodily signals.
Causes and Risk Factors
Anorexia Nervosa is a complex disorder with no single cause. Several factors may contribute, interacting in unique ways for each individual.
Genetic and Biological Factors
Genetic predisposition can increase vulnerability, with heritability estimates of 50-80%. Biological factors may include differences in brain structure and function affecting appetite regulation, reward processing, and anxiety responses.
Psychological Factors
Psychological factors such as perfectionism, obsessive-compulsive traits, anxiety, low self-esteem, and a history of trauma or abuse are often associated with anorexia. Difficulty with emotional regulation and a tendency toward black-and-white thinking contribute to the development and maintenance of the disorder.
Environmental Influences
Environmental influences include cultural and societal pressures promoting thinness, media portrayal of ideal body types, and critical comments about weight or eating from family members or peers. Participation in activities that emphasize leanness (such as ballet, gymnastics, or modeling) may increase risk.
Types and Variations
Anorexia Nervosa is categorized into two subtypes:
- Restricting Type: Weight loss occurs primarily through dieting, fasting, or excessive exercise without binge eating or purging behaviors.
- Binge-Eating/Purging Type: In addition to restricting food intake, individuals engage in binge eating or purging behaviors (like self-induced vomiting or misuse of laxatives, diuretics, or enemas).
Challenges in treating anorexia nervosa include the ego-syntonic nature of the disorder, meaning the behaviors align with your values and sense of self, and the significant medical complications that can arise from starvation, such as heart problems, bone loss, and organ failure.
Diagnosis and Assessment
Diagnosis of Anorexia Nervosa involves a comprehensive assessment by a healthcare professional, which includes evaluating your weight status relative to what is minimally normal or expected.
A thorough history of eating behaviors, weight concerns, body image perception, and any compensatory behaviors is taken. A physical examination and laboratory tests are crucial to assess the severity of malnutrition and identify any medical complications.
Psychological evaluation helps identify co-occurring mental health conditions and understand your relationship with food and body image. The diagnostic criteria from the DSM are used to guide the process.
Treatment Options
Treatment for Anorexia Nervosa typically requires a multidisciplinary team approach involving medical doctors, therapists, and dietitians. The primary goals are weight restoration, addressing the psychological issues driving the disorder, and establishing healthy eating patterns.
Family-Based Treatment (FBT/Maudsley)
FBT is the first-line treatment for adolescents with anorexia nervosa. In this approach, parents take temporary control of refeeding, as the illness impairs the adolescent's ability to make healthy food choices. Treatment progresses through three phases: weight restoration led by parents, gradual return of eating control to the adolescent, and establishing healthy adolescent identity and independence.
Cognitive Behavioral Therapy Enhanced (CBT-E)
CBT-E is effective for adults with anorexia nervosa. This transdiagnostic approach addresses the maintaining mechanisms of eating disorders, including overvaluation of shape and weight, dietary restraint, and perfectionism. CBT-E helps you understand how your symptoms are maintained and develop skills to change problematic thoughts and behaviors.
Specialist Supportive Clinical Management (SSCM)
SSCM combines clinical management focused on weight restoration and normalized eating with supportive psychotherapy. It provides education about the disorder and its effects while building a therapeutic relationship that supports recovery.
Medical Care
Medical monitoring is essential due to the serious health risks of anorexia nervosa, including cardiac complications, electrolyte imbalances, and bone loss. Medical stabilization is often necessary in cases of severe malnutrition, and higher levels of care (residential or inpatient) may be required. Medication is not a primary treatment for anorexia nervosa itself but may be used to manage co-occurring conditions like depression or anxiety.
Coping Strategies
Coping strategies for Anorexia Nervosa recovery focus on challenging disordered thoughts and behaviors around food, weight, and body image:
- Cognitive Restructuring: Learning to identify and dispute cognitive distortions about food and body image helps challenge the thoughts that maintain the disorder.
- Mindful Eating: Practicing awareness during meals helps you reconnect with hunger and fullness cues that have been overridden.
- Exposure to Feared Foods: Gradually exposing yourself to feared foods in a structured way reduces anxiety and expands dietary flexibility.
- Body Acceptance: Developing a healthier relationship with your body through gentle movement and self-compassion counters the harsh self-criticism common in anorexia.
- Support Networks: Building strong support and engaging in activities unrelated to food or weight helps restore a fuller sense of identity.
Additional Support
Crisis Support: If you're experiencing thoughts of self-harm, contact the 988 Suicide & Crisis Lifeline or go to your nearest emergency room.
Looking for more guidance? Visit our Learn center for information about starting therapy, or explore helpful resources including crisis support, recommended reading, and wellness tools.
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Frequently Asked Questions
Related Topics
Related Topics
Bulimia Nervosa
Cycle of binge eating followed by compensatory behaviors like purging
Binge-Eating Disorder
Recurrent episodes of eating large amounts with loss of control, without purging
Cognitive Behavioral Therapy (CBT)
Evidence-based approach addressing the connection between thoughts, feelings, and behaviors