Anorexia nervosa is a type of eating disorder characterized by food restriction in the fear of gaining weight. People suffering from anorexia have a strong desire to be lean and often perceive themselves as overweight. The condition denotes a serious and possibly grievous mental illness. People with the illness have not made a lifestyle choice but are in reality extremely ill and require assistance (Zipfel, Giel, Bulik, Hay, & Schmidt, 2015). The exact cause behind the development of the illness is not known. Genetic predisposition and a blend of cultural, social, and environmental aspects are some of the factors attributed to the cause of the illness. For several individuals, body image becomes an aspect of sentiment and self-esteem. It could as well be a means of articulating feelings that might appear intricate or terrifying, for instance, nervousness, stress, and pain. Too much exercise, mainly by men in an effort of having a muscular body, coupled with restrictive dieting, usually by females with the aim of achieving an ideal or slim body, are the most common causal aspects to the onset of the illness.
About Anorexia Nervosa
Anorexia nervosa is known to have existed in Medieval Europe, in a period where extreme fasting was considered a symbol of humility, holiness, and purity. The disorder mainly affects girls in their teenage years and young women that are past this age, but it is seen to have no bounds regarding age, gender, sexual bearings, and racial backgrounds. Though it is generally perceived that anorexia nervosa mainly affects young women and girls, recent studies suggest that the number of males, mostly adolescents, affected by the illness is on the rise. The major feature of the disorder is the deeply rooted fear of being overweight and having an undesirable body appearance, though in reality may not be the case (Zipfel et al., 2015). The fear results in self-starvation leading to extreme and unnecessary weight loss. The disorder affects an individual both physically and psychologically. Psychological issues include disruption in reasoning and responsive abilities, obsessive-compulsive disorder, body dysmorphic disorder, depression, alcoholism, anxiety disorders, insomnia, and other personality disorders. Physically, the affected individuals are most likely to suffer from infertility, osteoporosis, amenorrhea, malnutrition, constipation, electrolyte imbalance, and serious cardiac disorders. This situation results in a poor quality of life, both for the individuals and their families.
Classification and Diagnosis
A person’s family and biographical history, existing symptoms, and views on weight and eating patterns are the major parameters examined while conducting the diagnostic assessment. Apart from these, the mental state of the person is also evaluated to infer his thought content. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) uses Body Mass Index (BMI) as the indicator to diagnose and categorize the disorder. The 2013 revision of DSM-5 does not take into account the criterion of amenorrhea since the diagnostic criteria are applicable to other groups of people that include males, teenage girls who have not attained the first menstrual cycle, and adult women who intake hormones. DMS-5 can be used to diagnose a kind of anorexia nervosa that is uncommon and does not fulfill the requirement of low weight in BMI to indicate the presence of the disorder (Zipfel et al., 2015). The severity of the disorder is determined based on the BMI values. The disorder is categorized as mild when the BMI value is more than 17, moderate when the value is between 16 and 16.99, severe when the value is between 15 and 15.99, and extreme when the value is less than 15. Apart from BMI, a range of medical tests including complete blood count, liver function test, thyroid screen, and glucose tolerance test are conducted to infer the severity of physical deterioration.
Anorexia nervosa may be classified into two subtypes, restrictive type and binge eating or purging type. Binge eating refers to a condition where an individual takes to eating huge amounts of food rich in carbohydrate after a period of food restriction. Once huge amounts are consumed, the individual tries to rid himself of the food by means of purging. Restrictive type refers to the condition where the individual imposes food intake by means of fasting and diet pills. Individuals may resort to crash exercise to lose weight.
Psychiatric and Physical Comorbidity
Anorexia is normally accompanied with other kinds of disorders that affect different people at varying proportions. The disorder affects both the mental health and the physical well being, which is known to occur concurrently. A depressive disorder characterized by a low interest in activities occurs in about 75% of those affected by anorexia nervosa, which can even persist for lifetime. Anxiety disorder is manifested as extreme fear, which is seen to occur in 25% to 75% of the affected people (Zipfel et al., 2015). Obsessive-compulsive disorder is the most common form of anxiety disorder seen, with phobias and panic disorder also occurring in a good number of affected people. People with anorexia are also diagnosed with personality disorders, with Cluster C (anxious) and Cluster A (odd) being more common than Cluster B (dramatic). Approximately 15–29% of the affected people experience a disorder in which unchecked thoughts keep recurring, and they may end up behaving in a similar way time and again.
Other than the above-mentioned psychiatric disorders, people with anorexia nervosa are threatened by complications that touch on body cells with the exclusion of the brain. They are presented with feelings of dizziness, weariness, or temporal moments of unconsciousness (O’Brien, Whelan, Sandler, Hall, & Weinberg, 2017). Their body system may be affected due to the changes of either overindulgence or removal of food. Physical complications associated with anorexia are type 1 diabetes, weak bones, low blood pressure, short stature, hemorrhoids, and premenarcheal onset.
Anorexia nervosa has a high dominance in the adolescent age group than in the adult population. It is seen to arise at any stage in lifetime, but in most cases, is seen to set in during early and mid-adolescence. The condition is more prevalent in females than in males although in children there is no much variation in terms of gender (O’Brien et al., 2017). It is seen that adolescents recover at a faster rate than adults. Anorexia nervosa causes the most deaths out of all the mental disorders known (Zipfel et al., 2015). The deaths are as a result of several health complications in those affected by the disorder. The risk of suicide is also found to be almost 50 times higher than that in the normal population.
Almost 50% of women are seen to recover completely, while about 30% of them recover only partially. Studies have shown that recovery is termed “good” when women regain normalcy in menstrual cycles, and both men and women attain proper weight and eating habits. This, however, is observed in cases where the disorder sets in before one becomes an adult.
The disorder has two main eventualities depending on the time of its onset. These are (i) the good or positive possible events where normalization is attained and (ii) premature deaths in instances where the disorder has become chronic. Malnourishment-related illnesses that bring about difficulties in the functioning of some organs are a major factor leading to mortalities. The condition is seen to recur in about one-third of the affected individuals, with the highest probability seen during the first 6 to 18 months after recovery.
Just like every other eating disorder, treating anorexia may be difficult. However, successful treatment deals with treating the underlying psychological and emotional, medical concerns, problems that usually arise during childhood and influence an individual’s self-perception and personality. Certainly, most of the treatment methods employed focus on assisting the affected individuals in comprehending the manner in which they view the eating behavior (Danielsen, Rekkedal, Frostad, & Kessler, 2016). Personality may be viewed as a basis of transformation that an individual having anorexia requires tackling, since an inaccurate sense of self may be overwhelming, to the extent that a slim person perceives themselves to be overweight. Treatment should be focused on restoration of healthy weight, addressing psychological disorders associated with the illness, and elimination of wrong perceptions and thoughts that were the leading cause to the onset of the disorder.
Some individuals with anorexia nervosa could be in a state of denial; this means that they may deny that they have an issue, even in cases where their body weight is evidently extremely low. Some people even talk of models and celebrities to assert that they have no problem and that they are satisfied with their looks. A major setback in treating the illness, therefore, is finding the best way of convincing the affected individuals that they have a severe mental health disorder, which calls for treatment by a professional.
Though there are numerous approaches to treatment, nearly every one of them starts with visiting an eating disorder expert. Normally the eating disorder specialist is a psychologist with profound training and expertise in assisting people with the illness. A physical assessment by a health professional is as well an initial segment of the basic treatment of the illness with the aim of comprehending and starting to tackle the physical challenges that might have happened due to the disorder. Diet modification, medication, and nutrition are the main areas to be focused in order to rehabilitate the person physically. Some of the methods for treating the associated psychiatric conditions are discussed below.
Psychotherapy is one of the best treatment approaches for anorexia nervosa and has the maximum research backing. It may entail considerable time and monetary dedication, especially when a person is fighting with other problems (for instance, sexual abuse, drug use, relationship issues, and depression). Psychotherapy may be greatly valuable in tackling not just a person’s eating disorder but also his/her general emotional contentment and well being (Danielsen et al., 2016). In reality, the focal point of psychotherapy is tackling the psychological and emotional concerns that lead to the eating disorder. Psychodynamically oriented psychotherapies help patients overcome the struggle for autonomy and self-control.
Cognitive-Behavioral Therapy (CBT)
CBT is deemed the alternative treatment approach for people with anorexia nervosa. With the backing of a wide pool of studies, CBT is a time-restricted and centered method that assists people to comprehend the manner in which their thoughts and negative self-talk and self-esteem strongly influence their conduct and consumption. Being the paragon of excellence in the treatment of anorexia nervosa, CBT is concerned with the identification and variation of dysfunctional thinking patterns, mindsets, and convictions that may elicit and perpetuate people’s restrictive dieting (Danielsen et al., 2016). CBT focuses on reducing anxiety resulting from behavioral change. Since CBT is time-limited, an individual with anorexia nervosa will undergo treatment for a given time with particular objectives in mind. Just like psychotherapy, the treatment for anorexia nervosa may be carried out once a week in the outpatient department or at residential treatment amenities in an inpatient setting. Cognitive remediation therapy is also useful in the treatment of anorexia.
Family therapy represents a different kind of psychotherapy. The disorder is seen in the context of the family structure and any dysfunction associated with it. It involves the participation of the parents of the affected individuals, and has been proved to be more effective, especially while treating adolescents and teenagers. The therapy is normally carried out in affected individuals alongside their family members. The treatment method assists family members to know and value the activities they are taking part in treating the disorder and propose a manner in which other relatives may assist the affected individuals in recognizing the problem and look for treatment.
Family therapy entails family therapy sessions, couple therapy, multi-family therapy groups, and family-based treatment. Couple therapy includes sessions for couples where one of the partners suffers from the disorder (Chen et al., 2016). It may be done as outpatient sessions where critical issues related to negative body image or fertility problems may be discussed. One approach to family therapy is referred to as the Maudsley Approach, where parents play an integral role in assisting their children gain normal, healthy weight and better their eating patterns. The model is evidence-based and has been found to be very effective in the treatment of children and teenagers, particularly in preventing the disorder from becoming a chronic illness.
Though at times the disorder is not easily noticeable, people with anorexia nervosa are exceedingly ill and require help. The reasons for the development of the illness differ from one individual to another, with some identified causes being genetic predisposition and cultural, social, and environmental aspects. The illness has a high prevalence in the adolescent age group, with women being affected to a larger extent than men. The disorder is more psychological than physical. A major impediment in the treatment of anorexia nervosa is finding the finest means of convincing the affected individuals that they have a serious mental disorder. While psychotherapy, cognitive-behavioral therapy, and family therapy have been found to be useful in the treatment of the disorder, an early detection is highly important for complete recovery.
Chen, E. Y., Weissman, J. A., Zeffiro, T. A., Yiu, A., Eneva, K. T., Arlt, J. M., & Swantek, M. J. (2016). Family‐based therapy for young adults with anorexia nervosa restores weight. International Journal of Eating Disorders, 49(7), 701-707.
Danielsen, Y. S., Rekkedal, G. Å., Frostad, S., & Kessler, U. (2016). The effectiveness of enhanced cognitive behavioral therapy (CBT-E) in the treatment of anorexia nervosa: A prospective multidisciplinary study. BMC Psychiatry, 16(1), 1-10.
O’Brien, K. M., Whelan, D. R., Sandler, D. P., Hall, J. E., & Weinberg, C. R. (2017). Predictors and long-term health outcomes of eating disorders. PloS One, 12(7), 1-14.
Zipfel, S., Giel, K. E., Bulik, C. M., Hay, P., & Schmidt, U. (2015). Anorexia nervosa: Aetiology, assessment, and treatment. The Lancet Psychiatry, 2(12), 1099-1111.