Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.
Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Historians and psychologists have found evidence of people displaying symptoms of anorexia for hundreds or thousands of years.
Although the disorder most frequently begins during adolescence, an increasing number of children and older adults are also being diagnosed with anorexia. You cannot tell if a person is struggling with anorexia by looking at them. A person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.
ANOREXIA NERVOSA DIAGNOSTIC CRITERIA
To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met:
Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
Intense fear of gaining weight or becoming fat, even though underweight.
Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.
WARNING SIGNS & SYMPTOMS OF ANOREXIA NERVOSA
Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
Feeling cold all the time
Menstrual irregularities—amenorrhea, irregular periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
Cuts and calluses across the top of finger joints (a result of inducing vomiting)
Dental problems, such as enamel erosion, cavities, and tooth sensitivity
Dry and brittle nails
Swelling around area of salivary glands
Fine hair on body (lanugo)
Thinning of hair on head, dry and brittle hair
Cavities, or discoloration of teeth, from vomiting
Yellow skin (in context of eating large amounts of carrots)
Cold, mottled hands and feet or swelling of feet
Poor wound healing
Impaired immune functioning
Emotional and behavioral
Dramatic weight loss
Dresses in layers to hide weight loss or stay warm
Is preoccupied with weight, food, calories, fat grams, and dieting
Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
Makes frequent comments about feeling “fat” or overweight despite weight loss
Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
Denies feeling hungry
Develops food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate)
Cooks meals for others without eating
Consistently makes excuses to avoid mealtimes or situations involving food
Expresses a need to “burn off” calories taken in
Maintains an excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury
Withdraws from usual friends and activities and becomes more isolated, withdrawn, and secretive
Seems concerned about eating in public
Has limited social spontaneity
Resists or is unable to maintain a body weight appropriate for their age, height, and build
Has intense fear of weight gain or being “fat,” even though underweight
Has disturbed experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight
Postpuberty female loses menstrual period
Has strong need for control
Shows inflexible thinking
Has overly restrained initiative and emotional expression
HEALTH CONSEQUENCES OF ANOREXIA NERVOSA
In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences.
The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body.
Information via the National Eating Disorders Association
If you are seeking help and support for an eating disorder in the New York City area, please contact our Admissions team below to discuss treatment options at BALANCE.