Identifying and Treating Anorexia: What to do?

With an average age of onset of 15 years, anorexia nervosa stands to have a prevalence of 0.3% among young women, while having the highest mortality rate of any psychiatric disorder (Morries & Twaddle, 2007). 

According to DSM-5, anorexia nervosa is characterized by an intense, irrational fear of gaining weight, refusal to maintain a body weight that is above or near normal for the individual’s height and age, an inability to understand the seriousness of the weight loss, leading to the absence of three or more consecutive menstrual cycles (American Psychiatric Association [APA], 2013).  

Anorexia nervosa can be categorized into two sub-types - (a) the restricting type, where the individual induces weight loss through self-starvation and excessive exercise, and, (b) the binge eating/purging type, where the individual intakes large portions of food and uses laxatives or induces vomiting to purge the food consumed (Hoek, 2006). 

Secrecy is often high in individuals suffering from these eating disorders leading to great difficulty in the early identification of signs and symptoms. Though the exact cause of the disorder is unknown, biological (genetic), psychological (obsessive-compulsive personality traits), and environmental (cultural and peer set societal beauty standards) causes have been cited.

Identifying the Anorexia symptoms

• Avoiding food they consider to be fattening or missing meals
• Excessive exercising, to an unhealthy extent, and/or using laxatives to lose weight
• Developing and following strict rituals around food
• Intense fear of putting on weight
• Considering excessive weight loss a positive
• Dry skin or loss of hair
• Misleading statements about when and how much food was consumed

How to Spot the Signs of Anorexia in Others

• BMI lower than 17.5 in adults
• Skeletal appearance in extreme cases
• Absence of three consecutive menstrual cycles
• Easy fatigue
• Bluish tinge to fingers
• Dehydration
• Abnormal erosion of teeth
• Severe trends in fasting or dieting
• Denial of feelings of hunger
• Self social isolation
• Reduced libido
• Flat affect

The need for Anorexia Nervosa treatment: Effect on Mental Health and Well-being

Apart from the myriad of physiological health problems listed above, individuals suffering from anorexia, also undergo several struggles with mental health. These individuals may have symptoms of heightened anxiety, guilt, shame, obsessive thoughts accompanied by compulsive behaviors, and depression. The anxiety may be a product of the intense fear of weight gain and the need for constant weight loss, the guilt and shame may arise from the inability to see or attain sufficient loss of weight, while the same along with social withdrawal may be precursors for depression. 

These symptoms along with the physiological symptoms mentioned hamper the daily functioning of the individual in various spheres of their life and may serve as indicators of the need for assistance.

Anorexia diagnosis: Recognizing the Need for Immediate Help

Individuals with anorexia rarely seek out treatment as their concerns of health are countermanded by their obsession with not gaining weight and/or losing weight. Thus, the burden falls upon the people around the suffering individual, to identify signs and symptoms and urge them to undergo treatment. 

 Certain signs that may indicate the immediate need for attention and medical care include:

• A long period without a menstrual cycle
• Gastrointestinal problems
• Anemia
• Cardiac problems
• Renal problems
• Loss of bone and muscle tissue
• Low sodium, potassium, and chloride levels

Special care is also required if the following comorbidities are present:

• Substance abuse
• Anxiety and mood disorders
• Self-harm and suicidal ideation

Can Anorexia be treated?

Treating individuals with anorexia nervosa may pose various challenges to both medical professionals and psychologists as the individual does not believe they require help and form a big source of resistance. Overcoming this resistance is the first step toward recovery and may often require immense amounts of patience and care on the part of the caregivers. 

Medical Care

Though no medications have been found to affect individuals suffering from anorexia nervosa, medical care in the form of hospitalization, regular monitoring of vitals, regulating food intake through feeding tubes, and the enlistment of a dietician become important in restoring the health condition to normality. 

Psychotherapy

Psychotherapy in the form of group therapy, cognitive behavior therapy, interpersonal therapy, and family-based interventions are often key in treating individuals with anorexia nervosa. Through the different methods of therapy, the individual is given support and an attempt is made to change how they think about food and their perception of self. Family-based therapies help parents (caregivers) understand how to tackle symptoms in adolescent and young adult sufferers while interpersonal therapy reinforces positive social interactions and relationships by resolving interpersonal problems.  

Though the road to recovery is difficult, 75% make a partial recovery while 21% achieve full recovery (Leigh, 2019). 

FAQ

1. How to stop binging in anorexia recovery
   Eating breakfast is seen to be a good first step. Many people skip breakfast, eat a little lunch, and then binge in the afternoon because they are starving. All throughout the day, eat at regular intervals. Meals that are scheduled and predictable help you gain control over bingeing.

   Overcome Temptation: If you can easily access fast food and desserts, you're more likely to overindulge. Schedule your rewards. Visit a store and have a cup of ice cream but resist the urge to buy all of it.

   Create a network of support. Choose a few loved ones or friends that you can share your struggles with and who can help you. When making your decision, keep in mind that they must be able to lift your spirits when you're having a bad day.

2. How many people have Anorexia?
   Overall across the world, around 9% of people suffer from various types of eating disorders. Around 1-2% of women across the world will face Anorexia at least once in their lifetimes, while this ratio increases to 1-3% for men across the world.