Anorexia Nervosa
What is anorexia nervosa?
Anorexia nervosa is a psychiatric diagnosis where a person has severe weight loss resulting in a BMI <18.5 kg/m^2, often due to an intense fear of gaining weight, body image distortion, and more. The weight loss associated with anorexia nervosa can be due to eating less (food restriction), exercising more, using laxatives, and/or vomiting.
People of all ages and racial, ethnic, and socioeconomic backgrounds experience anorexia nervosa, and anorexia nervosa can present with different symptoms, depending on the person.
What causes anorexia nervosa?
The cause of anorexia nervosa is believed to be multifactorial, including biochemical (your body and how it functions), genetic (your family medical history), environmental (the things around you both past and present), and psychosocial (your experiences and relationships) factors. In the brain, anorexia nervosa is currently theorized to be due to changes in the brain’s chemical reward pathway causing differing levels of neurotransmitters, especially serotonin and dopamine. Ongoing research hypothesizes social media use, changing (and often unrealistic) appearance standards, and peer pressure may also play a unique role in eating disorders.
What’s the difference between anorexia nervosa and restricting calories?
Not all people who restrict their calories have an eating disorder. Restricting calories in safe amounts can be a part of healthy weight loss. Anorexia is different, in that it is a clinical diagnosis and individuals who struggle with anorexia typically have a distorted self-image that involves an intense fear of gaining weight. People diagnosed with anorexia nervosa also restrict their eating to the point where the amount of weight lost relative to their height and build is detrimental to their health, and there are nutritional deficiencies that can have long-term effects on their bodies. Some individuals may also have disordered eating, but not meet the diagnostic criteria for anorexia. For more on that, we suggest How to Tell If Your Disordered Eating Is an Eating Disorder.
What’s the difference between Anorexia Nervosa and Bulimia Nervosa?
Perhaps in contrast to public perception, both anorexia and bulimia nervosa can involve purging (e.g. vomiting, taking laxatives, etc.) The main difference between people who have anorexia nervosa and bulimia nervosa is that people with anorexia have severely low body weight, while individuals with bulimia have normal or above-average body weight.
are there treatments for anorexia nervosa?
Several treatments exist for anorexia nervosa, and most of them center around nutrition rehabilitation (treatment centered around eating and nutrients) and psychotherapy (talking to a therapist or other provider to discuss your thoughts and feelings). Because anorexia can cause a variety of complications, some patients may benefit from inpatient (staying in a hospital) or partial hospitalization programs. Although medication is not commonly used for anorexia nervosa, there is a medication option to help treat people with anorexia. Overall, treatment for anorexia nervosa typically uses a team approach, involving a mix of doctors, mental health professionals, and dietitians.
The take-home message here is that several treatments exist for anorexia nervosa, so help exists, and if one method doesn’t work for you there are other approaches that you can try. You should always reach out to your doctor and see what options are right for you.
Here’s what people with anorexia nervosa want you to know:
“Through working with an amazing nutritionist (who I still see to this day) I was able to recover and have a healthy weight and a healthy mind.”
- Aiya P. (University of Virginia)
“It is important for everyone to be kind, to listen, and to lend a hand because we truly do not know what others are going through... Mental health struggles tire us out, but we are a community, and we have the resources to help one another. Every single student deserves to allow their heart to rest.”
- Molly R. (Villanova University)
“Recovery is long. Recovery is painful. Recovery sucks. But to recover is to heal; to heal is to move on; to move on is to finally be free to live.”
- Rachel G. (Boston College)
“To those struggling with an eating disorder, I want you to know that it can get better if you let it. Your body does amazing things for you – it’s fighting to keep you healthy, it allows you to live your life, and it keeps you close to those you love. Don’t let the eating disorder take that away from you. You are worth so much more than what it’s trying to make of you.”
- Alena S. (University of Southern California)
“It made me anxious to put healthy weight back on, and ashamed to discuss that I was anorexic with anybody, but I resolved never to quit on myself on the path to salvation.”
- Bill B. (Villanova University)
Where to go for help with anorexia nervosa:
Your primary care physician (these are typically doctors specializing in Family Medicine or Internal Medicine)
A psychiatrist (a doctor specializing in Psychiatry)
A psychologist (a mental health provider with a PhD os PsyD degree), therapist, or counselor (note that these providers cannot prescribe medications but can provide valuable interventions such as therapy)
Eating disorder health clinics (most utilize a team-based approach and dietitians or nutritionists)
For help finding treatment, visit the National Alliance on Eating Disorders’s treatment finder tool.
WHEN Do I go The Doctor?
If you experience physical symptoms such as fatigue, insomnia, bluish tint to the fingers, dizziness, fainting, missing menstruation cycles, yellowing skin, swelling of the limbs, or irregular heart rhythms.
If you experience emotional or behavioral symptoms such as depressed mood, suicidal thoughts, or avoiding gatherings with food involved.
If any of your symptoms cause you distress or impair your day-to-day functioning.
Any thoughts of suicide should prompt emergency treatment. Please call/see your physician, call 988, or visit your local emergency department if you have any thoughts of suicide.
When in doubt, see a healthcare provider or mental health professional. They can give you an accurate diagnosis, suggest treatment options, and recommend a different treatment plan if one isn’t working.
HOW Do I find a provider that takes my insurance/form of payment?
Visit your insurance provider’s website and locate the provider finder page. This should assist you in finding care in your area that accepts your insurance.
Call your insurance provider to have them assist you in finding a provider in your area.
Use FindTreatment.gov.
See “Mental Health Providers: Tips on Finding One” for more tips and suggestions.
With all that being said, this is your reminder that you don’t need to be a psychiatrist or psychologist to discuss your mental health or to be an empathetic ear to a friend. All you need is an open mind.
Where Can I Learn More?
National Alliance for Eating Disorders, Anorexia Nervosa
Wondermind, How to Tell If Your Disordered Eating Is an Eating Disorder
National Alliance for Eating Disorders, How to Support a Loved One
what people with anorexia nervosa have to share with you:
Disclaimer: The information above is intended to provide education regarding anorexia nervosa. It is not medical advice and should not be used for medical diagnosis. For questions regarding diagnosis, treatment, and more regarding any mental health conditions, contact a mental health professional.
Published: February 20, 2024.
Written by Nafia Ali (Medical Student) and Alexandra Lawlor (Medical Student).
References:
Cleveland Clinic. (2021, November 17). Anorexia nervosa: What it is, symptoms, diagnosis & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9794-anorexia-nervosa#management-and-treatment
Mayo Clinic. (2018, February 20). Anorexia nervosa - Diagnosis and treatment - Mayo Clinic. Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/diagnosis-treatment/drc-20353597
Moore, C. A., & Bokor, B. R. (2023). Anorexia Nervosa. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459148/#:~:text=Anorexia%20nervosa%20is
Dane, A., & Bhatia, K. (2023). The social media diet: A scoping review to investigate the association between social media, body image and eating disorders amongst young people. PLOS global public health, 3(3), e0001091. doi: 10.1371/journal.pgph.0001091.
Avena, N. M., & Bocarsly, M. E. (2012). Dysregulation of brain reward systems in eating disorders: neurochemical information from animal models of binge eating, bulimia nervosa, and anorexia nervosa. Neuropharmacology, 63(1), 87–96. doi: 10.1016/j.neuropharm.2011.11.010
Steiger H. (2004). Eating disorders and the serotonin connection: state, trait and developmental effects. Journal of psychiatry & neuroscience : JPN, 29(1), 20–29.
If you’re reading this, it’s ok to need help.