Often anorexia starts with a harmless diet to get rid of some extra pounds. But the transition into anorexia can be smooth. If the weight keeps dropping and eating behavior gets out of control, professional help in the form of psychotherapy is usually necessary. Girls and young women in particular are at risk of developing anorexia – but men can also be affected. The disease can be life-threatening. Early therapy significantly improves the chances of recovery.
What is anorexia?
Anorexia nervosa, along with bulimia (binge eating disorder, bulimia nervosa) and binge eating disorder, is one of the eating disorders. These mental illnesses are characterized by a pathological approach to food intake. Anorexia nervosa is defined as having a body mass index (BMI) of less than 17.5 kg/m². Other criteria for diagnosis are self-induced weight loss, a body schema disorder in which the affected person feels too fat despite being underweight, and hormonal disorders as a result of malnutrition. When not all of these criteria are met, experts refer to the condition as atypical anorexia.
Binge eating in bulimia nervosa and binge eating disorder.
In contrast to anorexia, the focus in bulimia is not on starvation but on binge eating followed by intentional vomiting. Common to both eating disorders is a pathological fear of gaining weight, as well as a constant preoccupation with food in one’s mind. Binge eating disorder is also characterized by binge eating. However, because there is no subsequent countermeasure such as vomiting, patients are usually overweight.
Orthorexia: pathologically healthy eating
A newly emerged form of eating disorder is the so-called orthorexia: Here, the affected compulsively pay attention to a healthy diet and strictly refuse in their eyes unhealthy foods. Long-term consequences can include malnutrition and social isolation. However, orthorexia is not yet a recognized disease.
Who has anorexia?
Anorexia is particularly common in teenagers and young women. However, men can also be anorexic. However, this is far less common, as women are about ten times more likely to be affected. As a rule, the disease begins between the ages of 10 and 25, but mostly during puberty at 13 to 16. In Germany, around 1.4 percent of adults suffer from anorexia nervosa – according to the results of a representative study from 2013. However, frequency figures vary greatly in this regard. In addition, the number of unreported cases is enormously high, especially in the case of eating disorders.
Slimming mania as a cause?
Various causes can lead to the development of anorexia nervosa. Genes seem to play a role, because in identical twins, both siblings are affected in up to 50 percent of cases. Biological factors such as changes in nerve messengers may also be involved. In addition, childhood trauma, disturbed conflict management in the family or an overprotective upbringing can contribute to the development of anorexia. Whether the spread of the slim beauty ideal in the media and society can promote or cause anorexia is controversial.
How do you recognize anorexia?
The transition from dieting to anorexia is often gradual. But at what point does one speak of anorexia? The alarm sign is the so-called body schema disorder (body dysmorphia): anorexics find themselves too fat despite being obviously underweight and want to lose more weight. Another characteristic of anorexia is strict control of food intake, whereby “fattening” foods are usually avoided. It is important to distinguish this from pure underweight: often, underweight people are labeled as anorexic, even though they have normal eating behaviors.
Anorexia: Possible symptoms
In addition to the main characteristic of being “underweight due to self-induced weight loss,” anorexia can manifest itself in a variety of ways. Other possible symptoms include:
- Long periods of fasting
- Excessive sports
- Abuse of medications such as laxatives, drainage tablets, thyroid medications, or appetite suppressants
- Intentional vomiting with or without prior binge eating.
- Strict control of body weight with very low target weight
- Panic fear of gaining weight
- Hiding weight loss – such as by wearing loose clothing or hiding weights at weigh-ins
- Very slow eating or self-imagined “eating rituals”.
- Constant mental preoccupation with the topics of weight and nutrition
Not infrequently, anorexics also suffer from psychological symptoms or disorders such as depressive mood, obsessive behavior, anxiety disorders or personality disorders. Thus, a vicious circle can develop, which may aggravate the anorexia.
Consequences of anorexia nervosa: physical symptoms
Because the body receives too little energy and nutrients in anorexia, there are often physical deficiency symptoms or, in severe cases, even permanent damage. Short-term consequences of decreased energy intake include, for example:
- Freezing, cold hands and feet
- Headache
- Constipation
- Low blood pressure, slow heartbeat
- Sleep disturbances
- Concentration problems, reduced performance
Long-term malnutrition can also cause the following physical changes due to lack of energy and nutrients:
- Dry, flaky skin
- Brittle nails
- Hair loss
- Fluffy hair all over the body (lanugo hair).
- Suspension of the period due to a drop in sex hormone levels.
- Reduced interest in sexuality (loss of libido).
- Potency disorders in men
- Cardiac arrhythmias (such as due to potassium deficiency during vomiting, as well as abuse of laxatives or dehydration tablets).
- Kidney damage
- Osteoporosis
- Tooth damage (due to calcium deficiency or vomiting).
- Susceptibility to infection due to weakening of the immune system
- Water retention due to protein deficiency
- Atrophy of brain tissue with concentration disorders, memory impairment or change of character (usually normalizes when normal weight is reached)
Gaining weight: Acute treatment of anorexia
Therapy of anorexia consists of treatment of physical symptoms and psychotherapeutic support. Depending on the extent of underweight, stabilization of the physical condition is a priority. For this purpose, patients must gain body weight depending on their BMI and possible deficiency symptoms such as electrolyte disorders must be compensated. In severe cases, inpatient admission to a clinic is advisable. In the case of a lack of understanding of the disease, force-feeding by means of a stomach tube may be necessary under certain circumstances.
Psychotherapy: core element of treatment
Psychotherapy – for example, in the form of so-called cognitive behavioral therapy – is essential in the treatment of anorexia. This is because in most cases, a cure for the disease is only possible with psychological support. Those affected learn how to accept their bodies and are gradually introduced to normal eating behavior and life after anorexia. Often, a treatment contract is designed in which treatment goals – such as a certain weekly weight gain (usually 500 to 1,000 grams) – are set.
Therapy: medications only for concomitant diseases
In addition to psychotherapy, group or art therapies may be used. Especially in children and adolescents, the involvement of relatives – for example, in the form of family therapy – is also very important. Medications that influence the psyche (so-called psychotropic drugs), on the other hand, are only used in anorexia in the case of concomitant mental illnesses such as depression. The duration of treatment in anorexia depends on the success of treatment and is different for each patient.
Early therapy increases chances of recovery
The early start of therapy is crucial for the prognosis of anorexia nervosa. In addition, the following generally applies: the more pronounced the weight loss is and the older the affected person is at the onset of the disease, the more frequently relapses occur. The cure rate for anorexia is given as approximately 50 to 70 percent. This contrasts with a mortality rate of about 5 to 20 percent, and suicide is a common cause of death among anorexics, in addition to the physical damage caused by extreme underweight.
Help service on the Internet
Patients with anorexia are usually inhibited to see a doctor and do not know where to turn. Here, the Internet offers numerous information services for those affected, as well as advice for parents. Also addresses of counseling centers and tests for initial assessment (“Am I anorexic?”).can be found online. The following links provide further information and help service on anorexia:
- Federal Center for Health Education
- Hungry Online
- Patient guideline diagnosis and treatment of eating disorders.
- Anorexia nervosa – self-help for eating disorders
Pro Ana: Dangerous exchange on the Internet
The Internet offers sufferers low-threshold and free exchange platforms – but also in a negative sense: “Pro Ana” is an anorexia movement that emerged on the Internet at the beginning of the 21st century and whose goal is not to fight the disease, but to continue losing weight. On blogs and in forums, the disease is idealized and personified in the form of “Ana” (derived from anorexia). Anorexics give each other tips on how to lose weight and hide the disease, and motivate each other – for example, with pictures of themselves or of underweight models (so-called “thinspiration”).
