Anorexia nervosa is an eating disorder identified by a failure to support normal body weight, dread of weight gain, eating behaviors that limit weight growth, and distorted proportions of body weight and shape. Atypical anorexia nervosa happens in people with significantly reduced weight but not at a dangerously low body mass index or weight (BMI). Because of their self-perceived weight loss, people with anorexia typically engage in unsafe eating practices. They tend to eat fewer calories, reduce food intake, skip meals, throw away food, exercise a lot, and make themselves sick or use laxatives. Anorexia nervosa can appear as early as the teenage years or as late as the preteen years or later in life. Even though anorexia nervosa is commonly associated with women, it can also affect people of any gender or sex. The cause of anorexia nervosa is indefinite, but there are some associated factors that have been identified, such as family influences, developmental issues, social attitudes, brain chemical imbalances, and genetics. There are common endocrine abnormalities that include reduced gonadal hormones, raised cortisol secretion, and low levels of thyroxine and triiodothyronine. The diagnosis is based on clinical criteria based on the constraint of food intake, substantially low body weight, fear of excessive weight gains, and body image perception.
The Anorexia Nervosa self-starvation cycle deprives the body of the nutrients it needs to function properly. It has severe medical consequences and can lead to organ damage and death since the body is obliged to slow down all of its operations to conserve energy. People with anorexia often have low self-esteem, other mental health conditions, especially depression, find it hard to cope with stress in life, and have obsessive or compulsive behaviors (Ghandour et al., 2018). Two physicians, Doctor William Gull and Sir Ernest-Charles Lasègue coined the definition of anorexic Nervosa and described several instances in detail in their publications in 1873. Women between the ages of 16 and 23 were noted as being extremely underweight among Gull’s patients (Wonderlich et al., 2020). Hypothyroidism, amenorrhoea, a slowed heart rate, and exhaustion were among the symptoms he saw that would later be used as diagnostic criteria. Gull, the first physician to stress the disorder’s mental component, described it as an “ego perversion” while noting that some of his patients always looked active, despite their inadequate intake. Nevertheless, the psychological component of the condition was not addressed in his suggested treatments. A combination of relaxation and reintroducing high-calorie foods like chicken and rice slowly was his preferred treatment approach, followed by a full nutritional rehabilitation program. In American psychology, a new method of treatment had gained traction by the 1940s (Niedzielski et al., 2017). When Austrian neurologist Dr. Sigmund Freud’s psychoanalysis was first popularized, it helped understand the basic causes of many mental disorders, including anorexia. It was widely believed that eating disorders were caused by sexual dysfunction. Still, many doctors disagreed, and more physicians were ready to see and treat patients with eating disorders due to this groundbreaking research. In 1952 medical experts were given the Diagnostic and Statistical Manual of Mental Disorders (DSM-I), and it featured the initial criteria for determining whether a patient had anorexia nervosa. For the most part, substantial weight loss was defined as being fifteen percent or more below one’s optimal weight. Psychological factors such as fear of weight gain, distortions of one’s body image, or extreme anxiety about food were not considered. Bulimia nervosa was added to the DSM-III in 1980, and the principles for anorexia nervosa were amended to include the perception of body image (Wonderlich et al., 2020). Thus emphasizing the importance of treating the whole person, not just the disease’s physical symptoms. Talk therapy and refeeding were introduced into treatment, and they began to resemble the methods used today. Dietary disorders, such as anorexia nervosa, were reclassified under the new DSM-V, which was released in 2013 (Niedzielski et al., 2017). The list of eating disorders has grown significantly over the years and now includes many new ones, such as pica, rumination disorder, and binge eating disorder. Before 2013, these illnesses were grouped with other well-known disorders like EDNOS, despite their obvious prevalence, which was changed to OSFED, meaning otherwise specified feeding or eating disorder. The parameters for weight for people with anorexia have been adjusted to take the person’s BMI into account (BMI). Anorexia is currently diagnosed when the body mass index (BMI) is less than 18.5, where the severity of the condition is then assessed based on the patient’s BMI (Wonderlich et al., 2020). People who felt that the amenorrhea criteria were promoting outdated ideas that only women may suffer from anorexia nervosa and contribute to the underdiagnosis of adolescents and men were happy to see it abolished.
Physicians today take a more comprehensive approach to treat patients with anorexia. They employ a wide range of techniques to make certain the patient receives the best treatment possible. An essential part of recovery from anorexia nervosa is discontinuing eating disorder behaviors such as avoiding meals, eating tiny portions, calorie counting, and receiving comprehensive nutritional therapy. Taking antidepressants can help patients deal with the mental conflict that comes with refeeding and chemical abnormalities in the brain. Talking therapies like dialectical behavioral therapy (CBT), cognitive-behavioral therapy (CBT), or acceptance and commitment (ACT) help patients change their minds so they can use healthier coping strategies and healthier attitudes toward food and the body. Therapies to help children and young people with anorexia have been developed where parents are actively involved in encouraging them to develop a healthy experience. Most patients engage in various activities, including art, yoga, music, community service, and creative writing to reassert their inner selves (Hay et al., 2017). Instead of trying to “cure” starvation’s physical symptoms, people today are going in the opposite direction. Support groups are also useful since talking to others with the same feelings and experiences is comforting (Frank et al., 2018). People are also using online platforms to share their writing and artwork to promote awareness, support rehabilitation, and share their understanding of the disorder, which is sometimes misapprehended by family, friends, and even medical experts. Research on teenagers and adults with anorexia nervosa has recently expanded our understanding of the molecular components that contribute to the growth and maintenance of the disorder. Malnutrition is indicated to affect substantial brain organization, which may be reversed by gaining weight. Still, it is unclear the extent to which these structural changes affect illness behavior. Malnutrition-induced alterations in dopamine reactivity, as well as neuroendocrine abnormalities and increased anxiety, may disrupt normal mechanisms that drive eating behavior, according to research on the operation of brain circuits (Gibson et al., 2020). The formation of habits and the associated striatal-frontal brain connection may represent another method of combining cortical and subcortical areas to maintain difficult-to-overcome disease behaviors (Frank et al., 2018). With these advances, anorexia nervosa may finally be recognized as a distinct brain disorder. Biological treatments that aid in recovery and relapse prevention will be developed with the use of this data. The creation of a unifying model will necessitate the merging of various brain research discoveries. Study designs that account for extraneous variables such as comorbidity and drug use and adhere to stringent data processing standards will be critical to this endeavor.
The number of persons who suffer from anorexia is far more than has previously been recognized. People need to realize that it is a serious mental health disease, and it has the highest fatality rate of any other psychiatric disorder. However, most serious medical complications resulting from this disorder are reversible with nutritional rehabilitation and weight gain. On the other hand, the strict BMI guidelines prohibit many people from obtaining early detection and treatment. We have a long way to go before understanding anorexia’s mechanisms completely, let alone treating it. Conversely, early detection and intervention can provide anorexics with a better quality of life by lessening the intensity of their symptoms, promoting normal growth and development, and improving their quality of life. It is possible that focusing more on the energy input/output ratio might be more helpful than weight. Nutrition counseling can also help in learning how to make healthy diet choices and also in restoring a healthy weight. It is helpful if community members and family members generally have healthy attitudes and a bright outlook on actions around weight, food, appearance, and exercise. It is also possible that fostering healthy eating habits and realistic perspectives on nutrition and weight might help avoid the disorder.
Frank, G. K., Favaro, A., Marsh, R., Ehrlich, S., & Lawson, E. A. (2018). Toward valid and reliable brain imaging results in eating disorders. International Journal of Eating Disorders, 51(3), 250-261.
Ghandour, B. M., Donner, M., Ross-Nash, Z., Hayward, M., Pinto, M., & DeAngelis, T. (2018). Perfectionism in Past and Present Anorexia Nervosa. North American Journal of Psychology, 20(3).
Gibson, D., Workman, C., & Mehler, P. S. (2019). Medical complications of anorexia nervosa and bulimia Nervosa. Psychiatric Clinics, 42(2), 263-274.
Hay, P., Mitchison, D., Collado, A. E. L., González-Chica, D. A., Stocks, N., & Touyz, S. (2017). Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population. Journal of Eating Disorders, 5(1), 1-10.
Niedzielski, A., Kaźmierczak, N., & Grzybowski, A. (2017). Sir William Withey Gull (1816–1890). Journal of Neurology, 264(2), 419-420.
Wonderlich, S. A., Bulik, C. M., Schmidt, U., Steiger, H., & Hoek, H. W. (2020). Severe and enduring anorexia nervosa: Update and observations about the current clinical reality. International Journal of Eating Disorders, 53(8), 1303-1312.