Anorexia Nervosa: Symptoms, Causes, Diagnosis, and Treatment

Eating disorders are an issue all around the globe. There are many different factors that can cause an eating disorder. Then most common eating disorders include anorexia nervosa, bulimia nervosa, and binge eating. Anorexia is common among children but can affect individuals of all ages. An eating disorder that develops at a young age can follow one for decades.

I will be focusing on the factors that fall into who is at risk of developing a disorder along with causes and treatments for anorexia. The objective is to discuss the importance of preventing anorexia, the dangers of anorexia and the diagnostic criteria. By taking a look at a case study, I will study a patient being diagnosed with anorexia nervosa. A patient diagnosed with anorexia nervosa is commonly at risk for depression and/or anxiety as well potentially fueling the eating disorder. 

Eating disorders are illnesses in which people experience severe disturbances among their eating behaviors and related thoughts. What are the differences between the different disorders?

Anorexia nervosa: a disorder triggered through emotions with a strong desire to lose weight by refusing to eat 

Bulimia nervosa: consuming large amounts of food in a short period of time followed by feelings of guilt or shame leading to forceful vomiting and purging

Binge eating: uncontrollably eating large amounts of food until feeling uncomfortably full

All three disorders can be severe and life-threatening if not treated properly. Anorexia is typically the most common eating disorder among young teens and females, however numerous different types of demographics can be affected by anorexia nervosa. 

According to the DSM-5, the following must be met in order to be diagnosed with anorexia nervosa:

Intense fear of getting fat

A patient weighs 15% less than their height’s average weight

Denial of current body weight being too low

If the criteria is not met, there may still be a serious disorder actively affecting the patient’s life. A doctor may perform a series of assessments and evaluations. A doctor may perform a physical test to rule out other physical causes for the disorder. A doctor may also perform psychological evaluation by asking questions about the patient’s thoughts, emotions, and eating habits. The patient may be asked to fill out a few self-assessments.  

It is well known that eating disorders are common in teenage girls following them throughout their lifetime. However, it can affect people of all ages and genders. A child can adapt to eating disorder lifestyles due to failure of parenting. Parenting failure can look like withholding food from them, feeding the child too much, or even just giving the child a hard time about their weight. As many people know, there is a social standard that is set by influencers and celebrities. For example, the Victoria Secret models are all very thin and their audience knows that the models participate in fasting. For a child to watch the fashion show, or if a child sees the models' social media pages, it may give the child a distorted perception of body weight. 

Teenagers have to deal with the stress of high school, puberty, and stepping into the dating world. High school can be a mean place where societal standards matter. Popularity can come into play when all the “pretty” girls and boys run the popular scene. One who is not a part of the popular scene in their high school may develop thoughts about not looking good enough. Teenagers become introduced to the party scene during their high school years. Party goers typically revolve their weekends around drinking, dancing, drugs, and sex. Sex may persuade an insecure person to change their body type leading to a disorder. However, if one is too skinny, bullies could potentially call them out for being anorexic. As mentioned before, high school can be a very mean place where teens allow other people to get in their heads causing insecurities of all kinds.  

Relationships, whether in high school or not, can lead to toxic behavior. While a teenage girl may think her boyfriend is “looking out for her”, he may just be creating a disorder by commenting on her body. This can go both ways with girls commenting on a boy’s body type as all humans easily develop insecurities.  

According to Neda, 0.4% of young women and 0.1% of young men can suffer from anorexia at any given point in time. A group of researchers followed 496 adolescent girls until they were 20 years old and found that “5.2% of the girls met criteria for DSM5 anorexia” (NEDA, 2018). Researchers, Stice E and Bohon C found that anorexic people between the ages of 15-24 have a higher risk of dying by ten times. In 2016, Fichter, M. M. and Quadflieg, N found that men “represent 25% of individuals with anorexia nervosa, and they are at a higher risk of dying, in part because they are often diagnosed later since many people assume males don’t have eating disorders” (NEDA, 2018). This statistic helps our society understand how “under the raider” men are with eating disorders. Men dislike being seen as weak and will go to further extents to hide their disorder whether out of embarrassment or shame.  

Another huge population of people prone to developing eating disorders are athletes.  One of the most common athletes to develop eating disorders are wrestlers. The way wrestling operates is destined to have its participants develop eating disorders. Wrestlers have to meet their weight class. For example, a wrestler who may have a lot of muscle often wants to wrestle at a lower weight class for a better chance at winning. They have the strength so by wrestling at a lower weight class, their opponent may be smaller with less muscle. Before each meet, the wrestlers must weigh in to make sure they are able to wrestle for that certain weight class. This process is destined to have wrestlers starving themselves for days on end and maybe even for the entire wrestling season. 

Football players may develop binge eating habits because as opposed to wrestlers, football players need more weight on them to succeed in the game. Not only do bigger set guys perform better but it is not very often that you see a skinny short football player. This goes hand in hand with high school stereotypes. Football players tend to make up a lot of the popular scene in high school. A boy in high school may become insecure not being fit enough and lead to excessive exercise, limiting food intake or indulge in binge eating.  However, a student engaging in the sport of football may become overweight due to their commitment to the sport.  When leaving the sport, he/she may have insecurities that football left them with.  

Cheerleading revolves around looking perfect. Cheerleaders wear tiny uniforms with bows in their hair and a full face of makeup. Whether the stereotype comes from cheerleaders themselves, societal standards, peers, or their own coach, cheerleading is destined to have a good amount of teenage girls stressing out about their body and how they look. It is concerningly common for how frequent coaches body shame their athletes to look perfect. Another aspect of cheerleading that may lead to anorexia is the position of “flyer”. Flyers must be super small to the point where they can be thrown into the air and caught by their teammates. A coach will never make someone who is too heavy a flyer, even if that person is not overweight at all. Flyers are typically short and tiny weighing no more than 125 pounds.The position that catches and holds the flyer is called a “base”.  Bases must be strong enough to hold and catch the flyer.  Typically, a base consists of two to four people. This may make an athlete insecure about not being tiny enough to be a flyer but not strong enough to be a base. At that point, cheerleading may just not be the sport for them but still fuels body insecurities.  

A theoretical perspective for eating disorders among a different group of people can be the impact on adults. While eating disorders are very common in teenagers, they can most definitely still affect people of all ages. Adults have to deal with more responsibilities than children and teenagers. These responsibilities include working, paying bills, relationships, and maybe even parenting. A stressful job can possibly lead to binge eating. For example, police officers have a stereotype for eating junk food on and off the job all the time. This stereotype came about when it became obvious that police officers must deal with some crazy experiences. Police officers put their life on the line and must see some pretty devastating events. However, the stereotype regarding “fat” police officers may fuel the need to fast which could ultimately lead to anorexia. According to Eating Disorder Hope, “A police officer with poor coping skills may already be vulnerable to having an eating disorder”. Police officers who engage in “highly intense situations” (Eating Disorder Hope, 2016) may become more vulnerable making it harder to eat three meals a day or overeating.  

As mentioned before, working as a super model involves fasting as part of the job description.  Another occupation that may lead to anorexia or bulimia is accounting.  Accountants must work long hours especially during tax season.  Their job is known for working late nights in order to meet deadlines.  This causes immense stress where one may forget to eat which could last for days on end. When one forgets to eat for days on end, they may unconsciously develop a minor case of anorexia.  

Another way for adults to be put at risk for an eating disorder is by experiencing a midlife crisis. Most healthy adults tend to put on weight as they grow older. However, an adult who may be experiencing a midlife crisis may be feeling the need to have the body that they had when they were younger. If an adult is still single during their midlife crisis, that fuels more insecurities about their body and how they look. 

1. Professional Support

Being able to determine whether one has an eating disorder can be tricky as they are most likely in denial of having one at all or due to embarrassment. Once a patient is diagnosed with an eating disorder, the treatment process can be difficult but efficient. Treating an eating disorder requires teamwork with effort provided by primary care providers, mental health professionals, dietiticions, and support from family and friends. Psychotherapy helps the patient learn how to replace unhealthy habits with healthy habits.  Medications do not cure the patient but help control my urges. For severe cases, hospitalization may be the most beneficial with health professionals who can keep an eye on the patient to avoid death. 

2. Limit Looking in the Mirror

There are multiple at home remedies one can practice to help cure the disorder or stop it from growing stronger. One at-home remedy is to limit looking in the mirror. Looking in the mirror fuels thoughts of what that person may not like when looking at themself. By avoiding the mirror, they allow their brain to stay away from those negative thoughts. Another remedy is to resist the urge to weigh themselves. If stepping on the scale is going to lead to negative thoughts and actions then do not step on the scale. Another remedy is to resist isolation. When one is alone, the negative thoughts will come flowing in quicker than if they were surrounded by loved ones.  

3. Yoga, Meditation and Massage Therapy

A few other methods to avoid a growing case of anorexia is practicing activities that reduce stress and anxiety. One activity could be yoga. Yoga tends to release all tense muscles giving off a feeling of relaxation. Another activity is meditation. Meditation is very calming and leads to positive thoughts. Like yoga, meditation offers a calm and relaxing atmosphere. Another activity is massage therapy. Receiving a massage, especially from a loved one, offers a sense of comfort and a positive space for intentions to feel better about oneself. All three activities lead to positive outcomes and a reduction of stress and anxiety.  

The lady to be discussed for this case study is a 19-year-old female experiencing anorexia nervosa named D.R., a single teenager admitted to a mental health facility. D.R. weighed 64 pounds, about 54 pounds underweight when she was admitted. She was hospitalized for 59 days after discovering her liver, kidney, and pancreas damage. D.R. and her therapist mutually agreed upon the circumstances revolved around privileges. Privileges were granted when she gained weight and privileges were taken away if she lost weight. Her food intake was controlled by the staff. When D.R. was discharged, she weighed 104.5 pounds and agreed that if her weight dropped below 100 pounds, she would be readmitted. For years after her discharge, her weight stayed consistent between 102 and 104 pounds.  

Another 16 year old named Emma was showing many symptoms of developing an eating disorder. Her eating patterns were not normal and she seemed to be very depressed, withdrawn, and anxious. Her parents were very worried but every time they tried to ask her, she would get mad and irritated. However, she managed to stay on top of her schoolwork and earn good grades. Her school friends were also concerned for her health. One day her parents received a phone call from the school saying Emma had fainted and is in the hospital. After a doctor saw Emma, they noticed her weight was severely low, along with low heart rate and low temperature. She was nursed on bed rest with 24 hour care to help bring her eating habits back to normal. Emma engaged in all sorts of therapy and seemed to be on the right track to getting healthy. After 16 weeks, Emma had fully gained control of her anorexia nervosa. 

It is very important to raise awareness for eating disorders especially as most patients are in denial. It can be hard to tell how severe their disorder is as it is fairly easy to hide the symptoms. A few red flags that help notice when one is anorexic activity are limited food intake, excessive exercise, and using the bathroom to vomit after eating. One common red flag is isolation and abnormal eating habits. It is important to remember that anyone of all ages, genders, and races are all subject to develop an eating disorder. It may be tricky determining whether one has a severe or mild case of anorexia nervosa but it is better to treat a mild case to avoid it from becoming severe. It is important to always have an eye out for those who have an increased chance of developing anorexia.  

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