What is Severe Anorexia Nervosa?
Anorexia Nervosa (AN) is a highly lethal mental disorder manifested by marked food restrictions, resulting in a very thin body habitus, an abnormal focus on body image and a host of medical complications which progress as the malnutrition worsens. No body system is immune from the ravages of anorexia nervosa.
Note: Extreme anorexia nervosa is defined as a BMI < 15 in those meeting DSM-V diagnostic criteria for anorexia nervosa. ACUTE’s hospital-based, inpatient medical stabilization care is intended for the patients with severe anorexia nervosa and extreme anorexia severity.
Symptoms of Severe Anorexia Nervosa
The symptoms of severe anorexia nervosa can include:
- BMI < 15
- Intentional caloric restriction resulting in weight loss
- Intense fear of gaining weight
- Body image distortions (ie, believing they are extremely fat, when they are actually normal or even underweight)
There are two subtypes of anorexia nervosa:
- The restricting type (AN-R) is associated with the previously mentioned symptoms and behaviors and does not include regular bingeing of food
- The binge-eating/purging type (AN-BP) is marked by bingeing and purging behaviors such as self-induced vomiting or the misuse of diuretics or laxatives, or both
Medical Complications of Severe Anorexia Nervosa
Myocardial atrophy, mitral valve prolapse, pericardial effusion, sinus bradycardia, profound irreversible sinus node dysfunction, orthostatic hypotension, sudden cardiac death
Gastroparesis, constipation, superior mesenteric artery (SMA) syndrome, diarrhea, liver disease, functional bowel disorders
Spontaneous pneumothorax and pneumomediastinum, aspiration pneumonia, abnormal pulmonary function tests
Low White Blood Cell, Red Blood Cell, Platelet Counts
Multiple Endocrine Abnormalities
Amenorrhea, low leptin levels, growth hormone resistance, elevated serum cortisol levels, euthyroid sick syndrome, hypoglycemia
Loss of Muscle and Bone
Sarcopenia, bone loss (osteopenia and osteoporosis)
Generalized brain atrophy, damaged gray and white matter and cognitive deficits
Xerosis, acrocyanosis, lanugo hair growth, brittle hair and nails and unexplained hypercarotenemia
Anorexia Nervosa Facts
As BMI falls, medical complications increase in AN.
Incidence rates of AN are increasing in both males and females although AN primarily affects adolescent girls and young women; peak age of onset is during adolescence.
AN is significantly comorbid with many other DSM-V disorders including depression, obsessive compulsive disorder and generalized anxiety disorder.
Patients with AN are five times more likely to die prematurely and 18x more likely to die from suicide; most premature deaths are attributable to medical complications of AN, from refeeding gone wrong, electrolyte aberrations or suicide. AN continues to have the highest mortality rate of any psychiatric disorder.
Patients with AN may hide low weight and avoid seeking help by wearing bulky clothes and utilizing the emergency department rather than a primary care provider.
Risk Factors for Anorexia Nervosa
Biological vulnerabilities, including moderate to high heritability for AN
Environmental factors, such as western society’s extreme focus on thinness, verbal and sexual abuse, individuation/developmental transitions, parental tension, bullying and the onset of comorbidities such as depression and anxiety
Certain personality traits appear to have relevance to the development of AN, including negative emotionality and neuroticism. These are trait-based proclivities towards experiencing unpleasant emotions such as anxiety and anger, and perfectionism causing increased drive for thinness and overvaluation of weight and body shape.
Learn More About Severe Anorexia Nervosa
Most of the life-threatening medical complications of AN resolve with effective nutritional rehabilitation and weight gain, whereas others can lead to permanent damage if left unaddressed.
Severe Anorexia Nervosa Research
Anorexia Nervosa Articles