What is Anorexia Nervosa?
Anorexia — often referred to as “anorexia” — is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives. The health risks of anorexia nervosa affect all the major organ systems. With support from expert clinicians, people with anorexia nervosa – regardless of how long they have been living with the condition – can recover.
Anorexia Nervosa Subtypes
Anorexia nervosa is divided into two subtypes:
Restricting Subtype
Anorexia nervosa restricting subtype (AN-R) is categorized by severe restriction of food intake.
Binge-Purge Subtype
Anorexia binge eating and purging subtype (AN-BP) is categorized not only by severe restriction of food intake, but also includes binge-eating and/or purging episodes — eating large amounts of food in a short time followed by a compensatory method.
Signs of Anorexia Nervosa
There are some common behaviors associated with anorexia nervosa. Friends and family can look out for the warning signs below.
Extreme weight loss
One of the most common warning signs of anorexia nervosa is extreme weight loss, especially in a short amount of time.
Food restriction & refusal
Calorie or food restriction for an extended period can be a sign of anorexia nervosa, especially if the individual is severely limiting calorie intake. Another way this may manifest is through refusing food, which can start off small but quickly change over time to include whole food groups.
Obsession with food & dieting
Another warning sign is a preoccupation with food, weight or calorie intake. They may excessively track and may be obsessed with dieting behaviors. Sometimes an interest in preparing food for others, especially if they don’t eat it themselves, may develop.
Food rituals
Someone with anorexia may develop habits or rituals around meals. This can include counting foods, cutting foods into small pieces, eating foods in a specific order, excessive chewing or moving food around their plate.
Fear of weight gain
An extreme fear of gaining weight is also a common sign of an eating disorder. They might weigh themselves excessively, make comments about “feeling fat,” keep track of their weight daily and get upset if they’ve gained or haven’t lost weight.
Compulsive exercising
Some individuals with anorexia nervosa engage in compulsive or excessive exercise.
Anorexia Symptoms
While severe anorexia nervosa involves many behavioral symptoms, it can also have serious health consequences. Weight loss and compulsive exercise are two of the most common symptoms of anorexia nervosa. Rapid weight loss, low weight, compulsive exercise and malnutrition can pose serious health risks, including:
Medical complications of anorexia nervosa
While anorexia nervosa and other eating disorders are mental illnesses, they are also one of the few conditions that are regularly accompanied by severe medical complications.
Bradycardia
Bradycardia (heart rate under 60 beats per minute), is the most common medical complication in those with anorexia nervosa, occurring in up to 95% of patients with anorexia nervosa.
Hypotension
Changes in the autonomic nervous system associated with anorexia nervosa as well as the decreased basal metabolic rate contribute to reduced blood pressure.
Osteopenia & osteoporosis
Individuals with anorexia nervosa often have poor nutrition, which can contribute to osteopenia and osteoporosis.
Gastroparesis
Another common complication for those with anorexia nervosa is gastroparesis (delayed gastric emptying), which can contribute to the symptoms of bloating, fullness and nausea.
Hypoglycemia
Without adequate food intake to supplement glycogen stores, individuals with anorexia nervosa develop hypoglycemia.
Electrolyte deficiencies
Anorexia nervosa can be associated with a deficit in electrolytes, including low potassium, sodium, magnesium and phosphorous. Electrolyte deficiencies can cause a variety of neurological, cardiac, muscle, gastrointestinal and renal problems.
Super mesenteric artery syndrome
Significant weight loss from anorexia nervosa can cause atrophy of the mesenteric fat pad surrounding the super mesentery artery, compressing the small intestine and causing abdominal pain after eating, early satiety, nausea and vomiting.
Brain atrophy
Malnutrition can cause loss of brain mass. Brain atrophy can be significant in patients with anorexia nervosa, which may contribute to various cognitive, emotional and motivational processing deficits.
Amenorrhea
It is common for women with anorexia nervosa to experience amenorrhea (loss of menses), affecting between 66-84% of women with anorexia nervosa.
Psychiatric Comorbidities of Anorexia Nervosa
Research demonstrates that 55-95% of people diagnosed with an eating disorder also receive a diagnosis for another psychiatric disorder. Anorexia nervosa shares many traits with other mental illnesses, so it isn’t abnormal to see individuals with anorexia nervosa living with multiple conditions.
Generalized anxiety disorder
Many individuals with anorexia nervosa have generalized anxiety disorder (GAD). There may also be a relationship between the severity of disordered eating behaviors and GAD, with a higher prevalence of GAD in patients who restrict, excessively exercise or have a low body mass index (BMI).
Major Depression
Eating disorders and major depressive disorder have significant overlap in emotional presentation, sharing traits like low self-esteem and body dissatisfaction.
Obsessive-compulsive personality disorder
The prevalence of obsessive-compulsive personality disorder (OCPD) is much higher in patients with anorexia nervosa, particularly those with AN-R. Many of the characteristics of OCPD are mirrored in anorexia nervosa pathology.
A preoccupation with details, rules, order and schedules easily facilitates disordered eating behaviors like strict calorie and micronutrient counting, rigid exercise schedules, precision dieting and dedication to achieving lower weights or specific measurements.
Anorexia nervosa mortality
Due to the multitude of medical complications resulting from anorexia nervosa, it is one of the deadliest mental illnesses, second only to opioid use disorder. Individuals with anorexia nervosa are about 6x more likely to die than people without eating disorders. Death in this population is due to the associated medical complications and suicide.
What Causes Anorexia Nervosa?
There is no one cause of anorexia nervosa. We know that anorexia nervosa develops through a variety of means. Genetics, personality, co-occurring psychiatric disorders and sociocultural environment can all contribute to the development of an eating disorder.
Genetics
Family history of eating disorders
Twin, family and adoption studies have yielded strong evidence that anorexia nervosa and other eating disorders run in families. Anorexia has a heritability of up to 70% and the relatives of individuals with anorexia nervosa are up to 12 times more likely to develop the illness.
Molecular genetics
There is no one anorexia gene, and many experts believe there are multiple genes, possibly hundreds, that influence the development of anorexia nervosa. Linkage studies, genome-wide association studies and candidate gene association studies have increased our understanding of the role of genetics in eating disorders.
Personality Traits
Perfectionism
Many studies have demonstrated that patients with anorexia nervosa self-report higher levels of perfectionism and score higher on perfectionism scales. Perfectionism has also been shown to be both a risk and maintaining factor for anorexia nervosa.
Negative affect
Individuals with anorexia nervosa report significantly higher rates of negative affectivity (the tendency to experience negative emotional states), which is linked to disordered eating behaviors.
Harm avoidance
Harm avoidance is characterized by excessive worrying, pessimism and shyness and being fearful, doubtful and easily fatigued. Harm avoidance is elevated in individuals with anorexia nervosa, suggesting those with anorexia nervosa are more fearful and worried.
Sociocultural Environment
The thin ideal
The cultural pressure to achieve the thin ideal has been linked to increased body dissatisfaction and weight concerns, which may contribute to the development of anorexia nervosa.
High-risk social environments
Certain social environments have also been shown to increase the likelihood of developing anorexia nervosa. Participation in aesthetic and weight-dependent sports, sorority membership or working in an appearance-driven field like acting or modeling can all contribute to the development of an eating disorder as individuals strive to improve performance, status or employment opportunities.
Anorexia nervosa in boys and men
Anorexia nervosa is often considered a feminine illness, but the reality is that anyone of any gender or gender presentation can suffer from anorexia nervosa. Eating disorders in men are frequently overlooked even though men and boys compromise between 25-50% of those with eating disorders.
Anorexia nervosa treatment
We believe lasting recovery from anorexia nervosa is possible. Sustained recovery from anorexia is always the goal, and for many the first steps are medical stabilization and nutritional rehabilitation.
ACUTE aims to support patients in their eating disorder recovery by helping them achieve medical stabilization, nutritional rehabilitation and a restored weight. Once these are achieved, patients can continue their journey and embrace recovery at lower levels of care.
To achieve these goals, we support patients with:
- World leading medical expertise in the medical treatment of eating disorders
- Evidence-based multidisciplinary care across internal medicine, dietetics, nursing, behavioral health, physical therapy, occupational therapy and speech therapy
- Around-the-clock 1:1 nursing supervision
- Blood chemistry, vitals monitoring and treatments for other medical and/or surgical comorbidities
- Air ambulance transfer when necessary
How is inpatient medical hospitalization different?
Unlike other treatment programs, ACUTE is a medical hospitalization unit. Inpatient medical hospitalization is the highest level of eating disorder care, delivered in a hospital setting and primarily focused on treating severe medical complications. Patients at an inpatient medical hospitalization level require monitoring of vitals, intravenous fluids, daily lab monitoring and medications that aren't available at lower levels of care.
Who does ACUTE treat?
ACUTE accepts patients who are too medically complex for lower levels of care.
- 15+ years of age
- All gender expressions
- <70% of ideal body weight (IBW)
- BMI <14.5
- Severe medical complications associated with anorexia nervosa
Get connected to care
Our admissions specialist can help assess your needs and determine the appropriate level of care.
Even if ACUTE isn’t right for you, our experienced admissions team can connect you with other programs that meet your needs.
Living a life recovering from anorexia nervosa
“ACUTE completely changed my life. If it wasn’t for ACUTE, I wouldn’t have my life back. I might not even be here to share my story. ACUTE saved me. They showed me that recovery was possible. They were with me on every good and bad day and shaped me into the person I am today.” Rachel