Clinical signs of anorexia nervosa, its treatment and consequences
Clinical signs of anorexia nervosa, treatment and consequences
Anorexia nervosa is often called anorexia and means the eating disorder characterized by body weight lower than normal, intense fear to gain weight and twisted weight perception. People with anorexia set a high value on the control on their weight and physical fitness, using extreme conditions, which, as a rule, influence their life a lot.
People with anorexia usually strictly limit the amount of food they eat to prevent the weight gain or continue to lose weight. They can control the calorie intake causing vomiting after eating or abusing purgatives, dietetic agents, urinatives or enemas. They can also try to lose weight with excessive physical training. Independently of the amount of weight a person has lost, he/she keeps being afraid of weight gain.
Anorexia is actually not about food. It is an extremely unhealthy and sometimes even life-threatening way to cope with emotional problems. A person with anorexia often has problems with the self-esteem.
Anorexia, as well as other eating disorders, can take over the whole life of a person, and it is quite difficult to overcome. However, it is possible to better understand yourself, regain more safe eating habits and reverse some serious anorexia complications with the treatment.
Symptoms
Physical signs and symptoms of anorexia nervosa are connected with abstinence from food. Anorexia also includes emotional and behavioral problems connected with the unrealistic perception of the body and extreme fear to gain weight or become fat.
It can be difficult to notice signs and symptoms, because the concept of low body weight is different for every person, so some people may not look too skinny. Besides, people with anorexia often mask their thinness, eating habits or physical problems.
Physical signs and symptoms of anorexia can include the following manifestations:
- extreme weight loss or absence of the expected weight gain according to the age;
- kinny look;
- abnormal blood values;
- tiredness;
- loss of sleep;
- dizziness or syncope;
- bluish color of fingers;
- thin, brittle or falling hair;
- soft, downy hair that covers the body;
- absence of menstrual period (women);
- intestinal obstruction and abdominal pain;
- dry or yellowish skin;
- cold intolerance;
- irregular heart rate;
- low arterial pressure;
- dehydration;
- arm or leg swelling;
- dental injury and callouses on knuckles because of induced vomiting.
Some people suffering from anorexia look like people suffering from bulimia. However, people with anorexia often suffer from anomalously low body weight, when people with bulimia often have normal weight or slightly above normal.
Emotional and behavioral signs and symptoms can include as follows:
- concern for food that sometimes includes cooking of sophisticated dishes for other people and avoiding of eating them;
- frequent skipping of meal or food refusal;
- constant excuses for not eating;
- eating of few “safe” products, usually with low content of fat and calories;
- rituals, such as spitting out of food after chewing;
- avoiding of eating in public;
- lies about the amount of eaten food;
- fear to gain weight that can include reweighing or body measuring;
- frequent looking in the mirror in order to find visible defects;
- complaints of a person that he/she is fat or has fat body parts;
- covering of the body with clothing layers;
- mood flattening (absence of emotions);
- social isolation;
- irritability;
- loss of sleep;
- decline in interest in sex.
When you need to see a doctor
Unfortunately, many people with anorexia do not want a treatment, at least, at the initial stages. Their desire to stay thin overrides worries about own health. If you have a beloved one who you care about, ask him or her to talk to a doctor.
If you have the problems listed above, or you think that you may have an eating disorder, seek an assistance. If you hide your anorexia from your family and friends, try to find a person you trust to talk about your worries.
The exact cause of anorexia is unknown. As in many diseases, it may be a combination of biological, psychological and ecological factors.
Biological factor. Some people may have a genetic predisposition to perfectionism, sensibility and persistence. These factors are all related to anorexia.
Psychological factor. Some people with anorexia may have the treats of character that simplify following restricted diets and aversion to food despite the fact that they feel hunger. They may have an extreme striving for perfectionism that makes them think that they will never be thin enough. They may restrict themselves in food to reduce high anxiety level.
Environment. Modern western culture emphasizes thinness. Success and value of a person are often equated to being thin. Pressure from peers may contribute to develop the willingness to lose weight, especially among young girls.
Anorexia is more common for teenage girls and women. However, eating disorders become more common among boys and men, it may be related to the increasing social pressure or even accidental comments on weight or body shape.
Complication
Anorexia may have many complications. The most serious complication is death that can occur suddenly, even if there is no critical loss of weight. It can happen due to heart beat arrhythmia or electrolyte derangement of such minerals as sodium, potassium and calcium that maintain the fluid status in the body.
Other complications of anorexia include the following manifestations:
- anemia;
- heart problems;
- bone mass loss (osteoporosis) that increases the risk of fractures;
- muscular wasting;
- amenorrhea in women;
- decreased level of testosterone;
- gastrointestinal problems, such as intestinal obstruction, abdominal distention or nausea;
- blood electrolyte disorders such as the low level of potassium, sodium and chloride in blood;
- renal problems.
If a person with anorexia becomes very emaciated, any organ in the body can be damaged, including brain, heart and kidneys. This damage cannot be totally reversible even when anorexia is under control.
Diagnostics
If a doctor suspects that a patient has anorexia nervosa, the former makes several tests and examinations that will help to determine the diagnosis, to exclude medical causes of weight loss and to check for any related complications.
The tests usually include:
- physical check-up;
- laboratory tests. They can include complete blood test and more specialized blood tests to check electrolytes and proteins, as well as the functioning of liver, kidneys and thyroid, urine test;
- psychological evaluation. A doctor or a mental health expert will ask a patient about his/her thoughts, feelings and eating habits, and can also ask a patient to fill in psychological self-assessment questionnaires;
- other examinations. X-ray to examine bone density, presence of fractures or pneumonia, cardiac problems. Electrocardiography can be performed to reveal cardiac disorders.
Treatment
Treatment of anorexia is usually carried out applying the multidisciplinary approach; doctors, mental health experts and dietarians having the experience of work with eating disorders participate in choosing of treatment tactics.
If the life of a person with anorexia is in imminent danger, the person may require the treatment in the emergency assistance department of the hospital in case of cardiac rhythm disorders, dehydration, electrolyte derangement or he/she needs an emergent psychiatric support. A patient may have to be admitted to hospital in case of serious psychiatric complications, severe undernutrition or continuous food refusal.
The first goal of the treatment is restoring of the healthy weight. A patient will not be able to recover from anorexia if he/she does not regain his/her healthy weight and does not learn the principles of healthy diet. The role of the family that should support normal eating habits is indispensable.
The following types of psychotherapy may be useful in case of anorexia:
- Family therapy. It is the only evidence-based treatment for adolescents with anorexia. As an adolescent with anorexia cannot make the right choice regarding his/her diet and health being in such a serious condition, this therapy mobilizes parents to help their child in regaining weight.
- Individual therapy. Cognitive behavioral therapy for adults. Its main goal is to normalize dietary and behavioral patterns to support the weight gain. The other goal is to help in changing distorted convictions and thoughts that support restricted eating.
There are not any medications approved for the treatment of anorexia, as no one of these does not have sufficient proven efficiency. However, antidepressants or other psychiatric drugs may help in the treatment of other mental disorders such as depression or anxiety disorders, if any.4
People with anorexia may recover. However, they are at higher risk of recurrence in the periods of severe stress. Periodic sessions with a psychotherapist within a stressful period may help to preserve health.
Author of the article - Tatiana Anikieieva
Date of publication: 07.05.2020
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