Anorexia Nervosa Symptoms, Cause, types and treatment

The eating condition known as anorexia nervosa, or simply "anorexia," is characterized by unusually low body weight, an intense fear of gaining weight, and an incorrect perception of one's weight. The control of one's weight and appearance is very important to anorexics, and they will often go to great lengths to achieve this control.

Typically, anorexics significantly restrict their food intake to prevent gaining weight or to continue losing weight. By utilizing laxatives, diet supplements, diuretics, or enemas improperly, they may use vomiting as a calorie-control measure after meals. 

They could also try to exercise excessively in an effort to lose weight. The person still fears gaining weight, no matter how much they have shed.

Read this blog further to get a quick overview of this important topic and enhance your psychiatry preparation.

Cause Of Anorexia Nervosa

The specific cause of anorexia is uncertain. As is the case with many illnesses, it probably results from a confluence of biological, psychological, and environmental factors.

• Biological- Some people may be more prone to developing anorexia due to genetic defects, however, the genes implicated are still unclear. Perfectionism, sensitivity, and perseverance are all associated with this condition and this condition can also be genetically present in some people.
• Psychological- Some anorexics may have obsessive-compulsive personality traits, which make it easier for them to follow strict diets and refrain from eating even when they are starving. They could have a strong drive for perfection and feel insufficiently slim as a result. Additionally, due to anxiety attacks, these patients could restrict themselves from dietary intake.
• Environmental- In today's Western culture, being skinny is admired. Being thin is associated with pressure from peers, particularly among young girls.

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Risk Factors Of Anorexia Nervosa

Anorexia is made more likely by a number of circumstances, such as:

• Genetics: A person's chance of developing anorexia may increase if certain genes are altered. A person is far more likely to develop anorexia if they have a first-degree family who did, such as a parent, sibling, or kid.
• Hunger and dieting: There is compelling evidence that many anorexia symptoms are true signs of malnutrition. The effects of starvation on the brain include changes in mood, rigidity in thought, anxiety, and decreased appetite. 
  Starvation and weight loss may alter how the brain functions in susceptible people, which could lead to the perpetuation of restrictive eating behaviors and make it challenging to resume regular eating habits.
• Transitions: Change can cause mental stress and raise the risk of anorexia, whether it's a new school, house, or job; the end of a relationship; or the loss or illness of a loved one.

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Symptoms Of Anorexia Nervosa

People with anorexia nervosa use a variety of strategies to reduce weight and keep it off. Others engage in extreme activity while others severely restrict their calorie intake. Some people utilise a binge-and-purge technique that is similar to what bulimics do. To burn calories, some people use laxatives, induce vomiting, or use diuretics. The following signs and symptoms could indicate anorexia nervosa:

• Failure to maintain a healthy weight
• Exhaustion
• Sleeplessness
• Yellow or blotchy skin covered in soft, fine hairs
• Constipation
• More than three cycles having an absent period
• Hair thinning or falling out
• Scaly skin
• Low blood pressure

Additionally, you can see actions like:

• Excessive physical activity
• Cutting food into small pieces or moving food around the plate rather than eating it
• Irritability
• Withdrawal of social activities
• Depression
• Use of diuretics, laxatives, or diet medications denial of hunger

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Clinical Features Of Anorexia Nervosa

Following are mentioned some of the clinical features of anorexia nervosa:

• Restriction of energy intake results in low body weight than normal. According to ICD-11, if Body Mass Index (BMI) is less than  18.5 kg/m³ in adults and Under 5th percentile in children and adolescents then we can consider it for anorexia nervosa
• Intense fear of weight gain or obesity
• Disturbance of body image -  Inaccurately perceived to be normal or fat.

• Amenorrhea- It was Previously necessary criteria to diagnose, But it is removed from DSM-5 and ICD-11 as necessary criteria. Anorexia Nervosa can be diagnosed in the absence of amenorrhea.
• Peculiar behavior about food such as:
  • Trying to dispose of food in napkins.
  • Spending time rearranging the food plate.
  • Collecting recipes and preparing meals for others.
  • Hiding food
• Delayed sexual development:- Adults may show decreased interest in sexual activities.

Medical Complications Secondary to Starvation

• Major
  • Hypothermia
  • Bradycardia
  • Hypotension
  • Lanugo hair (neonatal-like hair)
• May have
  • Peripheral edema
  • QT_C prolongation
  • Muscle atrophy
  • Brain atrophy
• Other complications
  • Delayed gastric emptying
  • Constipation
  • Decreased bone mineral density

Endocrine changes

• Decrease: LH, FSH, Estrogen, Testosterone, T₄, T₃.
• Increase: Reverse T₃, Cortisol.
• Normal: TSH.

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Types of Anorexia Nervosa

• Restrictive- It is seen in 50% of the patients. The main cause of anorexia nervosa  is diet Restriction leading to a decrease in  food intake and excessive physical  exercises
• Binge Eating/Purging- Alternate attempts at rigorous dieting along with intermittent binge eating and purging episodes. Binge Eating/Purging is also seen in Bulimia Nervosa.

Q. What is Binge Eating?

Binge eating is explained as eating large amounts of food in a short duration of time. It is associated with the feeling of a lack of self-control.

Q. What is Purging?

Patients may perform compensatory methods for excess calorie intake. It Includes

• Use of Laxative, Diuretics, or Emetics
• May do excessive exercises
• Vomiting

If the patient performed repeated vomiting, it may lead to some complications such as:

• Dental caries
• Parotitis or salary gland swelling
• Hypokalemic alkalosis
• Electrolyte imbalance

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Diagnosis Of Anorexia Nervosa

Diagnosis of anorexia nervosa can be made with the help of certain examinations. These exams and assessments typically consist of:

• Health checkup: This could involve taking your height and weight, checking your vital signs including blood pressure, temperature, and heart rate, looking at your skin and nails for issues, and examining heart, lungs, and abdomen.
• Experiments in the lab: These could consist of a complete blood count (CBC) as well as more specialized blood tests to examine your electrolytes, protein levels, and the health of your liver, kidney, and thyroid. Also possible is a urinalysis.
• Psychological analysis: Your ideas, feelings, and eating habits will probably be questioned by a doctor or mental health specialist. Additionally, psychological self-assessment questionnaires can be required.
• Additional research:  X-rays may be done to examine bone density, look for stress fractures or fractured bones, or look for pneumonia or heart issues. To check for heart abnormalities, electrocardiograms may be performed.

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Treatment Of Anorexia Nervosa

Patients are often secretive. They may deny their symptoms and resist the treatment. Hospitalization may be needed in:

• Restoring nutritional status.
• Managing complications like Dehydration and Electrolyte imbalances (↓Na, ↓K, ↓Cl).

Hospitalization criteria

• Short term: 20% below the normal weight for height.
• Long-term psychiatric hospitalization: 30% below the normal weight for height.

Treatment goal

• Nutritional rehabilitation and weight restoration- At the start 1500-1800 Kcal/day (divided meals) then it is Gradually increased to 3500-4000 Kcal/day.
• Monitoring the Patient- To prevent self-induced vomiting  2 hours after each meal. For Refeeding Syndrome As diet is increased, patients may be habituated to eating more which Leads to refeeding syndrome.

Psychotherapy

• Behavioral management like Praise for healthy eating habits and Restriction of self-induced vomiting.
• Individual therapy
• Family education

Pharmacotherapy

• SSRIs may be beneficial.
• Antipsychotic: Olanzapine is showing promising results as it Promotes weight gain and helps in reducing distressing psychological symptoms.

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