Anorexia Nervosa: Causes, Warning Signs, Treatment, and Prevention
Thu, October 21, 2021

Anorexia Nervosa: Causes, Warning Signs, Treatment, and Prevention


Anorexia can threaten one’s life. It can make parents feel helpless while watching their own children lose more and more weight at a time when their bodies should be developing. According to Lisa Esposito of American media company US News, this eating disorder forces individuals to shun food, avoid meals with loved ones and friends, and experience the consequences of starvation and malnutrition.

Anorexia is not a new condition. In fact, it has been around for a long time. Written case reports dating from the 1500s and 1600s reported anorexia-like symptoms in individual patients, explained Dr. Evelyn Attia, a professor of psychiatry and director of the Columbia Center for Eating Disorders at Columbia University Irving Medical Center. 

In the book “Holy Anorexia,” St. Catherine of Siena had a condition that resembled anorexia in the late 1300s. According to the book, she fasted to reportedly alter her appearance to avoid marriage and to dedicate her life to religion. This happened when she was just a teenager. Presently, experts argue that biological, genetic, and environmental factors contribute to the triggering of the development of anorexia, said Esposito.

Anorexia Is the Not the Most Common Eating Disorder

Anorexia nervosa is the most known eating disorder but it doesn’t mean it is the most common one, as noted by the editorial staff of the American Addiction Centers, a healthcare company. Per the 2014 findings of Rhonda S. Karg and colleagues from the Center for Behavioral Health Statistics and Quality, a government agency, it is less common among adults over 18 years old than bulimia and binge eating disorder (BED) as it affects less than 0.1% of the adult population, the American Addiction Centers cited.

The government agency also mentioned that the lifetime prevalence of anorexia rose to 0.9% of women in the population when younger women aged 15 to 19 years old were included, according to a study by Frédérique R. E. Smink, Daphne van Hoeken, and Hans W. Hoek, which was published in free full-text archive journal portal PMC. Moreover, 0.3% of men exhibited anorexia nervosa at some point in their lives, usually later in life than women. The figure totaled to 1.2% of the population 15 years old and above that had anorexia at some point in life. In comparison to bulimia and BED, the total prevalence amounted to 1.6% and 5.7% respectively.

The American Addiction Centers explained that anorexia has historically caused more deaths than bulimia or BED despite its lower prevalence. Since the 1980s, the mortality rate from anorexia has been decreasing perhaps due to improvements in medical and psychological treatments.

The Relationship Between Self-Injurious Behavior and Anorexia

During the study period May 2011-September 2011, Linda Smithuis and colleagues of peer-reviewed research portal Journal of Eating Disorders approached 272 patients for participation. Of those, 158 returned the questionnaire, which had a response rate of 42.5%. Smithuis and colleagues excluded 22 patients with bulimia, limiting their study to accommodate those with anorexia and EDNOS (eating disorders not otherwise specified).

Of 136 participants, 98 participants (72%) had anorexia and 38 (28%) had EDNOS. The authors found in their 2018 Dutch study that a 41% prevalence of self-injurious behavior (SIB) was present in the previous month.

A total of 108 acts of self-injurious behavior were reported by 56 respondents. Such behaviors done by the respondents consisted of cutting (59%), scratching (46%), bruising (34%), biting (20%), burning (14%), hair-pulling (11%), and hitting (9%). The reasons why the participants engaged in SIB were to “avoid negative feelings” and “to punish myself.” The reason “to get attention from to others” was hardly cited by the respondents.

58% of the total number of registered SIB acts had not been planned beforehand by participants who engaged in SIB in the past month. They were also sometimes (46%) or often (39%) aware of what caused the SIB. 56% of the SIB acts remained hidden from others. The researchers concluded that patients with anorexia and EDNOS demonstrated a high prevalence of SIB, which can be considered as a functional emotion-regulation behavior for patients.

Causes of Anorexia

Hunna J. Watson and colleagues of research portal Nature found that the genetic basis of anorexia appears to overlap with a person’s metabolic traits such as their blood cholesterol and insulin levels, including their body fat and waist size measurements. They also found a genetic overlap between anorexia and other psychiatric conditions such as anxiety, depression, and obsessive compulsive disorder.

Genetic factors that influence physical activity also overlapped, indicating that people with anorexia tend to be highly active. Anorexia can run in families, but most family members are not affected. Cultural influences may trigger anorexia for those who are vulnerable. Societal expectations to lose weight and stay slender, regardless of one’s natural body type, are strong.

Signs of Anorexia

Weight misconception is seen in individuals with eating disorders like anorexia. In a January 2019 study done by Kiya Dues and colleagues, 11.6% of 12,016 participants overestimated and 11.3% underestimated their weight. The figures represented 22.9% of individuals who misperceived their weight. The authors also found that 31.8% of the participants were overweight and obese.

Other signs include drastic food reduction, being preoccupied about weight, drastic weight loss, engaging in food rituals like separating foods on a plate, overexercising, and more. A person with anorexia can also have low blood pressure, slow heart rate, gastric problems, irregular menstruation or absence in girls, and reduced sex drive in men. An individual may also have dry, brittle or thinning hair or brittle, dry or blue nails.

How Should Anorexia Be Treated and Prevented?

Healthcare company Mayo Clinic said there is no guaranteed way to prevent anorexia. Primary care physicians like pediatricians, family physicians, and internists may help identify the early warning signs of this disorder. To prevent anorexia from further developing, they can ask questions about the patient’s eating habits and satisfaction with appearance during routine medical appointments.

Treatment must address both psychological and physical problems, emphasized medical news source WebMD. Successful treatment often includes continuous medical care, nutritional counseling, regular therapy, and sometimes medication. Doctors should be mindful of bone loss, electrolyte levels in the blood, and heart functions.

Mental health professionals should aid the patient in letting go of self-destructive thoughts and behaviors, enabling the patient to adopt more positive behaviors. Support groups properly moderated by a mental health professional can be helpful for those with anorexia. Treatment doesn’t happen overnight as long-term psychological and medical attention is needed. But with a well-rounded treatment program, recovery from anorexia is possible.

Societal pressures and the internet, especially those that promote unhealthy dietary habits, can exacerbate and trigger eating disorders. Loved ones should be aware of the signs of anorexia and consider long-term treatment. Care and support are also needed to ensure the safe recovery of the patient.