Anorexia nervosa is an eating disorder characterized by a relentless pursuit of thinness, difficulty maintaining an appropriate body weight, and a distorted body image. People with Anorexia Nervosa generally restrict the number of calories and the types of food that they consume on a daily basis. As with Bulimia Nervosa, some people with the disorder exercise compulsively, purge via vomiting and laxatives, and/or binge-eat as compensatory behaviors. Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities and can be deadly if left untreated.

by: Enchi Dai

Out of all the mental disorders including depression, anxiety, schizophrenia, and bipolar disorder, which do you think is the deadliest? The answer is Anorexia Nervosa. A review of nearly fifty years of research confirms that Anorexia Nervosa has the highest mortality rate of all mental illnesses (Arcelus, Mitchel, Wales, & Nelson, 2011). But why is that so? Today, we are going to discuss the evidence behind this statistic and address the common medical complications associated with Anorexia Nervosa. We are also going to talk about how & where to get properly evaluated for medical concerns and the different treatment options for Anorexia Nervosa.

But first of all,

What is Anorexia Nervosa?

Anorexia Nervosa is an eating disorder defined by a relentless pursuit of thinness. According to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnostic criteria for Anorexia Nervosa are:

1. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal, or for children and adolescents, less than that minimally expected.
2. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

There are two types of Anorexia Nervosa:

• Restricting type: during the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.
• Binge-eating/purging type: during the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior.

Common Medical Complications of Anorexia Nervosa & Why It Is Fatal

Simply put, Anorexia Nervosa affects your whole body.

Physical symptoms include:

• Heart problems: abnormal heart rhythms, mitral valve prolapse, and heart failure
• Bone loss, leading to fractures
• Anemia
• Females may suffer from amenorrhea—the loss of the period; males may have decreased testosterone.

*Amenorrhea is very serious. It can lead to infertility, osteoporosis, and hair loss.

• Gastrointestinal problems: constipation, bloating, and nausea
• Electrolyte abnormalities, such as low blood potassium, sodium and chloride
• Kidney problems
• Hair loss

Comorbid mental disorders include:

• Depression
• Anxiety Disorders
• Personality Disorders
• Obsessive-ccompulsive Disorder (OCD)
• Substance Use Disorder

But how and why is it so deadly?

Research has found that the rate of mortality due to all causes of death for subjects with Anorexia Nervosa is 5.9% (Sullivan, 1995). At least one-third of all deaths are estimated to be due to cardiac causes, mainly sudden death (Neumärker, 1997). Moreover, due to the psychological effect of Anorexia Nervosa, 1 in 5 deaths is caused by suicide (Arcelus et al., 2011).

Evaluations for Medical Concerns

With all the health risks listed above, a medical evaluation is necessary to assess clients for these complications in order to determine whether hospitalization is necessary. Since patients often do not present with a chief complaint of an eating disorder, the primary care physician plays a major role in detecting and evaluating signs of Anorexia Nervosa. Annual health supervision examinations and preparticipation sports physicals both are ideal screening opportunities. A medical evaluation usually includes—

• Medical history
• Physical examination: weight and height; vital signs including heart rate, blood pressure both supine and standing, and temperature; cardiovascular assessment; and skin examination.
• Laboratory assessment: serum electrolytes, blood urea nitrogen, serum creatinine, serum glucose, liver function tests, etc.
• Excluding medical disorders: neoplasm, chronic infections, uncontrolled diabetes mellitus, hyperthyroidism, etc.

Treatment Options

Early diagnosis and treatment can make a huge difference in the prognosis (the expected development of an illness) of Anorexia Nervosa. According to the National Eating Disorders Association (NEDA), the following three types of psychotherapy are some of the evidence-based treatment options for Anorexia Nervosa.

• Cognitive Behavioral Therapy (CBT): A relatively short-term, symptom-oriented therapy focusing on the beliefs, values, and cognitive processes that maintain the eating disorder behavior. It aims to modify distorted beliefs and attitudes about the meaning of weight, shape, and appearance, which are correlated to the development and maintenance of the eating disorder.
• Dialectical Behavior Therapy (DBT): A behavioral treatment supported by empirical evidence for treatment of binge eating disorder, bulimia nervosa, and anorexia nervosa. DBT assumes that the most effective place to begin treatment is with changing behaviors. Treatment focuses on developing skills to replace maladaptive eating disorder behaviors. Skills focus on building mindfulness skills, becoming more effective in interpersonal relationships, emotion regulation, and distress tolerance. Although DBT was initially developed to treat borderline personality disorder, it is currently being used to treat eating disorders as well as substance abuse.
• Acceptance and Commitment Therapy (ACT): The goal of ACT is focusing on changing your actions rather than your thoughts and feelings. Patients are taught to identify core values and commit to creating goals that fulfill these values. ACT also encourages patients to detach themselves from emotions and learn that pain and anxiety are a normal part of life. The goal isn’t to feel good, but to live an authentic life. Through living a good life, people often find they do start to feel better.

At BALANCE eating disorder treatment center, we treat the spectrum of eating disorders, including anorexia, bulimia, binge eating disorder, compulsive overeating, and other disordered eating behaviors and body image issues. We offer a variety of virtual programs and services to help our clients not only reduce eating disorder symptoms but also move toward a more harmonious relationship with food and their bodies. Click the button below to browse our full selection of virtual programs & services.

Looking for eating disorder treatment programs or services in the New York City area? Learn more about our options at BALANCE eating disorder treatment center here or contact us here.

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This post was written by BALANCE Blog Intern, Enchi Dai.

Enchi is a Bachelor’s-Master’s student at New York University, majoring in Psychology. After her recovery from disordered eating, Enchi became passionate about spreading ED awareness, advocating for intuitive eating, and promoting Health at Every Size. Enchi is also an ACE Certified Personal Trainer and Registered Yoga Teacher (RYT 200). Her goal is to help people become healthier both physically and mentally, instead of encouraging them to pursue a certain body image. Along with her internship at BALANCE, Enchi works as a Research Assistant and Crisis Counselor to prepare herself for the future career as a Clinical/Counseling Psychologist.

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with Anorexia Nervosa and other eating disorders. Archives of General Psychiatry, 68(7), 724-731.

Neumärker K. J. (1997). Mortality and sudden death in anorexia nervosa. The International journal of eating disorders, 21(3), 205–212.