Anorexia Nervosa: What Is It? What Are the Symptoms?

• There are two different kinds of anorexia: the restricting type and the binge eating/purging type.
• With the former, the individual severely restricts their food intake, but does not binge eat or purge.
• In the latter case, the individual eats large quantities of food and then makes him or herself vomit afterward so as to offset the binge.
• There are different causes or contributors of anorexia, of which include societal pressures, childhood trauma, and genetics.
• Fortunately, there is treatment for anorexia; cognitive behavioral therapy (CBT), family therapy, and group therapy all prove effective.

There are two types of anorexia nervosa: the restricting type and the binge eating/purging type. In a person with the restricting type, their food intake is restricted, and they don’t participate in binge eating or purging. Binge eating/purging type is when an individual eats large quantities of food and then self-induces vomiting or misuses laxatives, diuretics, or enemas. Below are overviews of both anorexia nervosa restricting type and binge eating/purging type.

What Is Anorexia Nervosa, Restricting Type? What Are the Symptoms?

People with anorexia nervosa, restricting type seriously cut their calories and eat very little. The most obvious sign of anorexia nervosa, restricting type is a person’s underweight appearance. The goal of people with the disorder is to quickly lose weight or maintain a dangerously low weight. According to the Diagnostic and Statistical Manual of Mental Disorders, fifth Edition (DSM-5), which is published by the American Psychiatric Association, the following are criteria for diagnosis:

• Restriction of food intake leads to a significantly low body weight in the context of age, sex, development and physical health. The weight is less than minimally normal or, for children and adolescents, less than minimally expected.
• Intense fear of gaining weight or of becoming fat; continuous behavior that disrupts weight gain even though the weight is significantly low.
• A disturbance in body image (self-perceived weight or shape), undue influence of body weight or shape on self-evaluation, or continuous lack of realization of the seriousness of the low body weight.

The signs of people with anorexia nervosa, restricting type are physical, psychological, and behavioral. Below are signs for each area:

Physical Signs

• Rapid or sudden weight loss.
• Dizziness, fainting, and/or fatigue.
• Sensitivity to the cold.
• Lanugo (fine, soft hair) on the face and back.
• Dry skin.
• Hair loss.
• Dry, brittle hair, skin, nails.
• Gastrointestinal problems, such as constipation, cramps, pain, indigestion and bloating.
• Reduced ability for concentration and memory.
• Edema (retaining body fluid; puffy appearance).
• Reduction in metabolic rate.
• Lower heart rate.
• Lower blood pressure.
• Reduced body temperature.
• Dehydration.
• Hypoglycemia—low blood glucose levels—causing confusion, illogical thinking, shakiness and irritability.
• Easily bruised.

Psychological Signs

• Preoccupation with body shape, weight and/or appearance.
• Serious fear of gaining weight.
• Preoccupation with food or food-related activities/events.
• Negative body image.
• Distorted body image.
• Feeling or perception of being fat when at a healthy weight.
• Low self-esteem (feelings of guilt, self-criticism and worthlessness).
• Thinking is rigid—“good or bad” foods.
• Feeling out of control when around food.
• Increased changes in mood; irritability.
• Anxiety or depression.
• Anxiety around meals is increased.
• Increased sensitivity to comments or criticism about body shape, weight, appearance, eating and exercise habits.
• Suicidal thoughts or behaviors.
• Obsessive behaviors.

Behavioral Signs

• Constant dieting, restriction of food, rigid eating patterns.
• Changes in style of clothing.
• Extensive or compulsive exercise.
• School or work performance is impaired.
• Obsessive rituals when dealing with food.
• Food preferences have changed.
• Frequently avoid eating or make up excuses not to eat.
• Withdrawal from social network and events, especially where there’s food included.
• Repeatedly checking body.
• Eating is done slowly.
• Focus is around planning and preparing food.
• Dishonest behavior in regard to food.

Binge Eating/Purging Type: What Is It? What are the symptoms?

Binge eating/purging is when a person eats large amounts of food, overeats well beyond the point of fullness, and feels out of control while doing so. The sense of being out of control is what separates binge eating from regular overeating. As a way to offset the bingeing, the person often follows the eating with self-induced vomiting, the misuse of laxatives, enemas, diuretics, or excessive exercise.

People who binge eat are severely preoccupied with their body shape and weight, especially because that’s where they base their feelings of self-worth. The criteria to diagnose a person with binge eating/purging is that he engages in the inappropriate behavior at least twice a week for at least three months. Some people don’t binge eat, but regularly purge after eating small amounts of food.

People who struggle with binge eating may show the following signs:

• Eating a large quantity of food in one episode than in a normal meal or snack.
• Feeling that eating is not able to be controlled when the binge begins.
• Hiding food.
• Hoarding food.
• Makes up excuses for food that goes missing or money that’s taken to pay for food.
• Eating until the point of discomfort or pain.
• Feelings of shame and self-disgust follow the bingeing.
• After the binge, there’s a compulsion to purge in order to get rid of the extra calories (vomiting, abusing laxatives or diuretics, starvation periods, or excessive dieting).

The signs of purging include:

• Vomiting (the most prevalent sign of purging)
• Habit of using the bathroom after eating or during meals.
• Swollen salivary glands in the cheeks.
• Damaged teeth and gums.
• Sores, scars or calluses on knuckles and hands because of self-induced vomiting.
• Continuous sores in the throat and mouth.
• Voice is scratchy.
• It’s common to find empty boxes from laxatives, diuretics or enemas hidden in a person’s trash.
• Exercise for hours on end.
• Excuses cover up their behavior or periods when they’re absent from work, school or events.

What Causes Anorexia Nervosa?

The causes of anorexia nervosa are complex. It’s thought that the disorder develops as the result of biological and environmental factors, such as:

• Stress on thinness in the media with reinforcement that thin people are ideal.
• Activities and careers that promote being thin, such as dancing and modeling.
• Family and childhood trauma (sexual abuse, serious trauma).
• Peer pressure from friends or coworkers to be thin.
• Irregular hormone functions.
• Genetics. The relation between anorexia and the genes is being researched; it is known that genetics is part of the factors.
• Nutritionally deficient.

Treatment for Anorexia Nervosa

1. Cognitive behavioral therapy (CBT): If the person isn’t in immediate danger or experiencing medical complications due to the disorder, cognitive behavioral therapy (CBT) is one of the most popular treatments. The therapy focuses on issues of self-image and self-evaluation. The issue of distorted body image is the most common among people with the disorder and is the focus of the beginning stages of treatment. Therapy will teach the individual how to recognize the appropriate weight and body fat proportions of a normal body and relate it to his own body.

2. Family therapy: The person may have problems with negative self-image because of traumatic events or memories that occurred during the developmental stages of childhood. In addition, parents may inadvertently play a role in the individual’s negative self-image. Family therapy is ideal to identify the “reinforcers” that significant people in the person’s life are conveying. This means that there may be the message to stay thin that the family member/s are giving the person with the disorder. Family therapy can also be helpful in educating the family about the disorder and how they can help their loved one in the treatment process.

3. Group therapy: Group therapy is helpful because it offers the individual a strong support system. The individuals in the group can share their personal experiences with their eating disorder, and everyone can work together to recover. Furthermore, group therapy helps one realize they are not alone in this fight.

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