Eating and weight management behaviors have profound effects on public health outcomes among adolescents, teenagers, and young adults in the US and worldwide. Anorexia nervosa (anorexia) is one of the debilitating eating disorders with immense psychological and physical implications for health. The history of anorexia has strong associations with the fundamental of religion, including fasting. Scholars contend that some notable historical figures suffered from a psychological disorder. The initial medical description of the disorders was by Richard Morton in 1689 (Pearce, 2004). Two neurologists separately described anorexia in 1873 as the refusal of food for an indefinite period. The acceptance of anorexia as a medical condition was not until the 19 th century. Global awareness of the condition occurred following the publication of a book on the disorder by Hilde Bruch in 1978. Numerous accounts exist of the description of anorexia nervosa as a fasting condition, with the majority associating it to religious practices. The evolution in the understanding of the disorder is evident in the different records of individuals alleged to have suffered from the condition. All evidence suggests that anorexia is a fasting condition with potential adverse health effects that can lead to death.
Symptoms of Anorexia
The symptoms of anorexia nervosa are primarily physical due to starvation. On the other hand, an individual may experience emotional and behavioral conditions associated with an extreme and unrealistic view of body weight. The most dominant psychological condition is heightened fear of weight gain or fatness. Experts observe that the different expectations of low body weight that vary with each individual create diagnosis challenges. Some people with anorexia may fail to exhibit thinness, while others tend to disguise the signs and symptoms that include thinness, eating habits, and physical exacerbations. The most appropriate diagnostic tool is the DSM-V.
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The DSM-V classifies anorexia nervosa as a feeding and eating disorder. The manual provides a dual definition of the condition based on behavioral and psychological signs and symptoms. Individuals with anorexia exhibit restriction of energy intake relative to their body’s requirements. Consequently, anorexic people have significantly low body weight for their age, gender, development stage, and physical wellbeing (SAMHSA, 20116). The DSM-V defines significantly low weight as that below the reasonable standard for children and adolescents than minimal expectations. Anorexic people also show extreme levels of fear of weight gain or fatness. Also, present, are recurring behaviors intended to limit possible weight gain even in situations where they have a significantly low weight. An anorexic individual would show perturbed emotions concerning the way they experience weight gain or change in body shape, aspects that influence self-evaluation, and contribute to the inability to recognize the risk posed by their body weight.
Partial remission occurs if the full diagnosis is met, but symptoms on the restriction of energy intake do not occur over a long period though others may be present. Full remission is present when one of the criteria persists for some time, even if others do not manifest. Diagnosis of the level of severity of the condition depends on the current body mass index (BMI) for children and adolescents as per the World Health Organization recommendations. There are for levels of severity associated with anorexia based on BMI (kg/m 2 ): mild (BMI > 17), moderate (16-16.99), severe (BMI 15-15.99), extreme (BMI < 15) (SAMHSA, 20116).
Individuals diagnosed with an anorexia condition show various signs and symptoms that can be detrimental to their health. The experience physical fatigue, insomnia, dizziness or fainting, thinning and loss of hair, discoloration of the fingers, and disruption of the menstrual cycle in females. They may also manifest with abdominal discomfort, dryness and yellowing of the skin, dehydration, low blood pressure, and swollen arms and legs. Behavioral symptoms may include excessive exercising, and binging and self-induced vomiting (this behavioral train is dominant in bulimia nervosa). Emotional symptoms include an obsession with meals with failure to participate in eating, skipping meals or refusal to eat, and denial of hunger. Anorexic people may also be shy of eating in public, lie about the amount of food intake, frequent use of the mirror to check for perceived laws, have a low mood, social withdrawal, irritability, and disinterest in sex. The presence of a number of the above physical, behavioral, and emotional symptoms causes psychological disturbances, leading to recognition of the condition as such.
Origin of Anorexia Nervosa
The complexity and severity of anorexia cannot be understated. However, like many psychological disorders, the cause of the condition remains unknown. Several attempts try to explain the disorder from physiological and psychological perspectives. The examination of genetic composition in the loci of significance in anorexia showed a strong similarity to clinical presentation, with genetic associations noted in psychiatric, physical, and metabolic symptoms, independent of common factors related to BMI (Watson et al., 2019). The evidence presented corroborates the biological theory that attributes the condition to the existence of genetic triggers for perfectionism, sensitivity, and perseverance. Anorexic people manifest the above factors through the obsession with body image, weight watching, and fasting to restrict food intake.
Psychological factors are also possible causes of anorexia. Some anorexic people show symptoms of obsessive-compulsive personality traits that enable adherence to strict diets and refusal to eat despite being hungry. They also show exceptionally high levels of perfectionism and anxiety related to weight gain and body image. Environmental factors, including exposure to socio-cultural settings that emphasize thinness mediate anorexic behavior. Young girls have an obsession with fitting into the acceptable thin body of the perfect western woman. Overall, the interaction between biological, psychological, and environmental factors leads to enhance symptoms of anorexia in the affected individuals.
Treatment
Anorexia has no specific treatment because of its status as a psychological disorder. The goal in the treatment of the condition is to reverse weight loss and eliminate the symptoms and behavioral practices that lead to the restriction of food intake. Therapy integrates diverse approaches, including psychotherapy, medication, hospitalization, nutrition counseling, and group or family therapy. Psychotherapy targets to change the thinking and behavior of the affected individuals using cognitive and behavioral strategies. Psychologists use practical methods to induce a response to different situations. Psychotherapy can change the actions by encouraging acceptance and commitment, changing distorted views and attitudes about weight and body shape to facilitate behavior modification, and development of new skills to cope with the imminent change in behavior (Cleveland Clinic, 2020).
According to Cleveland Clinic (2020), physicians may prescribe antipsychotic medication, such as olanzapine (Zyprexa), to enhance weight gain. Antidepressant medication is used in controlling anxiety and depression prevalent in anorexic people. Nutrition counseling is crucial in helping the affected person design an acceptable and healthy diet list to influence their eating behavior. For patients with severe or extreme levels of anorexia and debilitating symptoms, hospitalizations may be necessary for stabilization. Group or family therapy can be critical in encouraging acceptance of oneself and adopting positive eating behavior and practices.
Population Affected
Gender is the leading risk factor in anorexia, with high prevalence observed in girls and women. The heightened social pressures to conform to the thin body concept are responsible for the rise in eating disorders among boys and men. Overall, anorexia is common in teenagers compared to any other age group and is rare in those aged over 40 years. The high prevalence in teenagers is due to changes associated with puberty and social and peer pressures based on sensitivity and criticism about weight and body shape. Some people have genetic predispositions, some undergo dieting and starvation, and others experience transitions in life that serve as risk factors for anorexia.
References
Cleveland Clinic. (2020). Anorexia nervosa: Management and treatment. Retrieved 2 May 2020 from https://my.clevelandclinic.org/health/diseases/9794-anorexia-nervosa/management-and-treatment
Pearce, J. M. S. (2004). Richard Morton: Origins of anorexia nervosa. European Neurology , 52 (4), 191-192. https://doi.org/10.1159/000082033
Substance Abuse and Mental Health Services Administration (SAMHSA) (2016). DSM-5 Changes: Implications for child serious emotional disturbance. National Center for Biotechnology Information. Retrieved on 2 May, 2020 from https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t15/.
Watson, H. J., Yilmaz, Z., Thornton, L. M., Hübel, C., Coleman, J. R., Gaspar, H. A., ... & Medland, S. E. (2019). Genome-wide association study identifies eight risk loci and implicates metabo-psychiatric origins for anorexia nervosa. Nature Genetics , 51 (8), 1207-1214.
