If you or someone you know may be suffering from anorexia nervosa, this blog is for you. In this post we will discuss anorexia nervosa treatment and how to overcome this serious eating disorder.
Anorexia nervosa is a serious eating disorder that involves consuming very small amounts of food and sometimes bingeing and/or purging. Anorexia can quickly become life threatening when a patient becomes starved, malnourished, and dehydrated. It also can be a horrific mental experience as a sufferer finds themselves trapped between their need to eat and the intense fear about eating.
When you have anorexia, pursuing extreme caloric restrictions feels like the right thing to do in an effort to pursue stronger health. In addition, a sufferer often is driven to be thin, which causes serious caloric intake restrictions and sometimes includes over-exercising, which can quickly become a sufferer’s sense of purpose and self-worth.
Because sufferers’ symptoms provide comfort and peace, the desire to get rid of them is not often a priority. For many, letting go of this disordered behavior feels like a huge loss.
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What is Anorexia Nervosa?
Anorexia Nervosa is an eating disorder that causes a sufferer to consume very little food, which starves their body of essential nutrients. If untreated, sufferers can become dangerously malnourished from severe starvation and still see themselves as overweight. Hospitalization is often required for sufferers of anorexia.
Who is Affected by Anorexia Nervosa?
According to WebMD.com, nine out of every ten people with anorexia are female. In total, about one percent of all U.S. females between the ages of ten and twenty-five are anorexic. Anorexia typically begins in adolescents or children under the age of 15 years old, however, it can affect anyone at any age.
Actresses, models, athletes, dancers, and others whose appearance and weight are very important are at a higher risk of developing anorexia.
Sufferers of anorexia nervosa tend to be perfectionists and typically perform at a high level in an activity like sports, school, work, and more.
Characteristics of Anorexia Nervosa
A person suffering from anorexia nervosa usually exhibits some of these characteristics:
- A strong effort to restrict food intake which leads to a significantly lower body weight (compared to age, sex, height, and other factors).
- An intense fear of gaining weight or becoming overweight, or regular behavior that interferes with gaining weight (such as exercise).
- A disturbance in how a sufferer’s body weight or shape, a negative self-evaluation of their body shape or weight, or a persistent lack of awareness in regards to their extreme low body weight.
Symptoms of Anorexia Nervosa
Anorexia nervosa is a very serious illness that causes starvation, but starvation isn’t the only sign of anorexia. Below are some symptoms sufferers may be experiencing if they have anorexia nervosa:
- A person is underweight for their age/gender/height
- A person is dehydrated
- A person’s arms and/or legs are swollen
- A female no longer gets periods
- A person’s hair is falling out
- A person often feels dizzy or faints
- A person is obsessed with losing weight
- A person’s self-esteem is directly tied to their appearance or weight
If you’re experiencing any of the above, it’s important to reach out to a professional as soon as possible.
Side Effects of Anorexia
Anorexia nervosa can cause serious side effects to a sufferer. Here are few of the harmful effects of anorexia:
Effects of Anorexia on the Heart
Improper nutrition can cause a number of harmful effects on a person’s heart including but not limited to:
- Mitral valve prolapse from loss of heart muscle mass
- Higher risk of ventricular arrhythmia
- Higher risk of sudden cardiac death
- Low blood pressure, or hypotension, and orthostatic hypotension
Effects of Anorexia on the Brain
Improper nutrition can cause a number of dangerous effects on a person’s brain including but not limited to:
- Decreased brain activity
- Appetite regulation problems
- Impaired functions related to decision making
- Inability to focus
- Issues with mood
- Issues with memory
- Issues with emotional control
Effects of Anorexia on the Digestive Tract
Improper nutrition can cause a number of dangerous effects on a person’s digestive tract including but not limited to:
- Discomfort and/or pain in the abdomen
- Bloating
- Fatty liver disease
- Constipation
- Feelings of being full
Effects of Anorexia on the Body
Improper nutrition can cause a number of dangerous effects on a person’s body from purging including but not limited to:
- Damaged kidneys
- A loss of hydration and electrolyte imbalance can lead to damaged skeletal muscle
- Dangerous stomach acid can wear down a person’s teeth enamel
Effects of Anorexia on Hormones
Improper nutrition can cause a number of dangerous effects on a person’s hormones including but not limited to:
- Puberty that is delayed
- Menstrual periods that are missed, or amenorrhea
- Euthyroid sick syndrome
- Weak bones in older individuals, or osteopenia
- A reduction in levels of female hormones
- Stress fractures in older individuals
- Lowered levels of testosterone
- Slowed growth
- A thyroid that is underactive, or hypothyroidism
- Bone loss in older individuals, or osteoporosis
How is Anorexia Nervosa Diagnosed?
If you’re suffering from above symptoms, a medical professional trained in eating disorders can begin an evaluation by performing a physical examination and a complete medical history. Your medical professional will most likely ask about the variety of foods being consumed, as well as what your thoughts are on food. A medical professional can then measure your weight and height and compare them with age-based and weight-based growth charts.
Additional questions about the frequency of binges and purges should also be asked by your medical professional.
DSM-5 Diagnostic Criteria for Anorexia Nervosa
The Diagnostic and Statistical Manual of Mental Disorders (DSM), or DSM-5, has been updated to include males who may have anorexia. “Do I have anorexia” should only be answered by a trained professional.
A person must have all of the below DSM criteria to be diagnosed with anorexia nervosa:
- Restriction of food intake leading to weight loss or a failure to gain weight resulting in a “significantly low body weight” of what would be expected for someone’s age, sex, and height.
- Fear of becoming fat or gaining weight.
- Have a distorted view of themselves and of their condition (Examples of this might include the person thinking that they are overweight when they are actually underweight, or believing that they will gain weight from eating one single meal. A person with anorexia might also not believe there is a problem with being at a low body weight; these thoughts are known to professionals as “distortions.”)
Different Types of Anorexia Nervosa
There are 2 different types of anorexia nervosa, restricting type and binge eating and purging type. Let’s review each below:
1. Restricting Type
The first type of anorexia is the restricting type. Sufferers with this type of anorexia place extreme restrictions on the type of food and the quantity that they eat. Some ways that a sufferer may place extreme restrictions include:
- Fasting excessively or skipping meals
- Restricting or limiting certain foods like carbs
- Following harsh rules like eating only certain colors of foods.
2. Binge Eating and Purging Type
The second type of anorexia is binge eating and purging type. Sufferers with this type follow restrictive rules on their eating but also binge eat or purge their food. Binge eating occurs when someone eats an abnormal amount of food very quickly. After this food has been consumed, a sufferer will purge the food by vomiting, taking laxatives, or misusing enemas and diuretics to remove the calories (and nutritional value) they took in during the binge.
5 Levels of Care for Anorexia Nervosa
Outside of the primary care setting, there are several levels of care depending on a sufferer’s state. Let’s review anorexia nervosa treatment levels of care:
1. Outpatient
- Often where the treatment process begins
- Patient lives at home and attends hourly sessions at their providers’ offices
- Appropriate for patients who are medically stable, motivated, self-sufficient, and have adequate support and structure at home
2. Intensive Outpatient
- Typically occurs in a specialized setting (e.g., a clinic or hospital)
- Patients live at home and attend sessions three to five times a week that last approximately three hours each
- Program may include numerous types of therapy, including, but not limited to, individual, group, and counseling
- Appropriate for patients who are medically stable, self-sufficient, and have adequate support and structure at home, but may need some degree of external structure beyond self-control
3. Partial Hospitalization
- Occurs in a specialized setting and can be connected to a hospital program or a free-standing facility
- Patient requires a high level of supervision and monitoring
- Patient must be able to demonstrate some ability to retain the gains made in treatment without 24-hour monitoring
- Patient must not be a suicide risk or medically compromised to the point of requiring hospitalization
- Patient must have sufficient resources and motivation to attend program
- Patient’s home or living environment must be one that can be supportive of the recovery process
- Wide variety in quality of programming and hours of available treatment across programs, making it critical that patient’s needs and circumstances are appropriate for this level of care
- Care is typically 5– 12 hours per day, 4– 7 days per week.
4. Residential Treatment
- Highly specialized programs that can be operated independent of hospital setting, but sometimes connected to a hospital setting
- Indicated when patient is not able to retain gains without 24-hour monitoring
- May be indicated when severity of symptoms necessitates constant monitoring in order to initiate and sustain symptom-free behavior and normalized eating
- May be indicated for patients whose activities of daily living are compromised by the disorder May be indicated for the development of a normalized, healthy lifestyle conducive to long-term health and well being
- May include specialized approaches that help the patient develop routines and activities of daily living that create patterns of behavior that are conducive to recovery
- Useful in situations with a high degree of psychiatric comorbidity that require intensified focus during treatment
- Sometimes indicated on the basis of a lack of supportive and safe environment where the patient can be expected be able to make meaningful, retainable progress
- May be appropriate when patient is overwhelmed with symptoms and unable to refrain from reverting to symptoms or other behaviors that compromise their well being when alone
- Appropriate for patients with either lower or higher levels of motivation, but generally patients must enter treatment voluntarily
5. Inpatient Hospitalization
- Generally used for a period of short-term stabilization proceeding initiation of treatment at lower levels of care
- Indicated in situation where patient is a suicide risk or gravely disabled by symptoms and unable to participate in residential or lower levels of care due to presenting symptoms, which may include depression, poor motivation, poor insight, and/ or other factors that limit ability to meaningfully participate in lower levels of care
- Appropriate in situations where hospital-based medical care is indicated (i.e., IV lines or other more invasive medical treatments are needed)
A person’s weight typically determines how aggressive treatment should be. According to Harvard Health:
“A patient’s weight usually determines how aggressive treatment should be. Generally speaking, when an adult patient loses 15% or more of her ideal body weight, she will require inpatient treatment or a highly structured outpatient program. Because children and adolescents are at risk for suffering irreversible developmental damage if they are malnourished, inpatient care may be necessary even before they reach the 15% weight-loss threshold.
In its treatment guidelines, the American Psychiatric Association (APA) recommends also taking other factors into account when making a decision. Items to consider include how quickly a patient has lost weight and whether she has developed a serious medical complication.”
Anorexia Nervosa Treatment Options
Treating anorexia nervosa is generally done via a team approach, which can include doctors, mental health professionals, dietitians, psychiatrists, and more. Let’s review some different Anorexia Nervosa treatment methods below:
Maudsley Method
The Maudsley Approach is the most effective therapy for children and adolescents who have been suffering from anorexia nervosa for less than 3 years, meaning that it is not a chronic condition yet. This approach follows a 3 step treatment process:
- In phase 1, Clinicians work with family members to share strategies to coach and encourage sufferers to gain weight by eating more.
- In phase 2, sufferers gain weight by eating in a more normal manner. This phase includes focusing on identifying and changing any family dynamics that will lead to more successful recovery.
- In phase 3, patients gain weight to a point of being more normal for their age, sex, and height. Medical professionals will continue to work with family members to help the sufferer to be more independent.
Nutritional therapy
Nutritional therapy is often used in anorexia nervosa treatment because sufferers are often highly malnourished. Starvation often affects a sufferer’s thinking processes, which can bring about negative, obsessive, or manipulative thought patterns.
Medical professionals can also provide support during this process of nutritional therapy, which includes positive reinforcement with weight gains. A major challenge in this process of therapy is doing so in a caring way, rather than through punishment if a sufferer fails to reach a weight goal or relapses.
Medication
Medications are often prescribed for sufferers of anorexia, but there is little evidence of their effectiveness to help regulate weight gain or alleviate distress in early treatment.
Psychotherapy
After gaining enough weight, psychotherapy will help sufferers of anorexia to realize and recognize distorted thinking patterns about food. Psychotherapy can also teach patients new ways to deal with emotional stress that anorexia causes and can also help sufferers avoid falling back into the trap of anorexia.
Finding Anorexia Recovery
If you think you or a loved one needs anorexia nervosa treatment, there is hope. The first step to anorexia recovery acknowledging you need help and then seeking help.
Those suffering from anorexia have developed this disorder from a combination of biological, psychological, and social variables. Because of the complex dynamic between these variables, treatment also requires a multi-tiered approach.
When recovering from anorexia nervosa, it’s important to find trained professional(s) that emphasize mindfulness, gentleness, and awareness to uncover the underlying function anorexia plays in your life. Recovering from anorexia nervosa is a process that explores how anorexia helps protect you from emotions, feel safer, and how it can even give you a sense of direction. With treatment, you will learn more sustainable way to experience connection and love in terms of hunger, fulness, and your relationship with food.
You have an internal compass you can rely on regarding food and your emotional needs. As you go through the process of recovery, you’ll discover that you can release the compulsion to follow rigid rules, external regulations, or outside mandates. Freedom and meaning are in reach.
Overcoming Anorexia Nervosa
Anorexia Nervosa doesn’t have to control your life. If you’re looking to overcome anorexia nervosa, search our directory for experts who can help. Anorexia Nervosa treatment experts are here to help you or a loved one.
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Author: Wendy Oliver-Pyatt
Dr. Wendy Oliver-Pyatt is a board-certified psychiatrist with over 25 years of medical and clinical experience. She is known for her innovative, humane, and dignity-enhancing approach to medically and psychiatrically thorough care. She has developed a unique treatment approach that delves into the underlying issues that place a person at risk for mental health conditions, leading them to healing, health, and inner peace. A world-leading expert on treating eating disorders, she founded three residential treatment centers—Center for Hope of the Sierras, Oliver-Pyatt Centers, and Clementine—which have helped thousands of patients recover.
