Anorexia / Starvation Tendency

Alternative names: Anorexia nervosa

Anorexia is a serious eating disorder in which people deliberately starve themselves to lose weight.  No matter how thin they become, they still see themselves as being overweight.

Although eventual outcomes of anorexia and starvation are very similar, it is important to rule out one or the other.  Anorexia is primarily psychological and not simply due to appetite loss whereas starvation may be due to physical, environmental or other factors.

Although here we will discuss only anorexia, several of the recommendations will also help overcome the effects of starvation.

There are two types of anorexia, both sharing essentially the same symptoms.  Binge/purge anorexia involves self-induced vomiting, laxative abuse, or excessive exercise after eating.  Restrictive anorexia involves severe calorie intake restriction, well below the body's needs.

Incidence; Causes and Development; Contributing Risk Factors

More than 90% of people with anorexia are females, though a growing number of males now have the disorder.  In Western countries, anorexia is estimated to affect between 1-in-100 and 1-in-20 women, and between 1-in-500 and 1-in-300 men at some point during their lives.  The most common age of onset is between the ages of 13 and 18.

Although the exact cause is not known, anorexia can be triggered by a severe emotional shock.

Common risk factors include:

• Severe trauma or emotional shock during puberty or pre-puberty
• A major, stressful life-changing event
• An overwhelming sense of being out of control, and attempting to take control of one's life by regulating food intake
• Unrealistic fear of developing an adult body
• Low self-esteem
• Depression, anxiety
• Anorexia is known to run in families
• Abnormal levels of certain chemicals in the brain
• Hormone imbalance
• Nutritional deficiencies
• Frequent dieters stand an 8-times greater chance of developing anorexia
• Living in a society that places unrealistic emphasis on thin-ness places certain individuals such as cheerleaders, dancers, runners, models, jockeys, wrestlers, and actresses and actors at higher risk for anorexia
• Loneliness

Signs and Symptoms

Common signs and symptoms of starvation in general include:

• low potassium levels (hypokalemia)
• cessation of menstrual periods (amenorrhea)
• unhealthy, dry, brittle hair and hair thinning/loss
• unhealthy, dry, yellowing skin
• foot discoloration (orange)
• intolerance of cold, low body temperature (especially in the extremities)
• abnormally fast or slow heart rate
• depression
• insomnia
• muscle aches, pains and tension
• distended abdomen
• bad breath (halitosis)
• (chronic) fatigue
• rapid mood swings

Anorexia is often accompanied by body dysmorphic disorder, in which the individual does not see themselves as they really are

Common signs and symptoms of anorexia specifically include:

• extreme weight loss (very low BMI) due to self-imposed starvation
• an obsession with food, such as collecting recipes, counting calories, eating rituals
• hoarding food
• eating only small amounts of food, despite possibly cooking a lot for others
• only eating certain foods
• an unwillingness to eat in public
• an irrational fear of gaining weight
• denying that one has a weight problem
• weighing oneself frequently on a scale
• believing one is overweight despite being underweight
• admiring thinner people
• a great fear of gaining weight
• excessive exercise
• obsessive-compulsive disorder (OCD)
• anxiety disorders
• personality disorders
• attention deficit hyperactivity disorder (ADHD)
• body dysmorphic disorder (BDD)
• self-induced vomiting (more common in cases of bulimia)
• use of laxatives, diet pills, or other weight loss aids
• being unsocial; avoiding friends, family, social occasions
• being secretive, hiding food, eating alone
• self loathing and self-harm

Diagnosis and Tests

A health care provider will generally ask questions about eating habits (how much and what is being eaten), current circumstances, family history, and exercise patterns.  A psychological evaluation is often performed.

Further possible tests are generally used to look for malnutrition-related health deterioration and other possible explanations for the excess weight loss:

• blood tests to look for evidence of malnutrition-related disorders
• urine tests to look for malnutrition-related disorders or substance abuse
• glucose tolerance test
• liver enzyme and liver function tests
• kidney function tests
• thyroid function tests
• electrocardiogram (EKG or ECG) to test electrical activity in the heart
• electroencephalogram (EEG) to measure electrical activity in the brain
• further hormone and enzyme tests

If anorexia nervosa is suspected then the patient should be referred to a therapist or psychiatrist who understands eating disorders.

The severity of anorexia can be roughly gauged in adults by the patient's Body Mass Index (BMI):

• Mild: BMI over 17
• Moderate: BMI between 16 and 16.99
• Severe: BMI between 15 and 15.99
• Extreme: BMI below 15

The BMI metric is unreliable for those under 18, so a BMI-for-age percentile can be used instead.

Treatment and Prevention

Treatment involves bringing the patient back up to a healthy weight, while at the same time identifying and treating any underlying psychological disorder.

It is best to get treatment as soon as the symptoms appear, from a psychiatrist specially trained both in treating the disorder and in nutritional counseling.  The patient may receive cognitive-behavioral, group, relaxation, or psychodynamic therapy, and be shown how to "relearn" correct eating habits.  In severe cases, hospitalization may be needed.  Long-term monitoring and support is necessary.

Prognosis; Complications

For some patients anorexia will be a one-off episode, whereas for others it may will recur over the years.  Many of the complications of anorexia will resolve or improve once a healthy weight has been regained.

Starvation can cause complications in every major organ system of the body: without proper treatment, the disorder can be fatal, with anorexia having the highest mortality rate of any psychiatric disorder.

Low potassium levels can cause arrhythmia, constipation, fatigue, muscle damage, and even paralysis.  Other possible consequences of extreme weight loss include osteoporosis, infertility, heart damage, and not having menstrual periods.  Those with eating disorders are at increased risk for premature death from a variety of causes, including suicide.