Anorexia / Starvation Tendency

Anorexia / Starvation Tendency: Overview

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.

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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
An young woman with severe anorexia taking a selfie in a mirror
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.

Signs, symptoms & indicators of Anorexia / Starvation Tendency:

Symptoms - Food - General

Frequent dieting

Frequent dieters stand an 8-times greater chance of developing anorexia.

Counter-indicators

Symptoms - Hair

Symptoms - Metabolic

Occasionally/regularly/often/always feeling unusually cold

Underweight people often feel cold due to having less fat and muscle mass.  Body fat acts as insulation to keep the body warm; muscle activity generates heat.

Symptoms - Mind - Emotional

Symptoms - Mind - General

Symptoms - Nails

Symptoms - Reproductive - Female Cycle

Symptoms - Reproductive - General

Symptoms - Sleep

Conditions that suggest Anorexia / Starvation Tendency:

Circulation

Coronary Disease / Heart Attack

Being severely underweight can cause heart failure.

Digestion

Female-Specific

Susceptibility To Miscarriages

Anorexia or starvation causes difficulties in conceiving and carrying a baby to term.

Female Infertility

Anorexia or starvation causes difficulties in conceiving and carrying a baby to term.

Amenorrhea

Women with anorexia and/or bulimia often experience amenorrhea as a result of maintaining a body weight that would be too low to sustain a pregnancy.  As a result, as a form of protection for the body, the reproductive system shuts down because it is severely malnourished.

Lifestyle

Overtraining

Compulsive exercising is a symptom of anorexia.

Mental

Metabolic

Edema (Water Retention)

Semi-starvation can cause edema.  People with eating disorders may interpret the puffiness of edema or any changes on the scale as weight gain or getting "fat" and may panic and purge or take laxatives even more.

Counter-indicators
Normal Weight
Counter-indicators

Musculo-Skeletal

Osteoporosis - Osteopenia

The common medical complications of anorexia/starvation include osteoporosis.

Organ Health

Kidney Disease

The common medical complications of being severely underweight include kidney damage.

Chronic Renal Insufficiency

The common medical complications of being severely underweight include kidney damage.

Skin-Hair-Nails

Symptoms - Food - General

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Risk factors for Anorexia / Starvation Tendency:

Nutrients

Magnesium Requirement

Early symptoms of magnesium deficiency can include fatigue, anorexia, irritability, insomnia, and muscle tremors or twitching.

Supplements, Medications, Drugs

Low/typical/high Metformin use

Metformin is used to treat type II diabetes, but several studies show that it helps people to lose weight by reducing hunger in people whether they have diabetes or not.  Metformin reduces sugar release from your liver to prevent blood sugar levels from rising too high, so your body doesn't need to produce as much insulin.  Insulin makes you hungry and causes fat cells in your abdomen to fill with fat.  If you are very underweight, see your doctor about lowering your dose or force yourself to eat more food.

Prednisone use

A side-effect of treatment with prednisone can include anorexia.

Symptoms - Food - General

History of frequent dieting

Frequent dieters stand an 8-times greater chance of developing anorexia.

Symptoms - Food - Intake

Counter-indicators

Anorexia / Starvation Tendency can lead to:

Autoimmune

Circulation

Coronary Disease / Heart Attack

Being severely underweight can cause heart failure.

Female-Specific

Susceptibility To Miscarriages

Anorexia or starvation causes difficulties in conceiving and carrying a baby to term.

Female Infertility

Anorexia or starvation causes difficulties in conceiving and carrying a baby to term.

Mental

Musculo-Skeletal

Osteoporosis - Osteopenia

The common medical complications of anorexia/starvation include osteoporosis.

Organ Health

Kidney Disease

The common medical complications of being severely underweight include kidney damage.

Recommendations for Anorexia / Starvation Tendency:

Botanical / Herbal

Goldenseal

Goldenseal, a strong digestive stimulant and tonic to the digestive tract, is especially useful for anorexia nervosa.

Lemon Balm

A mild sedative, spasmolytic, it may also gently help regulate thyroid-stimulating hormone and thyroid function.

Condurango

Condurango is a digestive stimulant for diminished appetite or dietary abuse; is a specific to anorexia nervosa.

Siberian Ginseng

A supportive adaptogen used to improve vitality and stamina.

Valerian Root

A sedative, digestive bitter, and appetite stimulant.

Wild Yam

Wild yam is hormone balancing and an antidepressant.

Oatstraw

A nerve tonic and antidepressant, it also relieves irritation of mucous membranes.  This herb is slow to start acting but is long-lasting.

Fenugreek

A nutritive and digestive tonic used where there is digestive debility and poor nutrition.

Saw Palmetto

A digestive tonic and connective-tissue rebuilder.

Licorice Root

Possesses antidepressant effects, and heals mucous membranes of the digestive tract.

St John's Wort

Used for depression or anxiety that leads to fatigue and adrenal gland exhaustion.

Diet

High/Increased Protein Diet

Protein supplements at 1 to 3 servings per day will help ensure sufficient amino acids and help prevent wasting.

Not recommended

Mineral

Zinc

15mg per day increased to 50mg twice a day may improve mood and appetite.

Psychological

Counseling

Anorexia requires counseling as it is mainly a psychological problem.

Vitamins

Multiple Vitamin Supplement

A multivitamin will help compensate for dietary deficiencies.

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