Anorexia Nervosa DSM-5 307.1 (F50.01) (F50.02)

Anorexia Nervosa DSM-5 307.1 (F50.01) (F50.02)

Anorexia Nervosa

Anorexia nervosa is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) diagnosis assigned to individuals who become preoccupied with maintaining a low body weight. A serious psychological disorder, anorexia nervosa is characterized by abnormal attitudes towards food that affect the sufferer’s behavior and eating habits, often with physical, psychological and social consequences.

Introduction

Anorexia nervosa is an eating disorder motivated by the desire to maintain as low a body weight as possible. Sufferers will often restrict their food intake or even starve themselves completely to prevent weight gain, otherwise they may exercise excessively.

The disorder usually stems from a fear of gaining weight or becoming overweight but is often more complex in terms of causation. Eating disorders may be associated with a range of issues, from biological predisposition or environmental pressures to be slim, to a specific event that triggered the onset of the condition.

Estimated to affect young women more often than males, anorexia nervosa is diagnosed in approximately 0.4 per cent of young females each year. The disorder also affects men but less is known about the prevalence of anorexia nervosa among males. However, the condition is thought to affect women and men at a ratio of 10:1.

Symptoms

The symptoms of anorexia nervosa may be difficult to identify, as sufferers often go to great lengths to hide signs of their condition. Symptoms of anorexia nervosa include:

  • Eating very little or missing meals altogether
  • An extremely thin or emaciated appearance
  • Distorted body image and denial of low weight
  • Becoming obsessed by the calorific and nutritional content of food
  • Using appetite suppressants or laxatives to control weight
  • Using weighing scales obsessively or constantly checking body shape in the mirror
  • Leaving the table quickly after a meal to vomit
  • Dizziness, dry skin and physical problems (NHS, 2016a)

Other symptoms may not be obvious at first, instead developing over time. These include:

  • Brittle hair or hair loss
  • Growth of fine hair all over the body
  • Osteoporosis
  • Muscle weakness or wasting
  • Low blood pressure and anemia
  • Constipation
  • Lethargy and fatigue
  • Infertility
  • Organ failure and brain damage (National Institute of Mental Health, 2016)

Diagnostic criteria for anorexia nervosa

For anorexia nervosa to be diagnosed, a number of criteria need to be met. There are three specific features of the disorder, namely:

  • The sufferer’s weight is significantly low, less than the minimal normal or expected body mass, taking into account the individual’s height and age.
  • The sufferer displays an intense fear of gaining weight or becoming fat and this fear does not usually improve, even when the individual loses weight.
  • The sufferer displays a distorted view of their body weight and shape, either feeling overweight all over or singling out specific areas as being too fat.

There are a number of additional features that support diagnosis: individuals suffering from the condition may appear seriously underweight, report symptoms such as depression, withdrawal and insomnia, and display obsessive compulsive tendencies.

Laboratory tests may also be helpful in diagnosing anorexia nervosa - abnormalities in blood serum chemistry, decreased levels of white blood cells, mild anemia, reduced levels of thyroid hormones, low bone density and a slowed heart rate may all support a diagnosis of anorexia nervosa (American Psychiatric Association 2013).

Subtypes of Anorexia Nervosa

Individuals with anorexia nervosa may be split into two subtypes, depending on how their condition presents. Sufferers usually fall into either the restrictive group or the binge-eating/purging subtype, although overlaps are common.

Sufferers who use dieting, fasting and/or excessive exercise to achieve their weight loss goals are classed as restrictive, while those who will overindulge and then purge their bodies of food through vomiting or misuse of laxatives fall into the binge-eating/purging subtype.

Because the two types may overlap, or the individual may not recognize that they are unwell, clinicians will often use information from family members or other sources to establish the person’s history of weight loss and features of their illness (American Psychiatric Association 2013).

Causes of Anorexia

The causes of anorexia nervosa are unclear but are often attributed to a variety of factors, often psychological, biological or environmental - or even a combination of the three.

Psychological Causes - Anorexia nervosa sufferers may display the following traits:

  • Depression and anxiety
  • Excessive fear or worry about the future
  • Difficulty handling stress
  • Obsessive or compulsive feelings
  • Difficulty expressing emotion
  • Setting overly demanding personal standards
  • Having phobic feelings of becoming fat

Environmental Causes of Anorexia

  • Hormonal and other changes during puberty
  • Stress or pressure at school or at work
  • Bullying, especially with regards to body weight or shape
  • A stressful life event, such as bereavement
  • Abusive or difficult relationships
  • Occupations or hobbies where being thin is idealized

The world around individuals and their experiences can also be a factor in the development of anorexia nervosa:

Biological causes

  • Displaying obsessive traits in childhood
  • Developing an anxiety disorder in childhood
  • A family history of eating disorders, depression or substance misuse
  • Changes or abnormalities in brain function

Some biological and temperamental factors are also associated with the development of anorexia nervosa, including those mentioned in the list above. (NHS 2016b, American Psychiatric Association 2013)

Living with Anorexia Nervosa

Anorexia nervosa is thought to affect one in every 200 American women - figures concerning men are less reliable but some statistics suggest that up to 10 million men in the USA will suffer from an eating disorder at some point in their lives (National Eating Disorders Association, 2016).

Commonly beginning during puberty or in young adulthood, anorexia nervosa is a complex disorder that manifests in varied formats for sufferers. Some individuals, especially younger sufferers, will display atypical symptoms, while older people are more likely to show longstanding clinical signs.

Individuals living with anorexia nervosa may try to hide their illness and many will not seek help independently. Several years of treatment may be necessary to make a full recovery from anorexia nervosa and relapses are common. Without treatment, anorexia can cause other serious problems and is a leading cause of mental health-related deaths (NHS 2016a).

Even with treatment, about half of sufferers will continue to experience problems with food. Some individuals will find that their weight fluctuates; others experience anorexia nervosa as a chronic condition. However, some individuals may recover completely after a single episode (American Psychiatric Association 2013).

Treatment for Anorexia Nervosa

Although the causes of anorexia nervosa are not always clear, the condition can be treated in ways that reflect the needs of each individual. Treatment plans may be drawn up to include psychotherapy, medical care and monitoring, medication or nutritional counseling. Sufferers may also be required to keep a food diary to become more aware of their triggers.

Psychotherapy

Therapy may be prescribed for individuals suffering from anorexia nervosa, either on a direct one-to-one basis or in a family group. A specific type of therapy commonly offered to sufferers is cognitive behavioral therapy, which helps individuals recognize that their thinking patterns may be unhelpful or distorted, thus helping them to change their belief systems over time. Family-based therapy called the Maudsley approach is an alternative, in which parents take responsibility for feeding their adolescent children who suffer from anorexia.

Medication

Eating disorders are often co-occurring with other illness, such as depression or anxiety, in which case medication may be prescribed to alleviate symptoms of one disorder with the aim of improving the person’s overall wellbeing. Anorexia nervosa co-occurring with other disorders may be treated with antidepressants, mood stabilizers or antipsychotic medication (National Institute of Mental Health (2016). Two of the main types of medication prescribed for anorexia sufferers are selective serotonin reuptake inhibitors, which are used to treat depression, and olanzapine, which is used to treat feelings of anxiety (NHS 2016c).

Eating disorders like anorexia nervosa can have serious health consequences - the sooner help is sought, the sooner recovery can begin. At this point, the prospects for long-term recovery are good for many sufferers, with treatment having the potential to help individuals regain control over their eating habits for a healthier, happier future.


Dr. Kevin Fleming obtained his PhD from Notre Dame and is the Founder of Grey Matters International (www.greymattersintl.com), a neuroscience-based behavior change consulting firm.

References

NHS (2016a) Anorexia nervosa: Introduction http://www.nhs.uk/conditions/Anorexia-nervosa/Pages/Introduction.aspx Date Accessed: 07/06/2017

American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

National Institute of Mental Health (2016) Eating Disorders https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml Date accessed: 07/06/2017.

NHS (2016b) Anorexia nervosa: Causes http://www.nhs.uk/Conditions/Anorexia-nervosa/Pages/Causes.aspx Date accessed: 07/06/2017.

National Eating Disorders Association (2016) Research on males and Eating Disorders https://www.nationaleatingdisorders.org/research-males-and-eating-disorders Date accessed: 07/06/2017.

NHS (2016c) Anorexia nervosa: Treatment http://www.nhs.uk/Conditions/Anorexia-nervosa/Pages/Treatment.aspx Date accessed: 07/06/2017.


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