Anorexia Nervosa

Various factors can increase the likelihood of developing anorexia nervosa, ranging from psychological triggers such as relationship breakdowns and life transitions to physical conditions like type 1 diabetes. While anorexia nervosa can affect both men and women, it is more prevalent in women, who are more prone to developing negative perceptions of their bodies.

Anorexia nervosa is a multifaceted psychological disorder, and like many eating disorders, it is influenced by a combination of biological, psychological, and sociocultural factors. Below are some of the most common risk factors associated with anorexia nervosa:

• A family history of eating disorders.
• Diabulimia, a condition in which individuals with diabetes deliberately restrict their insulin usage in order to lose weight.
• Extreme dieting and starvation, which can alter thought patterns and reinforce restrictive eating behaviors.
• Psychological stress brought on by loneliness or boredom, increasing the risk of developing anorexia nervosa.
• Age, with anorexia most frequently occurring during adolescence and puberty, although it can affect individuals at any age.

If you experience symptoms like significant weight loss, an obsessive focus on body image, extreme dietary restrictions, psychological stress, or an intense fear of gaining weight, it is important to consult with a psychiatrist or nutritionist. Early detection and intervention are crucial in reducing the risks associated with anorexia nervosa.

Depending on the severity and duration of the condition, your doctor may perform physical exams and review your medical history to rule out other similar health conditions. If the symptoms are unclear, your physician may recommend various tests to aid in the diagnosis.

Physical Examination

During a physical exam for anorexia nervosa, the following aspects are typically assessed:

• Examination of physical signs like dry skin, sunken eyes, and the development of soft hair over the body.
• Calculation of your body mass index (BMI), which is less than 17.5 in adults or less than 85% of the expected weight for children.
• Evaluation of vital signs, including heart rate, blood pressure, body temperature, and other malnutrition indicators.
• Abdominal examination for stretch marks and palpation of the liver.

Psychological Evaluation

A psychological evaluation for anorexia may involve:

• Analysis of behavior patterns such as substance abuse, self-harm, or suicidal tendencies.
• Review of your family or medical history for any other psychological disorders.
• Evaluation of your views on eating, appearance, and exercise.

DSM-5 Guidelines

Anorexia nervosa is classified under Feeding and Eating Disorders in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 does not have a specific BMI cutoff for diagnosing anorexia nervosa.

The diagnostic criteria for anorexia nervosa include the following (all of which must be met for a diagnosis):

• Restriction of energy intake relative to requirements, leading to significantly low body weight. (Criterion A)
• Intense fear of gaining weight or persistent behaviors that interfere with weight gain. (Criterion B)
• Distorted perception of one's body weight or shape or failure to recognize the risks of low body weight. (Criterion C)

The DSM-5, in its 2013 revision, removed the requirement for amenorrhea (absence of periods) as a diagnostic criterion, as it did not apply to males, women before or after menstruation, or those using birth control, and some women with anorexia still experience menstrual activity.

Levels of Severity

The DSM-5 uses BMI as an indicator of the severity of anorexia nervosa:

• Mild: BMI greater than 17
• Moderate: BMI between 16–16.99
• Severe: BMI between 15–15.99
• Extreme: BMI less than 15

Laboratory Tests

While there is no specific test to definitively diagnose anorexia, lab work can help uncover any underlying health issues linked to the condition. Common lab tests used in the diagnosis include:

• Blood Sugar Test: Individuals with type 1 diabetes are at an increased risk of anorexia.
• Electrolyte Level Test: Used to assess the severity and health effects of anorexia.
• Complete Blood Count (CBC): This can help identify underlying conditions that could be contributing to anorexia.
• Comprehensive Metabolic Profile (CMP): This test evaluates 14 parameters in the blood, providing insights into the body’s chemical balance and metabolism.
• Urinalysis: A routine urine test can help diagnose underlying conditions related to anorexia, as well as hydration and fluid intake levels.
• Electrocardiogram (ECG): Used to assess heart function and detect any related abnormalities.
• Liver Function Test: These tests evaluate liver health and can be used to assess malnutrition and protein deficiencies.
• Luteinizing Hormone (LH) Response to Gonadotropin-Releasing Hormone (GnRH): This test evaluates the pituitary gland’s response to GnRH and can help detect hypogonadism, which is commonly seen in anorexia nervosa cases.

While there are no guaranteed methods to prevent anorexia, several strategies can help reduce the likelihood of developing the condition and manage its symptoms. These include:

Early Identification of Anorexia

• Anorexia has multiple contributing factors, and its symptoms often overlap with other psychological disorders, making it difficult to pinpoint its exact cause. However, recognizing the signs early can lead to prompt interventions, reducing the risk of complications and even death.

Adopt Healthy Eating Habits

• The malnutrition that accompanies anorexia can severely damage the body. One effective way to prevent internal organ harm is by consuming nutrient-dense foods in smaller, more frequent meals. This is often easier to manage in the early stages of anorexia, as consuming large amounts of food can be challenging. Consulting with a dietitian or nutritionist can help create a balanced diet plan that meets your body's nutritional needs.

Avoid Alcohol Consumption

• "Drunkorexia" refers to the dangerous behavior of replacing food intake with excessive alcohol consumption. Studies have shown a link between alcohol use and the triggering of eating disorders, including anorexia nervosa. The combination of alcohol and anorexia can result in severe, life-threatening health issues, so avoiding alcohol can help mitigate these risks.

Stop Self-Criticism

• Individuals with anorexia often strive for perfection in every aspect of their lives. While perfectionism can be seen as a positive trait, it can also lead to unnecessary stress and mental health challenges. Learning to accept your current body, weight, and appearance can prevent the development of negative self-perceptions.

Avoid Encouraging Body Shaming

• Allowing others to criticize your body can damage your self-esteem. Body shaming is rampant on social media and can significantly affect one's mental health. Although body shaming is prevalent in the digital age, it is important not to let negative comments affect your well-being. Practicing self-love and positive affirmations can help you maintain a healthy mindset.

Understand Anorexia and Related Eating Disorders

• Anorexia nervosa has the highest mortality rate of any mental illness. Becoming aware of the risk factors and triggers associated with anorexia can help you avoid negative self-image issues and dissatisfaction with your body.

Seek Professional Guidance

• If you notice any signs of anorexia or suspect you may have it, it is important to consult a doctor to better understand your condition. Early identification of the root causes of anorexia allows for quicker intervention and a greater chance of recovery.

Specialists to Consult

The signs of anorexia may not always be immediately apparent. Often, individuals with anorexia are unaware of their symptoms or may deny having a problem. If left untreated, anorexia can quickly worsen and lead to severe health complications.

Early diagnosis can significantly improve recovery outcomes. If you are concerned about your mental health or are experiencing symptoms of anorexia, it is crucial to seek medical help as soon as possible to prevent further progression and associated risks.

Specialists who can help manage anorexia include:

• Primary care physician
• Nutritionist
• Psychiatrist
• Gastroenterologist

The goal of treating anorexia nervosa is to restore the body to a healthy weight while addressing both psychological and emotional well-being. There are various therapeutic approaches available, with treatment plans typically tailored to the individual’s age, medical conditions, and other health factors. In many cases, a combination of treatments is recommended to address issues like low self-esteem, anxiety, and other associated mental health concerns.

Here are some common approaches used in the treatment of anorexia nervosa:

Psychotherapy

Psychotherapy can assist individuals with anorexia in managing the mental health challenges associated with the disorder. It helps patients gain a better understanding of their condition and how to cope with it. Different types of psychotherapy used to treat anorexia include:

• Family-Based Therapy (FBT): Also known as the Maudsley method, this approach involves the family in the process of helping the patient regain a healthy weight at home. The family is encouraged to work together to ensure the individual receives proper nutrition to restore a healthy weight.
• Cognitive Behavioral Therapy (CBT): This therapy aims to improve mental well-being by focusing on changing distorted thoughts about body image and weight.
• Dialectical Behavior Therapy (DBT): DBT focuses on identifying triggers for anorexia and developing strategies to manage them. It also helps patients improve their mental health balance.
• Acceptance and Commitment Therapy (ACT): This therapy encourages self-motivation and personal acceptance rather than focusing solely on altering thoughts and emotions.
• Interpersonal Therapy (IPT): IPT helps patients address relationship problems and improve their social interactions. Strengthening relationships has been shown to reduce symptoms of eating disorders.
• Nutrition Counseling: Sessions with a nutritionist can guide patients in understanding the importance of healthy eating habits and help them restore normal eating patterns.

Medications

While there are no specific medications approved for treating anorexia nervosa itself, antidepressants or other psychiatric drugs may help address the mental health conditions associated with the disorder. Some commonly prescribed medications include:

• Cyproheptadine: An antihistamine that helps reduce inflammation and allergic reactions, cyproheptadine also stimulates appetite by promoting the release of growth hormones.
• Marinol: A cannabinoid that may help improve appetite and overall quality of life when used regularly.
• Megestrol: A synthetic version of progesterone, megestrol can help stimulate appetite.
• Olanzapine: An atypical antipsychotic that works by regulating dopamine and serotonin levels to improve mood and behavior.

Diet

Diet plays a crucial role in the treatment of anorexia nervosa and should be personalized to meet each individual’s specific needs. A balanced and varied diet is important, with a focus on high-energy foods to aid in restoring nutritional balance. The process of refeeding should begin slowly, with calorie intake gradually increasing at a manageable pace. While the use of zinc supplementation during refeeding has been suggested, its effectiveness remains uncertain.

Anorexia nervosa can lead to several serious medical complications, including:

• Increased risk of cardiovascular issues such as heart valve problems, mitral valve prolapse, arrhythmias (irregular heart rhythms), or heart failure.
• Kidney problems, including digestive disturbances.
• Osteoporosis, where bones lose density and become more fragile.
• Electrolyte imbalances, particularly low levels of sodium, potassium, and chloride.
• Eye conditions, such as lagophthalmos, where the eyelids fail to fully cover the eyes during sleep, causing irritation or discomfort in the cornea.
• Metabolic and endocrine disorders, including thyroid imbalances and infertility.
• Amenorrhea, which refers to the absence of menstruation.
• Gastrointestinal issues like nausea, bloating, constipation, and delayed stomach emptying.
• Hematological disorders, including anemia (low red blood cell count) and leucopenia (low white blood cell count).
• Neurological complications, including brain atrophy that may lead to mood changes and memory loss.

Additionally, anorexia nervosa can contribute to various psychological issues, such as:

• Obsessive-compulsive disorder (OCD), marked by persistent, repetitive thoughts.
• Anxiety.
• Personality disorders.
• Substance abuse.

Ayurvedic Remedies for Anorexia

Here are some natural and herbal approaches that may aid in managing anorexia nervosa:

Ginger (Adrak)

• Ginger is known for its antioxidant, antibacterial, antiviral, and anti-inflammatory qualities. A small amount of lime juice and rock salt added to ginger juice can stimulate the taste buds and help neutralize excess gastric secretion.

Tamarind (Imli) and Salt

• A mixture of tamarind and saltwater juice can stimulate the taste receptors on the tongue, which may trick the mind and encourage appetite.

Black Cardamom (Badi Elaichi)

• Black cardamom is packed with antioxidants and has antispasmodic properties, making it helpful in relieving stress associated with eating disorders like anorexia.

Trikatu

• Trikatu is a blend of three potent herbs: black pepper (kali mirch), ginger (adrakh), and long pepper (pippali). This combination promotes the secretion of gastric juices, aiding digestion and reducing gas. You can consume trikatu powder with water or honey.

Recovering from anorexia nervosa can be difficult, but with proper nutritional adjustments and dietary changes, it’s possible to reverse many of the negative effects caused by the condition.

Here are some guidelines to follow at home to manage anorexia nervosa:

Do’s

• Incorporate micronutrient-rich foods such as whole grains, citrus fruits, and leafy vegetables into the diet, especially for individuals with severe anorexia.
• Refeeding, which involves slowly reintroducing food after a period of starvation or malnutrition, should be done gradually to avoid complications.
• Drink fresh juices to help replenish vitamin and mineral deficiencies.
• Stay hydrated by drinking at least 2-3 liters of water per day.
• Include fiber-rich foods like beans, lentils, broccoli, berries, and avocados in your meals.
• Add herbs like cardamom, asafoetida, trikatu, quality-rich herbs, and ginger to your diet.

Don’ts

• Avoid drinking aerated beverages and alcohol.
• Limit caffeinated drinks such as coffee and tea.
• Steer clear of refined foods like pasta, noodles, white rice, and sugary products.
• Don’t consume food from unhygienic sources.
• Avoid overeating processed foods, such as canned or preserved items.
• Stay away from foods high in sodium and salt, such as pickled meats, highly salted cereals, cakes, buns, and pre-packaged soups or sauces.

Living with anorexia nervosa can result in feelings of dissatisfaction with one's body, leading to restricted calorie intake, excessive exercise, or overuse of medications in pursuit of unrealistic fitness goals. If left untreated, the ongoing fear of weight gain can contribute to serious psychological issues such as depression, suicidal thoughts, anxiety, and social withdrawal. However, early diagnosis and timely treatment can significantly reduce the risks and complications of anorexia.

Here are some tips to help manage anorexia:

• Recognize and understand your triggers
• Regularly monitor your vital signs
• Practice meditation or yoga for mental well-being
• Stay actively engaged in activities
• Maintain proper hydration
• Seek professional assistance if necessary
• Join support groups for additional help and encouragement