Anorexia Nervosa Is An “Eating

Anorexia Nervosa is an “eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image” (NEDA 2016). People with Anorexia Nervosa generally starve themselves to the point of malnourishment. Anorexia nervosa, sometimes referred to as AN, is one of the most common, severe eating disorders worldwide and affects people of all ages, genders, sexual orientations, races and ethnicities. AN has been around for hundreds of years, but has become more common over the last 20 years, most likely due to the intense unrealistic body expectations portrayed by the media. AN is most common among people with severe depressing and post-traumatic stress, and have low- self-esteem, are most affected, making up about 90% of the people who have AN.

A common misconception with Anorexia Nervosa is that it is the same as anorexia, which is not the case. Anorexia Nervosa is the eating disorder where people compulsively restrict the number of calories and types of food they eat because of unrealistic perception of body weight and fear of gaining weight. Anorexia, on the other hand is just a loss of appetite, which can be caused by an array of things, like depression, different medications, or a symptom of other diseases.

There are different types of AN, including restrictive, binge/purge, and atypical. Restrictive type, which is most commonly associated with Anorexia Nervosa, strictly limits the intake of food and usually obsessively over-exercises. Binge/purge type includes eating large amounts of foods in a short period of time and then intentionally vomiting, taking laxatives, exercising or fasting, to compensate (Segal, Smith 2017). There is also atypical AN which can go easily unnoticed. A person with atypical type can meet all the symptoms of AN while staying in a normal or above normal weight range. According to the National Eating Disorder Association, a person does not “need to be emaciated or underweight to have anorexia. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity” (NEDA 2016).

Anatomy and Physiology

Anorexia Nervosa takes a huge toll on the body, and negatively affects many parts of the human anatomy. The heart, stomach, liver, intestines, kidneys, bones, hormones and blood cells are all major body parts disrupted. The heart is affected by malnourishment and being overworked via exercise. This can result in an irregular or slow heart-beat, low blood pressure, and fainting. With prolonged low body weight, the heart muscle can ultimately stop working resulting in death. AN can cause the stomach to shrink causing the feeling of being full or bloated after only a small meal. The liver can become inflamed due to fat deposits into the liver from starvation. The gastrointestinal track losses muscle, causing constipation. The kidneys produce highly concentrated urine due to dehydration. The bones can become brittle, developing osteoporosis, which can lead to an increased risk of broken bones. According to Fundamentals of Nursing, “Eating disorders (such as anorexia nervosa) …can disrupt menstruation” (Lillis, Lynn, Taylor 2017). Absence of a menstrual cycle is a key component in AN and can lead to more weight loss. Red blood cells, which carry oxygenated blood throughout the body, and white blood cells, which fight infection are often low. This can cause increased weight loss, infection, and hemophilia.

Pathology

Anorexia Nervosa affects the entire body, inside and out. When a person develops AN, their bodies are immediately affected, and ultimately begin to shut down. When the body does not have the energy needed preform normally, it begins to conserve energy and slow all body process down. Basically, the body begins to consume itself. The hair on the head becomes thin and brittle while fine hair growth on the rest of the body becomes visible. The fine hair growth all over is the body’s way of trying to keep itself warm due to the lack of body fat. The skin becomes dry, yellow, and is easily bruised. Finger and toe nails also become very brittle and easy to break. The brain cannot think right, there is the constant fear of gaining weight. Because of the constant hunger for nourishment, the person can become moody, irritable, and often depressed. Hormones begin to diminish, causing changes in brain chemistry and menstrual cycle (in women). If a woman is to become pregnant, there is a higher risk of miscarriage and post-partum depression. There is a decrease in bodily fluids such as potassium, magnesium, and sodium and

an increase in constipation and bloating. (Segal, Smith 2017)

Physical Assessment Findings

When assessing a person for Anorexia Nervosa, there are many things to look out for. A thin appearance and a BMI lower than 18.5 is something to note. When assessing the inside of their mouth, look for bloody red gums, due to poor nutrition, and dry mouth due to swollen saliva glands. Insufficient vitamin intake and induced vomiting can lead to ulcers and other open wounds in the mouth, rotting teeth, and gum disease. Dry, red lips and dry, tenting skin are a result of dehydration. Skin may also be of a yellowish color and a rough texture and hands and feet may have Acrocyanosis due to poor circulation. Brittle, yellow nails are also common. Nails may also spoon due to lack of iron which can cause anemia. The skin may also have fine, soft hairs growing. When auscultating heart sounds, a slow heart rate or fluttering palpitations may be heard. When palpating the legs, feet and ankles, peripheral edema may be present. The patient may also have hypotension and in some cases, orthostatic hypotension (Mayo Clinic 2017). When palpating the nodes of the neck, they may be swollen due to induced vomiting. Teeth marks and callouses on the back of hands and knuckles are also common for people who induce vomiting. (NEDA 2016)

Signs and Symptoms

There are an array of signs and symptoms when it comes to Anorexia Nervosa. According to Mayo Clinic, “The physical signs and symptoms of anorexia nervosa are related to starvation” (2017) The most evident would be the extreme weight loss in a short period of time with no medical cause. The continuation of diet/exercising despite being underweight. A person with AN may also be fatigued but an insomniac and may experience dizziness or fainting (Mayo Clinic). This is due to the body’s utter exhaustion from trying to keep itself running. They may also have an intolerance to cold, causing soft, fine hair to grow all over the body to try and retain heat due to lack body fat (Mayo Clinic 2017).

Though there are many physical signs and symptoms of a person with AN, there also many behavioral signs. A person with Anorexia Nervosa tends to be obsessed with nutrition facts. They may be constantly reading food labels, measuring portions (counting calories, carbohydrates, and fat), keeping a food diary, or reading about dieting in books or online. They also may lie about eating or pretending to eat. They will hide or play with their food to give the illusion that some was eaten. They also may make excuses such as “I don’t think I can eat lunch, I had a big breakfast” or “I have a stomach ache”. Having strange food rituals is also super common with people with AN. They may refuse to eat in public, only eat from specific dishware, or even chew and spit out their food. In some cases, people with AN may self-induce vomiting, or use laxatives or diet pills to aid in a more rapid weight loss. (Segal, Smith 2017)

People with Anorexia Nervosa will have many emotional signs as well. They will most likely be obsessed with their image, fixating on weight and body shape. They may spend a lot of time in the mirror, critiquing themselves and looking for flaws. Despite being insanely thin, they will deny being too thin or having a problem. They may try to drink a lot of water to appear fuller, or wear baggy clothes to hide their thin appearance (Segal, Smith 2017). They may be irritable, depressed or even have lack of all emotion. Thoughts of suicide are common. (Mayo Clinic 2017). They will most likely withdraw from social interaction and have a lack of interest in sex.

People with Anorexia Nervosa often disguise their physical, behavioral, and emotional signs and symptoms. It can also be hard to notice signs and symptoms of AN, which is why so many cases go undiagnosed, especially in Atypical Anorexia Nervosa. It is important to be alert to the signs and symptom exhibited by people who have AN.

Diagnosis

According to Michigan Medicine from the University of Michigan:

If your doctor thinks that you may have an eating disorder, he or she will compare your weight with the expected weight for someone of your height and age. He or she will also check your heart, lungs, blood pressure, skin, and hair to look for problems caused by not eating enough. You may also have blood tests or X-rays. (Healthwise Staff 2016)

If the assessment findings are abnormal and correlate with and AN diagnosis, the doctor can make a diagnosis.

The Diagnostic and Statistical Manuel of Mental Disorders or the DSM-5 is also used to diagnose Anorexia Nervosa. There are three conditions that need to be met when being diagnosed with AN according to the DSM-5. The first would be, “restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health” (NEDA 2016). The second would be “Intense fear of gaining weight or becoming fat, even though underweight” (NEDA 2016). The third condition would be, “Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight” (NEDA 2016).

Treatment

Anorexia Nervosa can be treated. It is not always successful, but intervention and progress can be made. Getting a person to accept help is very challenging. According to the National Center for Eating Disorders, “95% deny that they need help and refuse treatment when they are first brought to medical attention. Most people who are obliged or forced to get help eventually admit that they are glad that they did, because a very small part of them knew they were ill” (Jade 2009). Weight gain is the main goal during treatment. Weight gain can relieve many of the effects of AN including, intolerance to cold, depression, absence of menstruation, fatigue, low blood pressure, and discoloration of the skin. Individualized treatment is determined by a doctor based on: age, overall health, and medical history, extent of the symptoms, tolerance for specific meal plans, therapies, or medications, and individual and family preferences (URMC 2017). There are many places where treatment can take place, including in the home, in the hospital or outpatient daily care. It is necessary for people of extremely low body weight and who are very depressed or suicidal to stay in the hospital. If the patients BMI is 30% below normal, has low blood pressure or potassium levels, or irregular heart-beats, hospitalization should also be considered. Patients should not be hospitalized for too long, to prevent dependency on medical services. It is also important for the patient to engage in a therapy of some kind. Therapies are individualized for each person. If necessary, enteral feeding can be implemented. This is only invoked if the person is near death from malnutrition and refuses to eat willingly.

Safety and Education

Preemptive measures to reduce the incidence of anorexia nervosa are unknown currently. The best way to prevent anorexia from developing is implementing healthy eating habits and positive body image at early ages. (NEDA 2016). Early detection and intervention can decrease the severity of the symptoms caused by AN. It can also aid in the patient’s normal growth and development. The primary goal for people who have already recovered from AN is to avoid relapse. Decrease the emphasis on weight, body shape and size, especially at meal time. There are many life-style changes when recovering from AN. It is important for the patient to be encouraged to stick to the eating plans, have a support system, and ignore the urge to use the scale. Diet pills, scales, and laxatives should be locked up or thrown away. It is vital to watch what is said regarding anorexia at all. The patient’s safety is most important.

Anorexia Nervosa is a severe eating disorder that is very prevalent in today’s world. Though it can be treated, if it goes undetected it can be life-threatening and lead to death. Anorexia nervosa can cause many issues with a person behaviorally, physically, and emotionally. When treating and recovering from AN, it is important to encourage body positivity and healthy eating habits. By doing this, Anorexia Nervosa can become less prevent in the years to come.