Anorexia – addicted to starvation

Anorexia often begins with a harmless diet to shed a few extra pounds. But the transition to anorexia can be fluid. If the weight continues to fall and the eating behavior gets out of control, professional help in the form of psychotherapy is usually necessary.

Girls and young women in particular are at risk of developing anorexia – but men can also be affected. The disease can be life-threatening. Early treatment significantly improves the chances of recovery. 

What is anorexia?

Anorexia is one of the eating disorders along with  bulimia  (bulimia nervosa) and binge eating disorder. These mental illnesses are characterized by a pathological approach to food intake.

According to the definition, anorexia has a  body mass index  (BMI) of less than 17.5 kg/m². Other criteria for diagnosis are self-induced weight loss, a body schema disorder in which those affected feel   overweight despite being underweight , and hormonal disorders as a result of malnutrition. If not all of these criteria are met, experts speak of atypical anorexia.

Binge Eating Disorder and Bulimia Binge Eating Disorder

In contrast to anorexia, the focus in  bulimia is  not on starvation but on binge eating followed by intentional vomiting. What both eating disorders have in common is the pathological fear of gaining weight and the constant mental preoccupation with food.

Binge  eating disorder  is also characterized by binge eating. However, since there is no subsequent countermeasure such as vomiting, the patients are usually overweight.

Orthorexia: Morbidly healthy diet

A newly emerged form of the eating disorder is the so-called  orthorexia : Here, those affected compulsively pay attention to a healthy diet and strictly refuse foods that they consider unhealthy.

Long-term consequences can be malnutrition and social isolation. However, orthorexia is not yet a recognized disease.

Who Has Anorexia?

Anorexia is particularly common in teenagers and young women. But men can be anorexic too. However, this is much less common, as women are affected about ten times as often.

The disease usually begins between the ages of 10 and 25, but mostly during puberty between the ages of 13 and 16. In Germany, around 1.4 percent of adults suffer from anorexia – according to the results of a  representative study from 2013 . However, frequency information in this regard varies greatly. In addition, especially in the case of eating disorders, the number of unreported cases is enormous.

Obsession with being slim as the cause?

Various causes can lead to the development of anorexia. Genes seem to play a role, because in up to 50 percent of identical twins, both siblings are affected. Biological factors such as changes in neurotransmitters can also be involved.

In addition , trauma in childhood,  a disturbed conflict processing in the family or an overprotected upbringing can  contribute to the development of anorexia. It is disputed whether the dissemination of the slim ideal of beauty in the media and in society can promote or cause anorexia.

How do you recognize anorexia?

The transition from dieting to anorexia is often gradual. But when do you start talking about anorexia? The alarm signal is the so-called  body schema disorder (body dysmorphia):  anorexics find themselves too fat despite being obviously underweight and want to lose weight further.

Strict control of food intake is also characteristic of anorexia, whereby “fatty” foods are usually avoided. The difference to pure underweight is important  :  Underweight people are often referred to as anorexic, even though they have normal eating habits.

Anorexia: possible symptoms

In addition to the main characteristic “underweight due to self-induced weight loss”, anorexia can manifest itself in various forms. Other possible symptoms include:

• long periods of fasting
• excessive sport
• Misuse of medications such as  laxatives , water tablets, thyroid medications or appetite suppressants 
• intentional vomiting with or without prior binge eating
• strict body weight control with very low target weight
• panic fear of gaining weight
• Concealing weight loss – for example, through loose clothing or hidden weights when weighing
• very slow eating or self-imagined “eating rituals”
• constant mental preoccupation with the topics of weight and nutrition

It is not uncommon for anorexics to also suffer from psychological symptoms or illnesses such as  depressive  moods, compulsive behavior, anxiety disorders or personality disorders. This can create a vicious circle that can make anorexia worse.

Consequences of anorexia: physical symptoms

Since the body does not receive enough energy and  nutrients in anorexia  , physical deficiency symptoms or, in severe cases, even permanent damage often occur.

The short-term consequences of reduced energy intake include:

• Freezing, cold hands and feet
• headache
• constipation
• low blood pressure , slow heartbeat 
• sleep disorders
• Concentration problems, reduced performance

Long-term  malnutrition  can also lead to the following physical changes due to a lack of energy and nutrients:

• dry, scaly skin
• brittle nails
• hair loss
• downy hair all over the body (lanugo hair)
• Missing your period due to a drop in sex hormone levels
• decreased interest in sex (loss of libido)
• erectile dysfunction in men
• Cardiac arrhythmias  (e.g. due to  potassium deficiency  in the event of vomiting and abuse of laxatives or water tablets)
• kidney damage
• osteoporosis
• Tooth damage (from calcium deficiency or from vomiting)
• Susceptibility to infection due to weakening of the immune system
• Water retention due to protein deficiency
• Loss of brain tissue with difficulty concentrating, poor memory or personality changes (usually normalizes when a normal weight is reached)

Gaining weight: acute treatment of anorexia

Therapy for anorexia consists of treating the physical symptoms and providing psychotherapeutic support. Depending on the degree of underweight,  stabilization of the physical condition is  a priority.

For this purpose, the patients must gain body weight depending on the BMI and possible deficiency symptoms such as electrolyte imbalances must be compensated. In severe cases, inpatient admission to a clinic makes sense. If there is a lack of insight into the illness, force-feeding by means of a gastric tube may be necessary.

Psychotherapy: core element of treatment

Psychotherapy – for example in the form of so-called cognitive  behavioral therapy  – is essential in the treatment of anorexia. In most cases, the disease can only be cured with  psychological support  .

Those affected learn how to accept their bodies and are gradually introduced to normal eating habits and life after anorexia. A  treatment contract is often  drawn up in which treatment goals – such as a certain weekly weight gain (usually 500 to 1,000 grams) – are recorded.

Therapy: Medication only for concomitant diseases

In addition to psychotherapy, group or art therapy can be used. In the case of children and young people in particular, it is also very important to involve family members, for example in the form of family therapy. 

Drugs that influence the psyche (so-called psychotropic drugs) are only used in anorexia in the case of psychological comorbidities such as depression. The  duration of treatment  for anorexia depends on the success of the treatment and is different for each patient.

Early therapy increases the chances of recovery

The early start of therapy is crucial for the prognosis of anorexia. In addition, the general rule is: the more pronounced the weight loss is and the older the affected person is at the onset of the disease, the more frequently relapses occur.

The  cure rate  for anorexia is said to be around 50 to 70 percent. On the other hand, there is a  mortality rate  of about 5 to 20 percent, with suicide being a frequent  cause of death  in anorexics in addition to the physical damage caused by being extremely underweight.

assistance on the Internet

Patients with anorexia usually have inhibitions about seeing a doctor and do not know who to turn to. The Internet offers a wide range of information for those affected and advice for parents. Addresses of counseling centers and tests for initial assessment (” Am I anorexic ?”) can also be found online.

The following links provide further information and help on anorexia:

• • Federal Center for Health Education
  • Hungry Online
  • Patient guidelines for the diagnosis and treatment of eating disorders

• Anorexia – self-help for eating disorders

Pro Ana: Dangerous exchange on the internet

The Internet offers those affected low-threshold and free exchange platforms – albeit in a negative sense: “Pro Ana” is an anorexic movement that emerged on the Internet at the beginning of the 21st century and whose goal is not to fight the disease but to lose weight further.

On blogs and in forums, the disease is idealized and personified in the form of “Ana” (derived from anorexia). Anorexics give each other tips for losing weight and hiding the disease and  motivate  each other – for example with pictures of themselves or underweight models (so-called “thinspiration”).