Anorexia nervosa – causes, symptoms, diagnosis, treatment & pathology
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Anorexia nervosa – causes, symptoms, diagnosis, treatment & pathology

August 14, 2019

On our Youtube channel, you’ll find a limited
selection of pathology and patient videos. With Osmosis Prime, you’ll get access to over
700 videos including complete coverage of pathology and physiology and a growing collection
of pharmacology and clinical reasoning topics. Try it free today. Anorexia nervosa, which is often just called
anorexia, is a disorder that is characterized by very low weight (typically less than 85%
of normal body weight), a constant fear of gaining even the slightest amount of weight,
and having a distorted view of their own body weight or shape, often believing that they
are overweight, while actually being underweight. Now there are two main types of anorexia. One form of the disorder is the restricting
type, where people reduce the amount of food they eat in order to lose weight. Another form of the disorder is the binge-eating
and then purging type, where individuals eat large amounts of food in one sitting and then
purge that food through vomiting or by taking laxatives. This can be confused with another eating disorder—bulimia
nervosa, but the main distinction between these two disorders has to do with an individual’s
weight. Individuals with bulimia are usually normal
weight or overweight, whereas individuals with anorexia are underweight. Because of this, people can potentially start
out with bulimia, and then develop anorexia over time. Anorexia can be further split by levels of
severity. A body mass index, or BMI, between 18.5 and
24.9 is considered healthy, someone with anorexia though that has a BMI between 17 and 18.5
is considered mild, a BMI of 16-17 is considered moderate, a BMI of 15-16 is severe, and having
a BMI of less than 15 is considered extreme. People who meet all the criteria for anorexia
except that they are within or above the normal weight range after significant weight loss
can be diagnosed with atypical anorexia nervosa. Now in addition to having a low BMI, individuals
with anorexia are typically fearful of weight gain, and often have a psychological obsession
with the caloric and fat content of food, often leading to food restrictive behaviors,
purging, exercise, and frequent weight checks. They might perform specific food rituals,
like cutting food into small pieces, or eating foods in a specific order. They might refuse to ever eat in front of
people, or cook elaborate meals for others, but then not eat themselves. Like a dinner party host who’s unwilling
to eat his/her own food. Anorexia literally starves the entire body
and can cause a number physical changes affecting every body system, which can end up being
clues to the diagnosis. There is often a loss of muscle tissue throughout
the body, reflected by a low creatinine level and symptoms of fatigue from weak muscles
throughout the body, including a weak diaphragm which can cause difficulty breathing. Even the heart can lose muscle, and this loss
of cardiac muscle tissue can lead to bradycardia—less than 60 heart beats per minute, and hypotension—a
blood pressure below 90/50, as well as orthostatic hypotension when blood pressure falls when
a person goes from a lying down position to a standing position. A weak heart can lead to congestive heart
failure and combined with low protein levels in their blood can cause significant edema
or swelling, especially in the feet. There may also be serious electrolyte abnormalities
like low potassium, magnesium, and phosphate level, as well as key vitamin deficiencies
such as thiamine also known as Vitamin B1. Women can have amenorrhea, where either the
normal menstrual cycle stops or menstruation doesn’t start by age 15. Prolonged food restriction can also make the
gastrointestinal tract unable to handle normal meals which causes terrible bloating and nausea
as well as constipation. Also, the bone marrow can start shutting down—so
you get fewer white blood cells which leads to a dampened immune response, fewer red blood
cells which leads to lower energy levels, and fewer platelets which leads to easy bleeding
and bruising. Anorexia can also cause osteoporosis where
the bones become weak and susceptible to fractures. The skin can change, with symptoms like dry
scaly skin, and also the hair on their head can become brittle and fall out easily, and
soft hairs called lanugo covering their body. Some people might also have halitosis or really
bad breath from repeated vomiting. Finally, it can affect the brain, which causes
atrophy and encephalopathy, which can cause symptoms like ataxia, confusion, and even
death. In addition to these complications, there’s
also something known as refeeding syndrome where refeeding stimulates secretion of insulin,
which causes cells to take in already low levels of potassium, magnesium, and phosphate,
which causes levels in the serum to be dangerously low, and these deficits in electrolytes can
lead to severe heart arrhythmias and even cardiac death. This is why patients with anorexia typically
get an exhaustive medical workup and are carefully monitored with ECGs as they are slowly refed
and brought back up to a healthy weight. Pinpointing the exact cause of anorexia is
tough right? Because it’s likely a complex interaction
of various factors like genetic and hormonal factors, for example abnormalities in the
signals that convey information about hunger and fullness, as well as social/environmental
factors like peer groups and popular culture. In addition, anorexia is associated with low
self-esteem, loneliness, sensitivity to peer pressure, and feeling a need for approval. Individuals with anorexia might also chronically
over-react to stressful situations, and they might exhibit perfectionist behavior, and
might feel the need to have control of specific parts of their life—like their weight. There are also higher rates of anorexia in
countries where thinness is valued, which could reflect an internalization of societal
standards of beauty. Anorexia typically starts in the teen years
or in young adulthood—a time when individuals usually start to pay attention to the media,
and rates of anorexia are higher for individuals who have higher exposure to media. Also, although anorexia is more common in
women, it’s worth mentioning that men suffer from anorexia as well, and in both genders
it can often be seen among athletes and professionals who are keenly focused on their body weight
and percent body fat, such as in some types of dancing, modeling, and wrestling. Finally, anorexia is also commonly associated
with other conditions like obsessive-compulsive disorder, depression, and anxiety, all of
which have overlapping symptoms and risk factors. As far as treatments go, medical treatment
with careful weight gain is important, there is an important role for psychotherapy and
cognitive behavioral therapy for both the individual and sometimes the family as well. These therapies focus on improving self-esteem
and teaching strategies to better cope with stress and social pressures, as well as identify
the patterns of thought that may be influencing their illness. So we’ve seen that anorexia can affect nearly
every body system in profound ways, but careful management and treatment and ultimately a
healthy pattern of eating can reverse a lot of these complications and issues associated
with anorexia.

Only registered users can comment.

  1. I don't understand some words can you please put lyrics with some languages like French and arabic please ? I hope the best life for you.

  2. A simple comment: usually in anorexia there is no “binging” as they eat little amount while in bulimia they may eat a full meal and then they purge it
    The purge is what they have in common but the eaten amount is different

  3. Iam Anorexic as fuck and this is definitely a wake up call.But one question to Osmosis can lack of digestive enzymes cause my troubles to gain weight . ???

  4. you CAN be overweight and have anorexia. anorexia and bulimia are not the same thing, it doesn’t work that way.
    and no; it’s not true that anorexic people don’t eat at all, they restrict, of course- but they eat. they binge. they’re doing fasts. it’s much more than just being skinny and “not eating”.
    also body dysmorphia is another problem

  5. I never was over weight but u Der and I never wanted to be come. Less I actually don't mind being fatter

  6. I haven't eaten in a week. I've gone week(s) without eating before. I also constantly workout. I'm not sure if I'm anorexic. I'm 110 pounds and 5ft 2. I feel overweight even though people tell me I'm not. I get bloated easily and I'm alwags sleepy. I have constant headaches and dry skin. Idk what's wrong with me.

  7. I have no clue if I have anorexic … I just think about food so much of not wanting to get fat anymore … so I eat a little bit a day.. or once a day … I used to weight 190 but now I’m at 148… I keep loosing and loosing … and I’m 19 years old 5’0 I was always overweight …

  8. I’m actually really complicated. I started binging and purging a while ago but only really done it one or two times. I stopped cuz I guess it just wasn’t for me. Then I stopped that and started restricting big time. Like not eating till 6:00 and then only having a snack. Now I restrict more but I try to keep it under control and don’t let it go too far up to the point to where I’m dizzy. I know what the cause is: bullying from my family because I’m fat. Telling me about how I look like a balloon or that I’m the only one that’s fat in my family. And I guess I got tired of it. Now this is my way of trying to fix it and become a good weight I want to be and I guess also relief system. I’m 14 at the moment but I guess age doesn’t really matter anymore 😅😐😐

  9. It's crazy because a girl was denied hospitalization when she clearly had the MENTAL ILLNESS anorexia , they told her she's not skinny enough or anorexic enough to get treatment. That needs to Change WTF anorexia is not a virus in your body that makes you lose weight It's mental

  10. im 45 kg, 166 cm (99 pounds, 5'6") and i can have restrictive type behaviours. i have anxiety and get anxious over my weight, my heaviest was only about 47 kgs (103 pounds) and i tend to either not feel hungry or ignore my hunger. i dont think im anorexic because i dont restrict that much and i do not purge but i am very sensitive about the topic of weight. my genetics also help with me being very thin, but i do not like the way i look. i know i have to gain weight but i feel sick at the thought of doing so. im very confused and have been for a long long time. please help.

  11. I think I have mild anorexia because I don't eat that much and whenever I do, I just throw it up. But then again I might just be over reacting since I have anxiety. Idk.

  12. i clicked off as soon as it said “bulimia is where you’re overweight and anorexia is where you’re underweight” WRONG.

  13. Yangzi Li hey quick Question am I at risk for Anorexic? Some times I can be over obsessed with my weight at times and some times I do feel like I’m fat even know I weight 120Lbs 5’3 is my height .. also I do feel guilty eating little sweets 🍭 stuff ! I do feel guilty eating sweets or eating crackers and stuff ! I do feel like I would gain weight if I eat sweets now and than

  14. I am 87 pounds and 5'1 height( 154 cm, 39kg) and I'm really checking my weight daily and the calories. I feel that I not thin even so people say I am. I don't want to eat because I afraid I could gain weight. Am I healthy ?

  15. I’m 14, and I’m overweight. I’d honestly rather have anorexia, or even be dead than be the way that I am now. I have been starving myself for 1 day now, and I’m going to continue. I’ve purged a few times in my life, and I often think about starting again.. My weight really bothers me, but I can’t seem to lose weight even when I exercise daily. I only lose it when I starve myself. I’m over being fat, and I hope to be skinny soon if I continue starving myself.

  16. NO

  17. In the video they forgot to mention that when you have anorexia you sometimes have a kind of weird fear of eating…

  18. I don't understand me, I feel like every compliment I've gotten was…a lie. I don't eat as much as I used to, and don't like going in public very often anymore. This started about a week…. five days ago. If you've watched Jaden animations, you know what I feel like.

  19. I have anorexia.. I get forced to eat and I can't even control 1 meal . It makes my stomach hurt so much and I get so stressed out hais

  20. I'm diagnosed with a typical anorexia nervosa, and I'm underweight. It's bc I still have my period. A typical just means, that you don't "full fill" every criteria that is "needed" for anorexia.

    Also, for all ppl reading this: every struggle is valid. You're beautiful. Stay strong. 🌹

  21. Anorexia is a mental illness which effects your body. I have anorexia which has an effect on my body but it causes problems for me mentally and emotionally too.

  22. This pisses me off. You do know that half the time anorexic people are overweight? You know overweight people exist, right? Its not always teenage girls that are like 40 pounds who are anorexic you inconsiderate pieve of shit.

  23. Anorexia has no weight limit. You can be at a normal weight or overweight and still exhibit anorexia symptoms.

  24. THANK YOU SO MUCH!! for explaining all the stigmas that are often damging Anorexics and preventing them from seeking help that is.

  25. I'm anorexia and my BMI is around 15.6. I'm under a medication. Maintaining my weight is the hardest thing for me though.

  26. I think these words are really important.

    We are inspired every day by the standards of beauty. Every day we look at the perfect photos in social networks, in magazines and think about what is wrong with us, but the whole point is that everything is so with us.

    I had a period in my life when I listened to the opinions of other people, of course, I inspired myself that I did not listen to anyone, but it was actually – I absorbed like a sponge, absolutely everything I was told. The people around me were talking about other people, discussing their bodies and what they should have removed, these people were making fun of me, so I thought there was something wrong with me.

    What were my actions? I stopped eating, hoping I'd lose a few extra pounds and people would love me. I thought about other people's love for me, but I had forgotten that the most important thing was my love for myself.

    Every day I killed my body, chased after what society had imposed on me. I was looking for food on rock, rock it does not want to eat. I thought that if my legs got thinner, I would love myself, but that didn't happen, I hated myself even more. I've been recovering for years and all because of the words of others.:

    You're fat.
    You're too skinny.
    – You have small Breasts.
    – Your Breasts are too big.
    – Have you seen your feet?
    – What's wrong with your nose?
    – You think it's okay to wear that shirt with your shoulders?
    What about your skin?

    You know what? Spit. I'm fat. I'm skinny. And I have small Breasts. Yes and with with with their feet I have indeed something not so. I agree, my nose is strange.

    Every day it hurts me to realize how many people do not like themselves, how many people sit on strict diets and every day passing by the mirror thinking: "why was I born this way?".

    I hate beauty standards. I hate people who say, "Oh, look at her feet, look at her face, what about her clothes?". And I'm proud of every person who tries to love themselves, because I know how difficult it is.

    Accepting yourself is always a very long way. And I feel sorry for people who do not understand this and easily destroy someone's love for themselves. There's no problem with you, there's trouble in the minds of the people who are trying to humiliate you.

    Always remember that you don't need reasons why you're beautiful. You're beautiful because you're you. There's a whole universe inside you, so I don't care what they say.

  27. I have most of theese symptoms, i am 11 and weigh 23.7 kg. Should I seek help? I mean I am still trying to lose weight and i still have a bumch of fat on my chest… my view isnt really distorted

  28. If you ask someone to describe the appearance of an anorexic, they will say a skeletal white teenage girl, I garuntee that as long as neither they, a friend or family member have experienced anorexia then they will say at least one of those adjectives but listen to me, the next obese black adult man you pass by in the street could be suffering with anorexia so if your overweight friend or your boyfriend or an elderly person who you are close to opens up about their restrictive eating disorder, believe them, don’t ask them ridiculous questions like “why aren’t you skinny?” or “but I thought guys can’t develop anorexia?” because that is nonsense, what they need is professional help so get them the help they need.

  29. I could never be aneroxic if I refuse to eat my mom said she will send me to a mental hospital 🏥 and I cause a lot of problems due to my insecurities….well……"….I ruined a family road trip cause I kept crying how ugly and untall iam…..I still do…just…not in front of people"………..I am not eating maybe only short portions of food only really,small,…I hate my height….im 11 and 5,3I hate it.inwosh I was a beautiful model the perfect body slim tall

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