The main feature of this ailment is the refusal of food. The term anorexia (literally lack of appetite) is not correct to describe a disorder in which the appetite is in most cases preserved. Rather, what characterizes the anorexic person is the fear of gaining weight and the need to control nutrition in search of thinness.

In subjects with symptoms of anorexia nervosa, self-esteem levels are strongly influenced by physical fitness and body weight. Weight loss is seen as an extraordinary achievement and a sign of iron self-discipline, while weight gain is experienced as an unacceptable loss of control skills. Let’s discover more about symptoms of Anorexia and treatments.

Anorexia nervosa symptoms

A person is anorexic if they exhibit the following characteristics:

• Restriction of calorie intake in relation to needs. This leads to significantly low body weight with respect to age, development and physical health.
• Intense fear of gaining weight or becoming fat.
• Excessive influence of body weight or shape on self-esteem levels.

Two types of anorexia nervosa are also identified:

1. Restricted type: In the past 3 months, the person has not had any episodes of binging or purging. Weight loss is achieved mainly through diet, fasting and / or excessive physical activity.
2. Type with binge eating / purging: in the last 3 months, the person has had recurrent episodes of binging or purging (eg self-induced vomiting, use of laxatives, diuretics).

To avoid gaining weight, those suffering from the symptoms of anorexia implement a series of typical behaviours of the disorder. For example:

• follow a strict diet
• exercising excessively
• induce vomiting after eating even small amounts of food

Diffusion and causes of anorexia

The incidence of anorexia nervosa seems to have been stable since 1970 at around 5-5.4 cases per 100,000 inhabitants per year. The peak of incidence is between 15 and 19 years. Around this age, in fact, the adolescent finds himself having to deal with sexuality and changes in his own body. It rarely occurs in the prepubertal period, although in such situations the clinical picture would be more serious. The disorder rarely occurs in women over the age of 40.

The prevalence of anorexia  appears to be far greater in industrialized countries, where there is an abundance of food and where the value of thinness is emphasized. This eating disorder occurs mainly in women .

The entry into anorexia nervosa almost always passes from the beginning of a diet. In any case, from a voluntary attempt at weight loss aimed at achieving that ideal of feminine beauty so much praised by modern society.

The causes of the eating disorder are not known, but individual risk factors can be identified:

• Conditions present in family members (for example, the presence of an eating disorder in one of the parents or obsessive and perfectionistic personality traits ).
• Experiences prior to the onset of psychopathology (relationship problems with parents, sexual abuse, experiences of derision due to the weight or shape of the body).
• Individual characteristics such as low self-esteem , perfectionism , anxiety and anxiety disorders, etc.

Course of anorexic disorder

The evolution and outcomes of anorexia nervosa are extremely variable. In some cases, a complete remission follows an episode of anorexia. In others, phases of remission, with body weight recovery, alternate with phases of exacerbation. Still others show a chronic evolution, with progressive deterioration over the years.

Admission to a hospital setting may be necessary for weight restoration or correction of electrolyte imbalances. Among those admitted to university facilities, long-term mortality from anorexia nervosa is greater than 10%. Death generally occurs in relation to malnutrition, electrolyte imbalances, suicide.

Factors of maintenance of anorexia

• The main specific maintenance factor is the overestimation of weight, body shape and control. These are used as the main way of evaluating oneself and one’s own worth.
• The strict diet represents both a symptom and a powerful maintenance factor for the psychopathological core.

A strict diet produces another symptom, low weight, which in turn causes malnutrition syndrome. In addition to causing physical damage, the low weight contributes to triggering concerns about nutrition, food and the body. This effectively maintains the food problem.

Frequently, in addition to the strict diet, excessive and compulsive physical exercise also occurs. This keeps worries about body shape and weight control.

People with anorexia nervosa place excessive value on physical appearance and body weight. Some feel fat in reference to the whole of their body. Others, while admitting their own thinness, perceive some parts of the body as “too fat”. Typically these are the abdomen, buttocks and thighs.

They can use a variety of techniques to assess body size and weight. For example, weigh yourself constantly, obsessively measure yourself with the measuring tape, or check the parts perceived as “fat” in the mirror. Frequent body checks act as maintenance factors. In fact, they increase concerns about the slightest variations perceived or recorded and encourage a strict diet.

Effects of malnutrition

Although some anorexic people may become aware of their own thinness, they typically deny the serious physical health consequences of their condition. Many signs and symptoms of anorexia are related to extreme malnutrition. In addition to the absence of menstruation (amenorrhea), they may complain of:

• constipation
• abdominal pain
• cold intolerance
• lethargy or excess energy
• marked hypotension
• hypothermia
• dry skin
• lanugo (a fine, soft down) on the trunk
• bradycardia

In those who engage in the practice of self- induced vomiting , we can also find erosions of the dental enamel. In addition, there are scars or calluses on the back of the hands. These are caused by rubbing against the dental arch in an attempt to induce vomiting.

A state of malnutrition also causes emotional and social changes such as:

• Depression
• Anxiety
• Irritability and anger
• Swings in mood
• Social isolation

There are also cognitive modifications such as:

• Decreased ability to abstract thinking
• Decreased ability to concentrate

Anorexia cure

Treatment of anorexia should ideally be conducted on an outpatient basis. However, this condition is not always possible and only indicated for patients with some characteristics:

• BMI not less than 15
• absence of medical complications
• real motivation for change
• presence of a favorable family environment

If not, specialist hospital intervention may be appropriate.

Psychotherapy for anorexia nervosa

All proven treatments for anorexia nervosa are psychological in nature.

At present, research shows that CBT-E cognitive behavioral therapy represents the best therapeutic choice for eating disorders.

CBT-E (Enhanced Cognitive Behavioral Therapy) developed at the University of Oxford by Christopher Fairburn. It is a specific form of cognitive behavioral therapy focused on the psychopathology of the eating disorder.

CBT-E aims to address the specific psychopathology of the eating disorder and the processes that maintain it. Adopt specific strategies and tools aimed at modifying problem behaviors and reducing the absolute need for thinness.

The  treatment of anorexia involves 3 steps:

1. The goal of the first step is to help people come to the conclusion that they are addressing their food problem. That is, we need to prepare them for an active change.
2. Step two has two objectives: to help the person with anorexia to reach a low healthy weight (BMI between 19 and 20) and to address psychopathology (eg body image module). Also within step 2, we work on the recognition of problematic mental states in order to avoid setbacks. The duration of this step depends on the amount of weight that needs to gain.
3. The last step aims to address the concerns related to termination of treatment and to prevent the risk of relapse.

Drug therapy of anorexia

Pharmacological studies are scarce and do not demonstrate a beneficial effect of drugs on the disorder. The most sensible approach is to not use any drugs in the acute phase of weight loss. This is because  depressive and obsessive-compulsive symptoms often decrease with weight gain.

If, however, after reaching an adequate body weight, depression persists, the use of antidepressants may be helpful.