Anorexia

Concerns about body image manifest their effects in many sectors today. People involved in professions such as actors, models, ballet dancers, martial artists, and long-distance runners may be under intense pressure to maintain or reduce their body weight.

Anorexia: Definition, Symptoms, Diagnosis, and Treatment
Concerns about body image manifest their effects in many sectors today. People involved in professions such as actors, models, ballet dancers, martial artists, and long-distance runners may be under intense pressure to maintain or reduce their body weight. Especially the portrayal of thin body types as synonymous with high self-esteem by media organizations can lead to uncontrolled weight loss practices. Anorexia nervosa is a health issue that causes excessively low body weight due to the restriction of the energy intake needed. Individuals with anorexia may not realize that their body weight is critically low due to a distorted perception of a healthy body image.

Anorexia, one of the common eating disorders, is often observed in women. It can emerge during early adulthood or late adolescence and can be influenced by biological, psychological, and environmental conditions. Factors such as childhood obesity, mood problems, sexual abuse, family or peer pressure, and social media can pose risks for eating disorders like anorexia. It is often found alongside depression and anxiety. Particularly in patients with anorexia nervosa, brain functions, dopamine and serotonin hormones, and habitual behaviors may change.

What is Anorexia?

Anorexia nervosa, or anorexia, is an eating disorder characterized by abnormally low body weight, an intense fear of gaining weight, and disturbances in weight perception. Individuals with anorexia tend to significantly restrict the amount of food they consume to prevent weight gain. However, behaviors such as using laxatives, diuretics, and enemas after eating, vomiting, and excessive exercise can occur. As a result of these actions, significant weight loss can happen in a short period, leading to an excessively low weight. These individuals may exhibit extreme efforts and interventions in controlling their weight and body perception. Anorexia, a physiological and psychological disorder, causes individuals to fear being overweight or gaining weight regardless of how much weight they lose. Therefore, underlying traumas, mood disorders, perfectionism, and other emotional issues may be hidden behind anorexia. Weakness may be equated with self-esteem.

Anorexia nervosa can be divided into two subtypes:

1. Restrictive type anorexia: In cases of this type of anorexia, individuals severely restrict the types and amounts of food they consume. Behaviors such as eating only certain foods, counting calories, skipping meals, and cutting carbohydrates may be observed.
2. Binge-eating and purging type anorexia: Individuals with anorexia apply extreme restriction and low food intake. However, this can be followed by binge-eating and purging behaviors. While binge-eating, the person may lose control and later engage in compensatory behaviors due to regret. These behaviors may typically manifest as vomiting, using diuretics, enemas, or laxatives.

Despite experiencing significant weight loss, individuals with anorexia may perceive themselves as overweight. Therefore, anorexia can reach dangerous levels and lead to life-threatening consequences due to malnutrition.

What Are the Symptoms of Anorexia?

The most prominent symptoms of anorexia may include significant weight loss over a short period, fluctuations in weight, and a Body Mass Index (BMI) below 18.5 kg/m². However, the symptoms of anorexia are not solely about losing weight or being thin. Other physical signs that may indicate anorexia include:

• Dizziness
• Slowed breathing and pulse
• Fatigue, weakness, and lethargy
• Pale, dry, cold, and yellowish skin
• Irregular menstruation in women
• Decreased libido in men
• Digestive issues and food intolerances, such as constipation, diarrhea, and bloating
• Disturbances in sleep patterns
• Fine hair on the face and body
• Muscle and bone loss, anemia
• Brittle hair and nails

In addition to physical symptoms, certain psychological and behavioral signs may indicate anorexia. The psychological effects of anorexia may include:

• Difficulty concentrating
• Depression, anxiety, and stress
• Feelings of worry and restlessness during mealtimes
• Preoccupation with body shape, weight loss, and rigid diets
• Low self-esteem and self-worth

Behavioral signs often manifest as counting calories, engaging in eating rituals, obsessing over recipes, displaying compulsive behaviors regarding body shape (such as measuring the waist and wrists), excessive exercise, and using laxatives, enemas, etc.

What Causes Anorexia?

Although the main cause of anorexia nervosa is not yet definitively known, many different factors can contribute to the development of anorexia. A combination of environmental, cultural, genetic, and social factors may create a predisposition to anorexia. Some conditions that may lead to anorexia nervosa include:

• Tendency toward depression, stress, and anxiety; controlling and perfectionistic personality traits
• Low self-esteem, obsessive-compulsive disorder
• Relationship problems, traumatic events such as sexual abuse
• Exposure to zero-size body perception in social media, magazines, and TV programs
• Disruption of the ideal body image in the fashion industry, ballet, bodybuilding sports, etc.

Additionally, a predisposition to anorexia nervosa may be genetic. However, excessively restrictive diets can alter body and brain structure and disrupt hormonal balance.

How is Anorexia Diagnosed?

The DSM-5 criteria, based on the American Psychiatric Association, can be used for diagnosing anorexia nervosa. The necessary criteria for anorexia include:

• Severe caloric restriction resulting in weight loss and having a body weight significantly lower than what is expected for the individual's age, gender, and height
• Fear of gaining weight and being "overweight/obese"
• Distorted evaluation of body weight and shape, denial of the medical seriousness of low body weight

Even if the DSM-5 criteria do not meet all requirements, an eating disorder may still be present. In this case, a comprehensive examination may be necessary for diagnosis. Investigating family and social history, medication history, psychiatric history, abuse, etc., may be part of the diagnostic process. Weighing, measuring body dimensions, and evaluating dietary patterns are important. Blood tests, metabolic profiles, hormone tests, and urine tests may be conducted. An electrocardiogram and echocardiogram may be recommended for diagnosing heart conditions that could lead to life-threatening arrhythmias.

Infectious Nature of Anorexia

Eating disorders such as anorexia nervosa are believed to have strong effects on individuals and within society, which can lead to viewing them as infectious. The contagion is more of a “social transmission” rather than a physical one. It can be said that eating disorders, especially among teenage girls, are commonly observed in high schools, universities, or student dormitories. Peer pressure, low self-esteem, and distorted body image can trigger the risk of developing eating disorders. However, the development of eating disorders among individuals with anorexia nervosa is not always automatic in their surroundings. This situation may indicate a predisposition among those exposed to the same risk factors.

With advancing technology, the use of social media has become widespread. Social sharing, advertisements, and social norms can influence the formation of body image and promote weight loss. Research has shown that approximately 69% of high school girls from grades 5 to 12 are affected by the ideal body types portrayed in magazines.

Treatment of Anorexia

The first step in treating anorexia nervosa involves refeeding interventions. The refeeding of individuals with anorexia is specifically tailored and may require fine adjustments. This can be explained as the body showing some side effects during the refeeding process after being at low weights for an extended period. The goal following weight gain may continue as a process of tolerating the ideal weight, maintaining the weight, and regaining weight. The nutritional process, led by doctors and dietitians, may require hospitalization and regular monitoring. Additionally, psychotherapy alongside nutritional care can positively influence the recovery process. Cases without psychological counseling may be at risk of relapse. Commonly used psychotherapy methods for eating disorders include individual therapy, cognitive analytical therapy, cognitive behavioral therapy, group therapy, and interpersonal psychotherapy.

There is insufficient evidence regarding the use of medication in cases of anorexia nervosa. Medication is generally considered for managing symptoms of issues such as depression, often in the form of antidepressants. Some literature suggests that certain antipsychotic medications can stimulate weight gain. Conversely, the use of medications can be dangerous, especially in patients who are prone to cardiac problems and malnourishment.