Anorexia

What is anorexia?

Anorexia nervosa (also referred to simply as anorexia) is a condition characterized by significant weight loss due to an intentional attempt to restrict eating. While the word anorexia is Greek for "without hunger," this can be a misnomer.  Some people find that they lose their sense of hunger, but other people with anorexia just develop a tolerance for feeling hungry all the time. In their lifetime, .5% to 3.7% of females will suffer from anorexia. Approximately 5-15% of the total number of people with anorexia and bulimia, will be male, however. (For more information about this group, see our page on Eating Concerns and Men.) A formal diagnosis of anorexia is made when someone:

  • Refuses to maintain body weight at or above a minimally normal weight for age and height (< 85% of ideal body weight)
  • Has intense fear of gaining weight or becoming fat, even though their weight is normal or low
  • Has a disturbance in the way his or her body weight or shape is experienced
  • Experiences undue influence of body weight or shape on self-esteem
  • Denies the seriousness of current low body weight
  • (If a female) Loses their menstrual period for at least three consecutive months.

Anorexia can also present as two different sub-types.  Many people with anorexia tend towards the restricting type, where types and amounts of foods are limited and no bingeing or purging behavior is present.  Others will alternate between dietary restriction and periods of bingeing or purging (e.g. self-induced vomiting, and misuse of laxatives, diuretics, and exercise).

Someone might meet all of the diagnostic criteria for anorexia, or he or she might meet just a few.  What’s most important is getting expert help as soon as possible in order to prevent health risks and allow them to feel better.  The consequences of  anorexia are serious, and can result in life-long damage to health, or even death.

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What are the physiological and psychological complications of anorexia nervosa?

  • Hair loss
  • Dry skin
  • Bruises
  • Cold and blue hands and feet
  • Delayed puberty: preadolescent females fail to menstruate and develop breasts at normal age. In males, testosterone levels might remain low, leading to impotence.
  • Amenorrhea (in females): As the body registers too great a caloric deficit, estrogen levels drop and menstruation ceases, increasing the risk for erosion of bone density (osteopenia, osteoporosis) and infertility.
  • For males, undernutrition and weight loss can lead to changes in testosterone levels, also resulting in weaker bones and increased risk for fractures.
  • Permanent bone loss: susceptibility to stress fractures and osteoporosis
  • Mood changes: impatience, irritability, depression, suicidal tendencies
  • Insomnia, constipation, sensitivity to cold, kidney failure, abnormally low heart rate and blood pressure
  • Cardiac arrythmias, heart failure, death

Why would anyone DO this to themselves OR Why can’t people with eating disorders just STOP?

It can be difficult to understand why anyone would repeatedly engage in a behavior that is ultimately harmful, but it’s important to remember that eating and exercise disorders are, first and foremost, an attempt at a solution.

Eating disorders often begin with a sense of dissatisfaction that is perceived to be about the body.  People start to diet or exercise, never intending or anticipating that they will develop a serious problem.  As they engage in the dieting and exercise behaviors, however, and particularly if their efforts are praised or reinforced by other people, the changes in behavior and changes in body size and shape can begin to take on powerful psychological functions.  People may find that the disorder provides them with a sense of control, self-esteem, identity, power or safety that felt lacking for them previously.  Suddenly, they find that the choice of what to have for breakfast, or whether or not to exercise, is emotionally “loaded” out of all proportion to rationality, and because of that, it becomes enormously difficult to challenge the disordered behaviors, even if they know the consequences are negative.  That eating disorders take on a life of their own psychologically, is strongly reinforced by genetic susceptibilities that can heighten an individual’s response in terms of brain chemistry, metabolism, and other important physiological processes.

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What is the role of genetics and biology?

It is now becoming clear that genetics and biological predisposition play a critical, though not exclusive role in the development of an eating disorder. Studies of people with anorexia and bulimia have found links to specific chromosomes, and a 2006 study led by the University of North Carolina, Chapel Hill, estimated that 56% of the responsibility for developing anorexia nervosa is determined genetically. Other studies have examined variations in serotonin and dopamine receptors in patients with anorexia and bulimia which could serve to reinforce eating disorder symptoms like food restriction.

What is the significance of biological predisposition for people with eating disorders?

Firstly, it can lessen some of the shame and blaming that goes on when someone develops an eating disorder. Too often, people with eating disorders blame themselves for becoming preoccupied with food and their bodies, not realizing the extent to which these obsessions can be driven by biological susceptibilities. People can be much more compassionate with themselves when they understand that—even though there may have been times when they’ve consciously chosen to use a disordered behavior in order to cope—they didn’t choose the disorder itself. Understanding the biological contribution may also allow some people to feel less shame about utilizing psychiatric medications like antidepressants or anti-anxiety drugs as part of their recovery.

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Does this mean that socio-cultural factors aren’t important in the development of an eating disorder?

Not at all. Plenty of people have variable neurotransmitter levels and do not struggle with eating or body image, and many other people with eating disorders have no corresponding predisposition. Even for people with a predisposition, it is the environment in which they live that can mitigate or promote the expression of their genetic tendencies. This is one of the reasons that it remains critical to address the “thinness culture.” Another is that dieting—with its potential for malnourishment and disruption of brain chemistry—can contribute to an existing problem in susceptible individuals, or create a completely new one to deal with. In fact, dieting has been called “ a necessary, but not sufficient condition for the development of an eating disorder.” When it comes to understanding and treating eating disorders, it’s important to think in terms of both nature AND nurture.

Denial

In a culture that glorifies body types radically at odds with physiological health, and that normalizes extremes of behavior with dieting and exercise, it can be difficult for someone with an eating disorder to believe that they have a problem with food, exercise, or weight.  Even if he or she is able to acknowledge some concern, the fear of losing what might feel like their primary source of safety or self-esteem is often powerful enough to make them want to defend or preserve this way of coping.

Dan Reiff,  MPH RD, and co-author of Eating Disorders: Nutrition Therapy in the Recovery Process, uses an analogy he calls “The Helicopter Story.”  In it, he likens the ambivalence of someone considering eating disorder recovery to a person, unable to swim, who has been stranded in the middle of the ocean with only a life-jacket to keep them afloat.  Rescue by helicopter will prevent them from ultimately drowning or dying of hypothermia, but the helicopter team tells the swimmer that he or she will need to give up their life-jacket in order to be pulled on board.  It’s a daunting prospect, and it’s also the reason why people with eating disorders need time and lots of expert support in order to give up their behaviors and recover completely.

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How do I help a friend who has an eating disorder?

If you are worried that a friend has anorexia, click for information and resources.

Is recovery possible?

When medical support, nutrition work, and psychotherapy are utilized, recovery is completely possible for individuals with anorexia.  Chances for complete recovery are highest when people receive early, expert treatment at the right level of intensity.

To get the support that you need at Brown University, follow the links below.

Resources at Brown

BWell Health Promotion 401.863-2794
Located on the third floor of Health Services.
Confidential information or care is available through individual appointments or phone consultation with a Nutritionist.  Students can discuss personal eating concerns, as well as any concerns they may have regarding a friend, a roommate, or a teammate. Health Promotion also offers workshops, pamphlets, and reading materials covering these and related issues. There are no fees for Health Promotion services.

University Health Services 401.863-3953
Located at the corner of Brown and Charlesfield streets.
Confidential information and care is available on a walk-in, or by scheduled appointment basis. Care is available for initial, current or past disordered eating patients. There are no fees for medical care at Health Services. However, there may be fees incurred if laboratory tests, medications, specialist or emergency hospital care is needed.

Counseling and Psychological Services 401.863-3476
Located on the fifth floor of J. Walter Wilson.
Confidential appointments are available at Counseling and Psychological Services for students concerned about their eating issues. Guidance is also available for those who are concerned about a friend, roommate, or teammates' eating. Services include crisis intervention, short-term psychotherapy and referrals. There are no fees for appointments at Counseling and Psychological Services.

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Links you can use

Body Positive 
This site looks at ways we can feel good in the bodies we have. One of their slogans: "Remember, your body hears everything you think." Other topics on the web site: Size Acceptance; What do you say when everyone around you is dieting? 200 Ways to Love the Body You Have; Dieting Detox; Evaluating Weight Loss Programs: What are the Red Flags? Free subscription to email newsletter "Body Positive Pages."

Something Fishy
This site provides signs of eating disorders, motivational support talks, information on cultural issues and how to help loved ones.

National Association of Anorexia Nervosa and Associated Disorders

National Eating Disorders Association
This site provides general information about eating disorders and body image concerns, tips for helping a friend and referral sources.

Eating Disorders Referral and Information Center
Provides information and treatment resources for all forms of eating disorders.

The American Dietetic Association 
Articles from the ADA on eating disorders, including The Female Athlete, Compulsive Eating and Anorexia.

Adapted from the Boston College Eating Awareness Team

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Disclaimer: BWell Health Promiotion is part of Health Services at Brown University. Health Promotion maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Promotion offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.