What is Anorexia Nervosa (AN)?
Anorexia Nervosa (AN) is an eating disorder diagnosis as per the DSM-V (Diagnostic and Statistical Manual of Mental Disorders - 5th Edition). It is classified under the disorder class “Feeding and Eating Disorders”. The DSM-V criteria are listed here for reference:
A. Restriction of energy intake relative to requirements, leading to a significant low body weight in the context of the age, sex, developmental trajectory, and physical health (less than minimally normal/expected).
B. Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain.
C. Disturbed by one’s body weight or shape, self-worth influenced by body weight or shape, or persistent lack of recognition of seriousness of low bodyweight.
D. In menstruating females, absence of at least 3 consecutive non-synthetically induced menstrual cycles (Previously in the 4th edition but has since been removed in the 5th edition)
With the Anorexia Nervosa (AN) diagnosis there are specifications regarding behaviors. They are listed below:
Restricting type: During the last 3 months, has not regularly engaged in binge-eating or purging
Binge-eating/purging type: During the last 3 months, has regularly engaged in binge-eating or purging
Partial remission: After full criteria met, low bodyweight has not been met for sustained period, BUT at least one of the following two criteria still met:
Intense fear of gaining weight/becoming obese or behavior that interferes with weight gain
OR
Disturbed by weight and shape
Full remission: After full criteria met, none of the criteria met for sustained period of time.
Atypical Anorexia is another diagnosis that includes individuals who meet all the criteria for Anorexia Nervosa (AN) but are not underweight despite experiencing significant weight loss. Research studies have shown there is no difference in the medical and psychological impacts of both Anorexia Nervosa and Atypical Anorexia - meaning both are severe and deserve quick and immediate treatment.
Something I discuss with clients and families often is that diagnostic criteria is necessary in the medical field. However, I treat conditions, behaviors and symptoms, not diagnoses alone. This means, that not everyone may fit the exact criteria mentioned prior but they are no less deserving of adequate care and support.
Our society is very focused on, and idealizes, thinness and restriction of food. Deb Burgard, a psychotherapist and one of the founders of Health at Every Size®, stated, “ We prescribe for fat people what we diagnose as eating disordered in thin people”. Because of this unfortunate dynamic it can be very hard to know if someone is struggling with an eating disorder such as Anorexia Nervosa (AN). Body size is not the only indicator of an eating disorder occurring and people of all body weights can be diagnosed with an eating disorder. This is why it is important to be aware of the signs and symptoms.
Signs of Anorexia Nervosa (AN):
Weight loss (see DSM-V for further details)
Body dysmorphia, fear of gaining weight, body image distress
Denial of hunger or lack of hunger cues - this may include things such as skipping meals, taking smaller portions of meals than before, etc.
Rejection of foods enjoyed in the past
Rigidity around food, concerns regarding counting things such as macros, calories, portions, measurements, etc.
Increase/exacerbation of current mental health concerns including anxiety and depression
Isolation - eating alone, withdrawal from friends and family, negative mood changes and demeanor
Extreme exhaustion and fatigue
Feeling cold
Sleep disturbances
Stress surrounding movement and/or exercise, rigidity in schedule, length of time spent, etc.
Wearing baggy clothing or many layers of food
Dangers of Anorexia Nervosa (AN)
Anorexia Nervosa (AN) has the highest mortality rate of all psychiatric diagnoses. For this reason, providers in the field recommend an individual showing signs or symptoms of an eating disorder, especially AN, receive quick and immediate care from an eating disorder specialized provider to address medical stability and plan of care.
The following are some medical complications and dangers of AN:
Low blood pressure
Vitamin and mineral deficiencies
Poor circulation
Gastrointestinal issues
Muscle loss
Slow and/or irregular heartbeat
Abnormalities of menstruation - hormonal fluctuations
Weak or brittle bones - possible osteoporosis development and frequent fractures
Dehydration and electrolyte imbalances (could lead to seizures)
Edema (swelling)
Decreased growth hormone leading to delayed physical growth/maturation
Delay in puberty
Infertility
Growth of fine, downy body hair (lanugo)
Dry skin, brittle nails, and thinning hair
If you or someone you know is struggling with any of these behaviors, please encourage them to reach out for help immediately. Early intervention significantly increases the likelihood of sustained recovery.
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Note to Self Nutrition LLC is an outpatient dietetics practice specializing in the treatment of eating disorders, women’s health and fertility including PCOS, endometriosis, and hormonal imbalances, diabetes and prediabetes, disordered eating, along with other chronic health conditions such as heart health, hypertension, and kidney disease. Owner and dietitian Lauren Hirschhorn-Tieu is passionate about empowering individuals to build trust with their relationship with food and their body. Lauren provides multiple services including nutritional counseling, recovery coaching, supervision and nutrition presentations. In person availability is offered in Denver. Virtual telehealth services are offered in Maryland, Virginia, Washington DC, Colorado, and Florida. We would be honored to join you on your journey to discovering food and body peace!
Contact us for more information regarding our services offered. To schedule a discovery call please visit this link. Be sure to visit our website and sign up for our newsletter at the bottom of the page.
Cited:
Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 19, DSM-IV to DSM-5 Anorexia Nervosa Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t15/
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