Understanding and Preventing Anorexia Nervosa

Anorexia nervosa is an eating disorder with an excessive fear of gaining weight. People with this condition will do anything to lose weight. If left untreated, anorexia nervosa can trigger serious health problems due to extreme nutritional deficiencies. Anorexia nervosa is included in mental disorders because of the wrong perception of body weight. Anorexia sufferers always feel that they are fat so they will continue to try to be thin.

However, the methods used to lose weight are often extreme, even when the sufferer’s body is already very thin. This eating disorder not only damages the function of the body’s organs, but also risks triggering serious mental problems.

Anorexia nervosa is not caused by a specific condition, but is influenced by factors, such as the environment, psychology, and biology, of the sufferer.
Here is the explanation:

• Biological Factors
  Anorexia nervosa can be influenced by inherited conditions from family members who have similar eating disorders. Growing up with a family with an eating disorder can make a child become a perfectionist or obsessed with their weight. In addition, changes in dopamine and serotonin hormone levels can also cause someone to experience anorexia. Disturbances in these hormone levels can make them feel anxious, then try not to eat to cope. This can develop into anorexia nervosa.
• Psychological Factors
  Anorexia nervosa generally arises from the sufferer’s lack of confidence in their own body. As a result, sufferers try hard to reduce the amount of food they should consume. Sufferers also often have perfectionist personalities so they are never satisfied and want their bodies to always be thin. A number of anorexia sufferers suffer from anxiety disorders or obsessive-compulsive behavioral disorders (OCD). This condition causes them to be stricter in refraining from eating so that it develops into anorexia nervosa.
• Environmental Factors
  The occurrence of anorexia nervosa cannot be separated from social assumptions that associate a thin body with standards of beauty, happiness, and even success. This demand can encourage someone to be thin even in unhealthy ways. In addition, peer pressure can also strengthen someone’s desire to have a thin body. This generally occurs in the circle of teenage girls. However, teenage boys can also experience it.
• Risk Factors for Anorexia Nervosa
  There are a number of factors that can increase a person’s risk of experiencing anorexia, namely:

• • • Female gender.
    • Teenage age.
    • Autoimmune diseases that attack the digestive system, such as type 1 diabetes, or inflammation of the intestines.
    • Demands of activities or jobs that require the body to be thin, such as models, cheerleaders, and ballet dancers.
    • Trauma due to bad experiences, such as sexual harassment or bullying related to weight or body shape.
    • Psychological problems, such as not liking your own body shape, low self-esteem, having high standards for body shape (perfectionism), severe stress, depression, or anxiety disorders.
    • The assumption and pressure in society that the perfect body shape is a slim body.
    • Lack of good nutritional intake due to being born premature or with low birth weight.

Anorexia nervosa can cause various symptoms, including changes in the physical appearance, behavior, and emotions of the sufferer. It is important to note that people who appear thin do not necessarily suffer from anorexia, but it could be caused by other medical conditions. In addition, not all sufferers of this eating disorder appear thin. This is because some of them often hide the symptoms of anorexia.

Symptoms of anorexia are generally characterized by the appearance of the following complaints:

• Physical Symptoms
  Some of the symptoms and physical signs experienced by anorexia sufferers are:

• • • Rapid weight loss.
    • Weight is not in accordance with the ideal number for height, age, or health condition.
    • Frequent headaches.
    • Heart problems, such as palpitations.
    • Low blood pressure.
    • The skin of the hands and feet is dry and yellowish due to lack of blood flow.
    • Easily dizzy and faint without cause.
    • Hair thinning and easy to fall out.
    • Swelling in the arms and legs.
    • Bluish fingers and toes.
    • Frequent stomach aches or flatulence.
    • Constipation.
    • Dehydration.
    • No menstruation at all.
    • Not being able to tolerate cold weather, body becomes weak more easily, and heart rate becomes slower.
• Psychological Symptoms
  In addition to physical symptoms, people with anorexia can experience psychological symptoms, such as:

• • • Difficulty sleeping (insomnia).
    • Feeling inferior.
    • Fear of gaining weight.
    • Thinking too much about body shape and weight.
    • Feeling fat even though your weight is below normal.
    • Obsession with diet, body shape, and weight.
    • Denying that you are hungry.
    • Trying not to socialize.
    • Getting angry more easily.
    • Difficulty concentrating or focusing.
• Behavior Change
  People with anorexia can also show changes in their behavior. This can also be known by the sufferer’s family or close friends. These behavioral changes include:

• • • Excessive dieting, such as counting the number of calories in each food consumed.
    • Feeling like you eat a lot even though you only eat small portions.
    • Not wanting to eat in front of people.
    • Forcing yourself to vomit after eating.
    • Abusing diuretics and laxatives.
    • Often commenting that you are fat even though your body is already thin.
    • Wearing thick and loose clothing to cover his thin body and keep him warm.
    • Withdrawing from social circles.
    • Often looking in the mirror to see his body shape.
    • Often weighing himself and feeling happy when he loses weight.
    • Doing excessive physical exercise or sports and being stressed when he can’t do it.

People with anorexia nervosa are generally unaware of the mistakes in their thoughts and behavior in getting a thin body. Sufferers of this eating disorder also often do not consider their condition serious and needs to be treated. Therefore, if your friend or family member shows symptoms of anorexia, provide support so that they consult a doctor or psychologist. The doctor will help the patient to find out the cause of anorexia. That way, the treatment given is appropriate and does not easily happen again.

The typical sign of anorexia nervosa, which is a very thin body, can also be suspected to occur due to other conditions, such as metabolic disorders. That is why a diagnosis by a doctor is needed so that the patient gets the right treatment.

The diagnosis of anorexia nervosa can be confirmed through a series of examinations below:

• Medical history check
  During the initial examination, the doctor will ask the patient several questions. If the patient is hiding his/her condition, the doctor may ask the patient’s family members.
  Some of the questions that will be asked include:

• • • Symptoms experienced and when they appeared.
    • Negative thoughts and feelings experienced.
    • Eating behavior in the last few months.
    • The patient’s self-view of their body shape.
    • Diseases suffered by the patient or their family.
    • Experiences that trigger the emergence of eating disorders as a diversion from sadness, such as losing a loved one.

      Based on how to lose weight, anorexia nervosa is divided into 2 types, namely:

• • • Restricting (restriction), namely by limiting the amount and type of food consumed excessively.
    • Binge eating/purging, laxatives.
• Physical examination
  Diagnosis can begin with an examination of vital signs, including heart rate, blood pressure, and temperature. After that, the doctor will also examine the patient’s skin and nail conditions, which can show signs of anorexia. Next, the doctor will examine the patient’s weight adjusted to height, age, and duration of weight loss. The doctor will calculate the body mass index (BMI) and compare how much weight has been lost in the last 6 months. A BMI value <17 kg/m2 is categorized as underweight.
• Supporting examinations
  Supporting examinations are carried out to rule out other possible conditions that cause weight loss, as well as to check the risk of complications.
  Some of these tests are:

• • • Laboratory tests, such as urine tests, electrolyte and protein levels through blood tests, and liver, kidney, and thyroid function tests.
    • X-rays, to check bone density, and the possibility of lung infection (pneumonia) or heart problems.
    • Nerve function tests, to check motor and sensory abilities.
    • Psychological evaluation of the patient, to check for possible mental health disorders that accompany the symptoms of anorexia, such as depression.

      A person can be diagnosed with anorexia nervosa if the symptoms of anorexia nervosa have lasted for at least the last 3 months. Through a series of examinations, the diagnosis of anorexia nervosa can be confirmed if the following criteria are present:

• • • Extreme weight loss not due to a medical condition or lack of food.
    • Constantly restricting food intake.
    • Extreme fear of gaining weight or becoming fat.
    • Having a disturbed view of one’s own body, such as denying that one is underweight.

Treatment for anorexia aims to address the symptoms that arise, prevent complications, restore eating patterns, and restore a healthy weight. Treatment also includes medication and therapy to support the patient’s overall mental health. This approach aims to help patients form healthy perceptions and positive attitudes towards food so that they can be applied in the long term. The treatment method for anorexia nervosa is adjusted to the severity of symptoms, age, health conditions, and medical history of the patient.

Here are some actions you can take:

• Psychotherapy
  Psychotherapy aims to change the patient’s eating patterns and perception of their weight to be more positive. The choice of psychotherapy is generally adjusted to the patient’s age, including:

• • • Cognitive behavioral therapy for adult patients, to change unhealthy thought patterns and behaviors, and build patient confidence regarding their body shape.
    • Family therapy (family based therapy) for children and adolescents, which involves the role of family members in forming healthy eating patterns.

      Both of the above psychotherapies can also be combined with group therapy (support group). Through group therapy, anorexia sufferers can share experiences, difficulties, and complaints with other anorexia sufferers. This method will raise the patient’s spirit to recover.

• Medical action
  Severe anorexia nervosa, and not successfully treated with psychotherapy, can be continued with inpatient treatment. Inpatient treatment aims to monitor the patient’s vital signs intensively, treat complications that could endanger the patient, and help the patient achieve a healthy weight in a safe way.
  Hospitalization will be recommended for anorexia nervosa patients who have shown serious conditions, such as:
• • • Heart rhythm disturbances (arrhythmias).
    • Electrolyte disturbances.
    • Severe dehydration.
    • Low blood pressure.
    • Suicidal ideation or attempts.

      If the patient’s condition is severe enough and the patient cannot eat independently, the doctor can install a feeding tube (nasogastric tube), which is a tube from the nose that is directly connected to the stomach. This is done to ensure that nutritional intake is still achieved until the patient is ready to eat independently.

• Medication
  In addition to medical procedures, doctors may also prescribe medications to help treat mental conditions that accompany anorexia nervosa, such as depression or anxiety. For example, antidepressants may be prescribed to help improve mood. In addition, doctors may recommend supplements to address nutritional deficiencies experienced by patients.

Although related to mental health, anorexia nervosa can cause serious organ dysfunction due to severe nutritional deficiencies. If left untreated, this eating disorder can lead to the following complications:

• Digestive system disorders
  Lack of food intake in anorexia nervosa often disrupts the levels of good bacteria and enzymes in the digestive tract. As a result, anorexia sufferers often complain of stomach aches, nausea, vomiting, or heartburn.
  Without proper treatment, anorexia nervosa can cause the following complications in the digestive system:

• • • Gastroparesis, which is weakness of the stomach muscles.
    • Chronic constipation.
    • Diarrhea, which may be accompanied by blood.
    • Acid reflux disease (GERD).
    • Liver disease.
    • Gallstones.
    • Malnutrition.
    • Severe dehydration.
• Hormonal disorders
  Anorexia can disrupt the functioning of the endocrine glands, causing hormonal disorders in sufferers. Hormonal disorders that can occur include:

• • • Thyroid hormone disorders.
    • No menstruation at all (amenorrhea).
    • Decreased testosterone levels in men.
• Heart disorders
  Anorexia nervosa can also interfere with heart function. Some complications that can arise from impaired heart health include:

• • • Very slow (bradycardia) or irregular (arrhythmia) heartbeat.
    • Shrinkage of the heart’s ventricular tissue.
    • Pericardial effusion.
    • Orthostatic hypotension.
    • Heart failure.
    • Heart valve disease.
• Bone loss
  Anorexia nervosa causes bones and muscles to lose a lot of nutrients. As a result, in addition to decreasing density, bones can also lose their function. Lack of nutrition in muscles and bones can also be influenced by low levels of hormones needed for growth. Without proper treatment, anorexia nervosa can develop into osteoporosis or sarcopenia. Loss of bone strength then makes people with anorexia more susceptible to fractures even though they are not yet elderly.
• Psychological disorders
  Anorexia can also cause or be accompanied by other mental disorders, such as:

• • • Mood disorders (e.g., irritability or depression).
    • Obsessive-compulsive disorder.
    • Personality disorders.
    • Substance abuse.
    • Self-harm or suicidal thoughts.
• Other complications
  In addition to a number of physical and psychological disorders above, anorexia nervosa can also cause other complications, namely:

• • • Anemia.
    • Low blood sugar levels (hypoglycemia).
    • Decreased white blood cell count (leukopenia) making the body susceptible to infection.
    • Seizures due to severe electrolyte disturbances.
    • Tooth decay.
    • Dry skin (xerosis).
    • Shrinkage of brain tissue causing disturbances in the senses of taste and smell, as well as body temperature regulation.
    • Impaired kidney function.
    • Lung disease.
    • Pregnancy complications, such as premature birth, miscarriage, or very low fetal weight.

It is not known exactly how to prevent anorexia nervosa. However, the risk of developing this eating disorder can be reduced by creating a healthy environment free from the demands of ideal body weight.

Some ways that can be done to reduce the risk of anorexia nervosa are:

• Don’t judge appearance based on weight
  Anorexia nervosa often starts with negative judgments about a person’s body shape or weight. Therefore, don’t make a habit of making negative comments about weight or appearance, either to others or to yourself. Also, try not to compare yourself to other people’s appearances on social media. Don’t make other people’s physical appearance the standard to follow.
• Getting used to a healthy diet
  Because they are entering puberty and often get pressure from peers, children and adolescents are susceptible to anorexia nervosa. This age group is very concerned with appearance so they can do unhealthy ways to become thin. Therefore, it is important to teach children about healthy eating patterns, as well as normal weight according to their age.

  Some efforts that can be made are:

• • • Prioritize balanced food sources, starting from vegetables, fruits, proteins, and carbohydrates.
    • Do not group foods as “good foods” and “bad foods”.
    • Introduce food portions that are appropriate for the child’s age.
    • Do not force children to finish their food, including by giving punishment.
    • Invite children to choose the food they like.
    • Get children used to eating with the family and not playing gadgets while eating.
    • Provide an explanation regarding normal weight gain according to the child’s age, height, and activities.
• Doing positive activities
  Feelings of insecurity about physical appearance can also be overcome by doing other activities that you enjoy. Instill the idea that weight and appearance are not everything. Try to do other positive activities that are not related to appearance, for example:

• • • Join a new community.
    • Pursue a hobby.
    • Participate in academic competitions.
    • Volunteer.
• Dealing with stress with mindfulness techniques
  Anorexia nervosa is also closely related to self-diversion during severe stress. Therefore, this eating disorder can be prevented by dealing with stress in a healthy way. One of them is with mindfulness techniques, which include:

• • • Meditation.
    • Relaxation.
    • Breathing techniques.
    • Tai chi exercise.

      However, if you are overwhelmed dealing with stress on your own, seek counseling from a psychologist, either in person or online.

• Consult a doctor to lose weight
  The desire to lose weight is not wrong. However, it is best to consult a doctor first if you want to go on a diet or weight loss program. That way, the method used will be healthier and in accordance with your condition. In addition, do regular health checks with a doctor if you have certain conditions that increase the risk of anorexia, such as suffering from diabetes or being an athlete.