What is anorexia nervosa and restrictive eating?
Anorexia nervosa is an eating disorder characterised by an intense fear of gaining weight, a distorted body image, and extreme efforts to control body weight and shape. Individuals with anorexia nervosa may severely limit their food intake, engage in excessive exercise, and exhibit other behaviours aimed at weight loss.
Individuals may have a preoccupation with food, calories and weight, leading to restrictive eating patterns and a determination to lose weight and maintain a thin physique. They may also exhibit behaviours such as avoiding meals, excessive exercise, using laxatives and self-induced vomiting.
Anorexia nervosa can have severe physical and psychological consequences caused by malnutrition. It can lead to electrolyte imbalances, hormonal disturbances, weakened immune system, bone loss and organ damage. Often individuals will experience low mood and irritability, anxiety, social withdrawal and difficulties with interpersonal relationships.
Diagnosis
Typically, diagnosis of anorexia nervosa will be done with a qualified healthcare professional, such as a psychiatrist, psychologist, or a specialised eating disorder practitioner. The evaluation may involve a thorough assessment of medical history, physical examination, psychological evaluation, and discussion of eating behaviours and thoughts related to food and body image. The healthcare provider will use specific criteria outlined for anorexia nervosa in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met:
- Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health.
- Intense fear of gaining weight or becoming fat, even though underweight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Treatment
Treatment for anorexia usually involves a multidisciplinary approach including medical, nutritional and psychological interventions. The goals of treatment are to restore a healthy weight, address underlying psychological issues, improve body image and develop healthier attitudes and behaviours towards weight and food.
Atypical anorexia
Even if all the DSM-5 criteria for anorexia aren’t met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Despite having a weight within the normal range, people with atypical anorexia still experience the same physical and psychological consequences as those with typical anorexia nervosa and is just as serious.
Atypical anorexia can significantly impact self esteem as individuals may have a negative and critical view of themselves, often basing their self worth on their weight and shape. They may feel a sense of inadequacy and strive for perfection, which can perpetuate eating patterns.
Often, there will be distorted perception of body size and shape. Individuals may perceive themselves as overweight or have an intense fear of becoming overweight, even when they are within a normal weight range. This distorted body image can contribute to the development and maintenance of disordered eating behaviours.
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