Epidemiology
Anorexia nervosa is most common between the ages of 12-25 years. The group of affected persons is divided into about 90% girls/women and 10% boys/men.
Measured against the total population, about 1% of young women are affected.
Definition according to the DSM-5
The abbreviation DSM-5 stands for "Diagnostic and Statistical Manual of Mental Disorders, 5 th edition" and can be described as a classification system developed by the American Psychiatric Association.
It determines for example how often and to what extent specific symptoms must occur to justify a certain diagnosis.
Symptoms of anorexia nervosa include:
- Intentional / self-induced weight loss
- Eating very little or skipping meals altogether
- Becoming obsessed by the calorific and nutritional content of food
- Distorted body image and denial of low weight, associated with an intrusive fear of becoming too “fat”
- Excessive physical activity
- Possibly self-induced vomiting and the exaggerated use of weighing scales, appetite suppressants and/or laxatives
Differentiation from bulimia
Two types of anorexia may be distinguished: the "ascetic type" (not taking in calories at all) and the "purging type" (getting rid of calories previously taken in, e.g. by throwing up intentionally). The difference to Bulimia lies in the frequency of the latter.
The main characteristics of bulimia are frequent episodes of voracious hunger or binge eating attacks, usually followed by self-induced vomiting or misuse of laxatives. Although anorectic persons also report such “eating attacks” and “loss of control”, the amount of ingested food is different.
For an anorectic person, consuming merely a fraction of what is a normal meal for a healthy person may be considered as such an “attack”. In comparison, individuals suffering from bulimia may devour truly large amounts of food exceeding the “usual and healthy” by far.
In both cases, an agonizing loss of control is often reported, followed by extreme feelings of guilt which are then encountered with self-induced vomiting, abuse of laxatives and/or excessive workouts.
Moreover, mixed forms exist for both types. These are disorders that show a fair share of some criteria of anorexia / bulimia alongside some criteria of another disorder. Comorbidity with depression and insomnia are common.
Health risks and likelihood of success in anorexia nervosa:
These include potassium deficiency and cardiac arrhythmias, as well as a drop in metabolism, pulse, blood pressure, and body temperature (fatigue, freezing, constipation). Dry skin, brittle fingernails, absence of menstruation, muscle weakness, growth of fine hair all over the body may occur. Years of malnutrition may lead to osteoporosis with increased risk of fractures.
The prognosis speaks of spontaneous remission in about 1/3 of all cases, 1/3 heal after treatment (psychotherapy, possibly combined with medication), and 1/3 develop a permanent addiction.
10% of those affected do not survive the disease.
The most common cause of death in anorexia is suicide.
3 of the most common misconceptions:
1. anorexia is a physical problem:
Anorexia is a mental illness, not a physical one. Being underweight is the symptom, not the cause.
Accordingly, it is a misconception to believe that a person who is (again) of normal weight cannot possibly suffer from anorexia nervosa.
2. the core of the disease is a misled concept of beauty:
Yes and No. It is true that a slim figure corresponds to the current ideal of beauty in our society and that anorectic persons strive for the slimmest possible body.
But this is only a superficial part of the problem. In essence, it is about coping with too much psychological pressure combined with a lack of self-esteem and a strong need for control and security.
3. Anorectic persons must inevitably realize that they are harming themselves:
Not necessarily. Many lack insight into the disease, especially at the beginning.
Being able to control one's own body creates the illusion of control. The illusion of control over the body may be synonymous with the illusion of control over one's own life.
In addition, anorectic persons have a distorted perception of themselves. They literally see and feel themselves to be larger than they really are.
Finally, individuals affected by anorexia often appear powerful, self-determined, disciplined, and successful to the outside world. But again, they perceive themselves differently: if one of the self-imposed, rigorous rules is being violated, feelings of shame and guilt usually follow, which are constantly held in consciousness.
