"Anorexia" describes a simple inability or aversion to eating, whether caused by a medical problem or a mental health issue. "Anorexia nervosa," however, is the name for the clinical eating disorder, the main symptom of which is self-starvation.
The terms anorexia and anorexia nervosa have often been used interchangeably. They, however, are not synonymous. “Anorexia” used by itself simply describes a loss of appetite or inability to eat. It may not always be due to a person’s pathological obsession with losing weight; it often occurs secondary to other conditions such as depression, cancers, infections or as a side effect of medications.
Anorexia nervosa, on the other hand, is a complex psychological disorder manifesting as self-starvation to maintain an abnormally low body weight. In this disorder, the perception of body image is distorted. The individual weighs less than the minimum considered normal for their age, sex, stage of growth and development, and physical health.
Anorexia nervosa needs prompt medical attention as it is a life-threatening disorder. Anorexia nervosa involes intense fear of gaining weight or becoming fat. The endless fear of gaining weight, despite being underweight, makes the people with anorexia nervosa starve themselves. This leads to extreme weight loss and electrolyte imbalance which may lead to dangerous health issues and death.
Hence, while people with anorexia nervosa suffer from extremely low body weight, those with anorexia may have a normal body weight.
Unlike people with anorexia, individuals with anorexia nervosa often resort to harmful practices such as misusing laxatives (medications that increase bowel movements) and diuretics (medications that cause increased urine output). They may also induce vomiting after they eat.
How does the treatment for anorexia and anorexia nervosa differ?
Simple anorexia is easier to manage by treating the underlying cause of the patient’s loss of appetite. For instance, if the person has anorexia due to acidity or gastritis the appetite will be restored by managing the gastritis. If certain infections such as tuberculosis are causing anorexia, the treatment of the infection typically restores the appetite.
Sometimes chemotherapy in cancer patients compromises their ability or desire to eat, in which case, appetite stimulants may be prescribed to treat this cause of anorexia.
In contrast to the symptom anorexia, the treatment for anorexia nervosa is more complex and involves three main principles:
- Stabilizing the weight loss
- Starting nutrition rehabilitation to restore healthy weight
- Treating emotional issues such as low self-esteem, distorted thinking patterns and developing long-term, healthy behavioral changes.
The treatment of anorexia varies depending on the person’s needs. Treatment options include:
- Psychotherapy
- Acceptance and Commitment Therapy: It aims to develop motivation for changing actions rather than thoughts and feelings.
- Cognitive Behavioral Therapy (CBT): CBT addresses the distorted views and attitudes about weight, shape and appearance.
- Cognitive Remediation Therapy: It uses reflection and guided supervision to develop the capability of focusing on more than one thing at a time.
- Dialectical Behavior Therapy (DBT): It involves teaching patients how to develop skills to regulate their emotions, stress-management, mindfulness and healthy interpersonal relationships
- Family-based treatment (Maudsley Method): This approach is a type of group therapy that involves the patient's family to help them improve communication and develop better skills for overcoming anxiety.
- Interpersonal Psychotherapy: It aims to resolve an interpersonal problem area. It helps improve the person’s relationships and help them communicate better.
- Psychodynamic Psychotherapy: It is directed towards the person’s underlying emotional needs and issues causing anorexia
- Medications such as antipsychotics and antidepressants. Olanzapine (Zyprexa) is a preferred drug for Anorexia nervosa. It has an additional advantage of stimulating appetite and thus weight gain.
- Nutrition counselling
- Stress management through yoga, meditation and relaxing massages
Are there different causes of anorexia and anorexia nervosa?
Anorexia is simply a symptom characterized by a lack of desire or inability to eat. It may be caused by many reasons such as:
- Depression
- Fever/infections
- Heart diseases
- Lung conditions
- Kidney diseases
- Bowel conditions such as ulcers, hyperacidity or gastritis
- Cancer treatment or other medications
The cause of anorexia nervosa is not well understood. Studies suggest that there may be a role of genes as the condition sometimes runs in families. Based on research, the factors causing anorexia nervosa include
- Genetics
- Environmental factors such as harassment, abuse, failed relationships, loneliness
- Social factors such as peer pressure to lose weight
- Psychological factors such as lack of self-esteem, anxiety, feeling of inadequacy
- Hormone changes regulating how the body and mind influence thoughts, mood, appetite and memory