Understanding anorexia

For years, anorexia nervosa was thought of as a mental health illness that primarily affects affluent teen girls. In fact, anorexia affects people of all ages, socioeconomic groups and genders. And a recent study has determined that anorexia nervosa is not just a psychiatric disorder, but also a metabolic disorder.

Anorexia is characterized by self-starvation and excessive weight loss. People with anorexia commonly show a variety of symptoms, including:

• Low calorie intake

• Intense fear of weight gain

• Preoccupation with food and nutritional values

• Distorted body image

• Self-esteem tied directly to body image

• Inability to appreciate the seriousness of the illness

How genetics, environment and social elements play a role
The disorder was often thought of as a choice or desire to maintain control over something — diet, weight and appearance — when other parts of a person’s life seemed out of their control. However, experts now recognize that anorexia is a biological, psychological and social disease, which means that genetic, environmental and social elements all play a role.

Furthermore, a worldwide study found that eight genetic variants — or differences in the common DNA sequence — are linked to anorexia, suggesting that the genetic origins of the illness is not just psychiatric, such as a family history of related mental health disorders, but also metabolic. This includes inherited metabolic conditions that affect the rate at which ingested food causes the level of glucose in your blood to rise; the ability of your body to create enough enzymes to break down lipids and convert them into energy; and your body measurement traits, such as height, weight and body mass index (BMI).

“This study is the first to suggest that anorexia is partially a metabolic disorder,” says Dr. Linda Santangelo, lead clinical psychologist with the Sharp Mesa Vista Hospital Eating Disorders Program. “This means that metabolic differences in certain people might mean that they are predisposed to the disorder, just as biology and family history can play a key role in determining a person’s risk for developing anorexia nervosa.”

Along with genetics, other risk factors for the development of anorexia include:

• Negative energy balance — calories consumed is less than calories burned

• Perfectionism

• Harm avoidance or aversion to risk

• Anxiety disorder

• Cultural weight stigma and internalization of the “thin ideal”

• Teasing or bullying

• Trauma

• Type 1 diabetes

Statistics and warning signs of anorexia you should know
According to the National Eating Disorder Association (NEDA), anorexia has the highest mortality rate of any psychiatric disorder. In fact, people with anorexia between the ages of 15 and 24 have 10 times the risk of dying compared to others of the same age. And males, who represent 25% of those with anorexia, are at a higher risk of dying because they are often diagnosed later than females because of false and dangerous assumptions that boys and men do not have eating disorders.

If you have a family history of anorexia or have concerns about a loved one, the following warning signs may indicate that professional care is needed:

• Dramatic weight loss

• Refusal to eat certain foods

• Complaints of constipation, abdominal pain, cold intolerance, dizziness, lethargy or excess energy

• Avoidance of mealtimes or situations involving food

• Excessive, rigid exercise regimen

• Withdrawal from friends and regular activities

• In females, irregular periods or lack of period

• Fine hair on body (lanugo)

• Thinning, dry and brittle hair on head

“It’s important to note that anorexia is treatable, and while we will continue to treat the psychiatric components of anorexia, studies like this will help us to determine new ways to treat the disorder,” Dr. Santangelo says. “Increased understanding of how anorexia develops and the role biology, environment and any co-occurring mental and physical health conditions play is paramount to developing a treatment plan to help people recover.”

Talk with your doctor if you or a loved one are concerned about disordered thoughts or behaviors related to food. Sharp Mesa Vista Hospital offers a specialized eating disorders treatment program.

For the news media: To talk with Dr. Linda Santangelo about the genetic component of eating disorders for an upcoming story, contact Erica Carlson, senior public relations specialist, at erica.carlson@sharp.com.