Anorexia nervosa

Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by predominant food restriction, body image disturbance, fear of gaining weight, and an overwhelming desire to be thin. These characteristics often means individuals undergo severe malnutrition as a result of the disorder.

Individuals with anorexia nervosa have a fear of being overweight or being seen as such, despite the fact that they are typically underweight. The DSM-5 describes this perceptual symptom as "disturbance in the way in which one's body weight or shape is experienced". In research and clinical settings, this symptom is called "body image disturbance" or body dysmorphia. Individuals with anorexia nervosa may also deny that their symptoms or behaviors are indicative of illness. They may weigh themselves frequently, eat small amounts, and only eat certain foods in order to be in as much control of their body appearance as possible. Some patients with anorexia nervosa binge eat and purge to further influence their weight or shape. Purging can manifest as induced vomiting, excessive exercise, and/or laxative abuse. Anorexia nervosa has the highest mortality rate of any psychiatric diagnosis. Medical complications may include osteoporosis, infertility, and heart damage, along with the cessation of menstrual periods and death. Complications in men may include lowered testosterone. In cases where the patients with anorexia nervosa continually refuse significant dietary intake and weight restoration interventions, a psychiatrist can declare the patient to lack capacity to make decisions, which results in a medical decision to be fed by restraint via nasogastric tube.

Anorexia often develops during adolescence or young adulthood. The causes of anorexia nervosa are complex and vary across individuals, many of which can include genetic, societal, physiological, and environmental causes. Most commonly, the exacerbation of the mental illness is thought to follow a major life-change or stress-inducing events. There is strong evidence, however, that anorexia nervosa also has a genetic component, with identical twins being affected more often than fraternal twins, which sees a large number of genetic risk factors underlying the disorder : similar to other psychiatric disorders with genetic components. Cultural factors also play a very significant role, with societies that value thinness having higher rates of the disease. Anorexia nervosa also commonly occurs in athletes who play sports where a low bodyweight is thought to be advantageous for aesthetics or performance, such as dance, cheerleading, gymnastics, running, figure skating and ski jumping (Anorexia athletica).

Treatment of anorexia involves restoring the patient back to a healthy weight, treating their underlying psychological problems, and addressing underlying maladaptive behaviors, often with forms of talking therapy; some examples of clinically proving therapies include cognitive behavioral therapy or Maudsley family therapy, an approach where parents assume responsibility for feeding their child. A daily low dose of olanzapine has been shown to increase appetite and assist with weight gain in anorexia nervosa patients. Psychiatrists may prescribe patients with anorexia nervosa forms of medication to better manage anxiety or depression, these being disorders often commonly associated with the disorder. However, medications are not considered a cure for anorexia nervosa: such pathways rather address underlying causes for the disorder, which often assist in recovery of it by allowing the individual to have a clearer and healthier mental state to understand the complications of anorexia nervosa. It does not assist those who do not have any other related mental conditions that affect their ability to do so. It has been proven to assist in the recovery of other eating disorders, such as bulimia nervosa and binge eating disorder.

In severe cases, individuals may require to be fed by nasogastric tube to restore weight and healthy nutritional levels by force. Evidence for benefit from nasogastric tube feeding is unclear; some individuals recover after the first incident of admission, while others have recurring treatments over many years: sometimes indefinitely. The largest risk of relapse occurs within the first year post-discharge from eating disorder therapy treatment. Within the first two years post-discharge, approximately 31% of anorexia nervosa patients relapse. Many complications, both physical and psychological, improve or resolve with nutritional rehabilitation and adequate weight gain.

Anorexia nervosa is estimated to occur in approximately 0.3% to 4.3% of women and 0.2% to 1% of men in Western countries at some point in their life. Levels in other countries are unclear due to undiagnosis and a lack of awareness, though it can be presumed it is more present in Western societies due to a higher focus on low body weight and beauty on social media and real life.There is an observation for an increase in the diagnosis of anorexia from the 20th century onwards: it is unclear whether this is due to an actual increase in its frequency or simply due to improved diagnostic capabilities. In 2013, it directly resulted in about 600 deaths globally, up from 400 deaths in 1990. Eating disorders also increase a person's risk of death from a wide range of other causes, including suicide. About 5% of people with anorexia die from complications over a ten-year period with medical complications and suicide being the primary and secondary causes of death respectively. Anorexia has one of the highest death rates among mental illnesses, second only to opioid overdoses.