Diagnostic Criteria for Anorexia Nervosa
As per the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Anorexia Nervosa (AN) is diagnosed when:
- Restriction of energy intake relative to requirements, leading to a significant low body weight
- Intense fear of gaining weight or becoming fat
- Self-worth influenced by body weight or shape
The two subtypes of Anorexia are:
Restricting Type: Individuals restrict their energy intake (calories), particularly carbohydrates and fats, and may engage in excessive exercise. They have not engaged in bingeing or purging behaviours over the past three months. This subtype involves achieving weight loss primarily through strict dieting, fasting and/or excessive exercise.
Binge/Purge Type: Individuals have regularly engaged in binge eating or purging behaviours in the past three months while meeting all other diagnostic criteria for AN.
Risk Factors for the Development of Anorexia
Biological Factors
Genetics: Studies have shown that eating disorders tend to run in families, suggesting a hereditary component. Specific genes may increase the susceptibility to some eating disorders.
Hormonal changes: Hormonal fluctuations, especially during puberty, can trigger the onset of eating disorders. These changes can affect mood, stress levels, and appetite, increasing the risk of developing disordered eating behaviours.
Neurological structure: The brains of children and teens goes through rapid growth and development. Preliminary research suggest that various changes in brain networks may be associated with eating disorder behaviours. This is especially important for children and youth, whose brains undergo rapid growth and development.
Psychological Factors
Low self-esteem: Individuals with low self-esteem are more likely to develop eating disorders. Feelings of inadequacy and worthlessness can lead to negative eating behaviours as a means of gaining control or achieving perceived societal standards of beauty.
Perfectionism: A tendency towards perfectionism, where individuals set unrealistically high standards for themselves and strive for flawlessness, is a common psychological risk factor for anorexia. This trait can manifest in obsessive control related to eating and body shape, weight and appearance.
Anxiety and depression: High levels of anxiety and depression are strongly associated with eating disorders.
Sociocultural Factors
Cultural pressure: Societal pressures and cultural norms that glorify thinness and equate body weight with self-worth significantly contribute to the development of eating disorders.
Family and peer influence: Family attitudes and behaviours regarding nutrition, weight and appearance can impact an individual's eating habits. Peer pressure and social comparisons, especially during adolescence, can also play a crucial role in the onset of eating disorders.
Trauma: Trauma can increase the risk of developing eating disorders. Victims often experience a sense of loss of control related to the event(s) and may attempt to regain control through strict regimens relating to food intake and body shape, weight and appearance.
Signs and Symptoms of Anorexia
AN presents through significant weight loss or lack of weight gain in youth, restrictive eating, and obsessive concerns about body shape and weight. Individuals often have a distorted perception of their body size and shape, believing they are overweight even when they are underweight, a condition known as Body Dysmorphia. Physical health is severely compromised due to malnutrition, and psychological symptoms such as depression, anxiety, and obsessive-compulsive behaviours are common.
Physical
- Extreme weight loss or lack of weight gain in youth
- Fatigue
- Dizziness
- Irregular menstrual cycles
- Muscle wasting
- Dehydration
- Abdominal pain
- Constipation
- Cold intolerance
- Thinning hair and/or hair loss
- Cardiac arrhythmias
- Impaired kidney function
Behavioural
- Severely restrictive eating behaviours
- Binge-eating
- Self-induced vomiting
- Excessive exercise
- Refusing to eat or skipping meals
- Making excuses not to eat
- Only eating certain foods, usually low in fat and calories
- Avoiding eating in public
- Exaggerating the amount of food eaten
- Frequent mirror and body checking
- Avoidance of social interactions
- A generally flat affect (change from baseline)
Psychological
- Intense fear of gaining weight
- Preoccupation with food, calories, and dieting
- Low self-esteem
- Depression, anxiety, and/or irritability
- Fear of weight gain
- Viewing themselves as "fat"
- Insomnia
- Irritability
Canadian Statistics for Anorexia Nervosa
In Canada, Anorexia Nervosa occurs in 0.5% of the general population (90% falling under the Restricting Type).
Adolescent males with Anorexia Nervosa show significant deficits in bone mineral density, with 65% affected.
In children and adolescents aged 5 to 17 years, the prevalence of Anorexia Nervosa is 0.19% for males and 0.45% for females.
In adults, males over 40 years old with Anorexia Nervose have a higher risk of fractures.
Our team helps individuals across Canada who are living with anorexia symptoms.
We know getting a diagnosis can be a barrier to accessing eating disorder care. That is why our team completes a thorough initial assessment to understand the thoughts, emotions and behaviours that impact your food intake so that we can create an individualized plan to overcome these challenges. Book a free consultation call to find out more!
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