Understanding Anorexia

Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. 

The following is the DSM-V diagnostic criteria:

  1. Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

  2. Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight.

  3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.



Anorexia is also more common among teenagers. Still, people of any age can develop this eating disorder, though it's rare in those over 40. Teens may be more at risk because of all the changes their bodies go through during puberty. They may also face increased peer pressure and be more sensitive to criticism or even casual comments about weight or body shape.

Certain factors increase the risk of anorexia, including:

  • Genetics. Changes in specific genes may put certain people at higher risk of anorexia. Those with a first-degree relative — a parent, sibling or child — who had the disorder have a much higher risk of anorexia.

  • Dieting and starvation. Dieting is a risk factor for developing an eating disorder. There is strong evidence that many of the symptoms of anorexia are actually symptoms of starvation. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.

  • Transitions. Whether it's a new school, home or job; a relationship breakup; or the death or illness of a loved one, change can bring emotional stress and increase the risk of anorexia.



Like most disorders, anorexia nervosa has both physical, and emotional and behavioural aspects.

It is important to note that identification of anorexia on the basis of solely body weight can sometimes be inaccurate, as every individual’s normal/high/low body weight varies. It is also not accurate to equate anorexia with low body weight and extreme thinness, as people with obesity can have anorexia too.

Atypical anorexia is present in those individuals who

meet the criteria for anorexia nervosa but are not underweight despite

significant weight loss. Psychologists have not found a difference in the

medical and psychological impacts of anorexia and atypical anorexia.

Therefore it becomes important to take into account other criteria of anorexia along with weight.

Physical symptoms of anorexia:

  • Extreme weight loss

  • Not meeting expected developmental weight gains

  • Extreme thinness

  • Electrolyte imbalance

  • Low level of blood counts

  • Low hormone levels and thyroid

  • Potassium deficiency

  • Fatigue as a result of weakness

  • Dizziness, fainting

  • Disruption in and/or absence of menstrual cycle

  • Irregular heart rhythms

  • Low blood pressure

  • Hair thinning/ falling

  • Abdominal pain/cramps

  • Constipation

  • Intolerance to cold

  • Dry skin

  • Brittle nails

  • Swelling in limbs

  • Eroded teeth (due to induced vomiting



Treating anorexia and recovery is definitely possible. Seeking professional help on time drastically improves chances of complete recovery. Treatment of anorexia varies in terms of individual’s needs. In most cases, an individual’s preoccupation with remaining thin overrides their concern for health, and seeking help becomes an extremely difficult process for them, also making family’s or friends’ intervention difficult. However, seeking help by talking to a trusted individual or even
a professional such as a physician, mental health specialist or even a dietician to begin a discussion with can prove to be a very necessary and helpful first step.


Screening Tool for Eating Disorders

You can screen yourself for risk factors of Anorexia using the SCOFF Questionnaire. The SCOFF questionnaire is highly effective as a screening instrument for detecting eating disorders. It is simple, memorable, easily applied and scored, and has been designed to suggest a likely case rather than to diagnose

The SCOFF Questionnaire is a five-question screening tool designed to clarify suspicion that an eating disorder might exist rather than to make a diagnosis. The questions can be delivered either verbally or in written form. 

It has a sensitivity of 100% and specificity of 90% for anorexia nervosa. Though not diagnostic, a score of 2 or more positive answers should raise your index of suspicion of a case, highlighting a need for more detailed history.

Do you worry you have lost Control over how much you eat?
Do you make yourself Sick because you feel uncomfortably full?
Have you recently lost more than One stone (6.35 kg) in a three-month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?

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Delhi, India

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