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Anorexia Nervosa
What is Anorexia Nervosa?
Even though Anorexia Nervosa is not the most common condition among the ED spectrum, it has some of the most serious repercussions on the sufferer both mentally and physically. The Statistical Manual of Mental Disorders (DSM-5) defines AN as ‘the persistent restriction of energy intake leading to significantly low body weight; either an intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain; disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight’ (American Psychiatric Association, 2013). AN has two subtypes: 1) the binge/purge subtype is characterized by severe restriction followed by binge eating and compensatory behaviors such as excessive exercise or laxative misuse 2) The restrictive subtype is defined by very low calorie intake that doesn’t meet daily requirements, calorie counting, and rigid rules around eating behaviors (Hales, 2003).
What causes Anorexia Nervosa (AN) ?
AN is a disorder of unknown cause, and the combination of many different factors such as genes, childhood trauma, and certain personality traits may play a role in its onset. There are certain personality traits that are associated with AN, such as anxiety, obsessions, and perfectionism, which are thought to contribute to its development (Kaye et al., 2013). Childhood anxiety disorders are associated with more severe ED symptoms, and high levels of anxiety have been determined in AN patients, with a life-time prevalence rate of up to 50% (Raney, 2008). Certain psychiatric comorbidities are associated with risk of AN, a survey conducted using the National Patient Register in Sweden found that females that are diagnosed with obsessive-compulsive disorders (OCD) have 16-fold increased risk of developing AN, which was 37-fold greater in males (Bulik et al., 2017).
Although AN was thought to be brought on mainly by psychosocial factors, recent substantial discoveries regarding the effect of genetics on eating pathology have determined that 50-80% of the risk for developing an ED can be explained by genetic heritability (Bulik, 2006). More recent twin studies show similar findings and reveal that AN runs in families mediated by a strong genetic basis with heritability estimates of 48-74% (Yilmaz, 2015).
The Royal College of Psychiatrists survey, which comprised of 83 ED services across the UK and Ireland that provide treatment for patients across a diverse age range found that the main therapeutic approaches used for AN was individual Cognitive Behavioral Therapy (84%) and family based treatment (77%) (Royal College of Psychiatrists, 2012