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Discover Monthly
Anorexia Nervosa
March 2023
What is Anorexia Nervosa?
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.
General Statistics
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At any given point in time between 0.3-0.4% of young women and 0.1% of young men will suffer from anorexia nervosa
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Several more recent studies in the US have used broader definitions of eating disorders that more accurately reflect the range of disorders that occur, resulting in a higher prevalence of eating disorders.
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A 2007 study asked 9,282 English-speaking Americans about a variety of mental health conditions, including eating disorders. The results, published in Biological Psychiatry, found that 0.9% of women and 0.3% of men had anorexia during their life.
What is Anorexia Nervosa?
Erin Parks, Co-Founder of Equip, answers "What is anorexia?”
Watch this video to find out what the symptoms of anorexia are and how to identify it.
ARTICLES ABOUT ANOREXIA
How My Recovery Started With Just 20 Minutes
By R. Lane
"You know, I was never great in high school. I mean, to be fair, I wasn’t a bad student by any means. I did a lot of stuff, made a lot of friends, volunteered, got decent grades, got into a four-year university, and did what I needed to do. But what I was really good at, what I was meant to do, was to control. The thing that I was the best at controlling was what food I put into my body and how much of it I chose to consume and when..."
The Next Right Thing
By Britt Bajier
"Countless 'next right things' and here I am, three years later. I still struggle sometimes. I know battles with depression and my eating disorder will continue to be the longest war I’ll ever be involved in. But now, I know that I’m in charge. I make the decisions. I sometimes may not be able to see tomorrow or may tend to think I have no future at all. But in those moments, that’s when I remember I have the power to choose the next right thing."
How Running Helped Heal My Eating Disorder
By Sonnet Alyse Medrano
"Amidst all the things I couldn’t control, there before me was something I could: my weight. When I compared myself to women in magazines and movies, I wasn’t enough. I fantasized about a false ideal of beauty. I’d stand in front of mirrors while grabbing at my thighs and waist, imagining how great it’d be if there was less. How pretty I’d be, then. How maybe I’d finally be enough."
THE CHEMISTRY
BEHIND
ANOREXIA
One of the answers to the neuroscience of AN lies in neurotransmitter (brain chemical) activity, specifically the activity of serotonin and dopamine. People with AN have altered activity at serotonin and dopamine receptors. Since serotonin is involved with satiety and dopamine is associated with the brain’s reward system, altered receptor activity may explain why people with AN have reduced hunger signals and alterations in their food reward system.
Through measuring the brain function of patients with AN, researchers can understand how brain activity circuits are correlated with certain traits and symptoms characteristic of patients with AN, such as impaired cognitive functioning and food/taste processing. In one study, researchers underwent fMRI scanning, which measures brain activity via blood flow changes in the brain, while completing a memory task. Although their performance on the task did not differ from healthy controls, people with AN over engaged the areas of the brain involved with memory, integrating information, and overall cognitive functioning (parts of the temporal and parietal lobes). Interestingly, when AN patients underwent weight restoration and completed the task again, their brain activity did not differ from healthy controls, demonstrating that weight restoration may help improve efficiency of cognitive functioning.
Understanding brain function can also help us understand hunger signals in AN. When given sugar, people recovered from AN have decreased activity in the 'primary taste cortex' (right anterior insula). Located deep within the brain, the role of the anterior insula is to integrate and evaluate information about hunger and taste.
So, altered brain activity in this region, even following recovery, may imply that this brain difference is hard-wired, or present before AN’s onset. Also, these research findings may explain why it is so difficult for people with AN to perceive hunger signals, and consequently, nutritionally recover.
Along with functional differences, researchers are trying to understand how brain structure (brain volume levels) differs in people with AN. Brain structure is measured through MRI scanning, a technique that uses strong magnets and radio waves to create a vivid image of the brain. In one MRI study, researchers found that people with AN have significantly less grey matter volume when compared to age-matched healthy controls. (Grey matter is mostly made up of dendrites and neuronal cell bodies, which receive and integrate signals from other neurons, respectively.) But, when they gain weight, grey matter volume is restored to normal levels. These results demonstrate the negative impact of malnutrition on the brain, but also the positive impact of weight restoration in restoring brain volume, emphasizing the importance of nutritional recovery in AN.
Temporal Lobe
Parietal Lobe
HOW DOES TREATMENT HELP?
"The biggest challenge in treating anorexia is helping the person recognize and accept that they have an illness. Many people with anorexia deny that they have an eating disorder. They often seek medical treatment only when their condition is serious or life-threatening. This is why it’s important to diagnose and treat anorexia in its beginning stages.
The goals of treatment for anorexia include:
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Stabilizing weight loss.
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Beginning nutrition rehabilitation to restore weight.
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Eliminating binge eating and/or purging behaviors and other problematic eating patterns.
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Treating psychological issues such as low self-esteem and distorted thinking patterns.
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Developing long-term behavioral changes.
People with eating disorders, including anorexia, often have additional mental health conditions, including:
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Substance use disorders
These conditions can further complicate anorexia, so if an individual has one or more of these conditions, their healthcare team will likely recommend treatment for the condition(s) as well.
Treatment options will vary depending on the individual’s needs. A person may receive treatment through residential care (outpatient care) or hospitalization depending on their current medical and mental health state. Treatment for anorexia most often involves a combination of the following strategies:
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Psychotherapy
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Medication
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Nutrition counseling
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Group and/or family therapy
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Hospitalization
Psychotherapy
Psychotherapy is a type of individual counseling that focuses on changing the thinking (cognitive therapy) and behavior (behavioral therapy) of a person with an eating disorder. Treatment includes practical techniques for developing healthy attitudes toward food and weight, as well as approaches for changing the way the person responds to difficult situations. There are several types of psychotherapy, including:
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Acceptance and commitment therapy: This therapy’s goal is to develop motivation to change actions rather than your thoughts and feelings.
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Cognitive behavioral therapy (CBT): This therapy’s goal is to address distorted views and attitudes about weight, shape and appearance and to practice behavioral modification (if “X” happens, I can do “Y” instead of “Z”).
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Cognitive remediation therapy: This therapy uses reflection and guided supervision to develop the capability of focusing on more than one thing at a time.
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Dialectical behavior therapy (DBT): This therapy helps you not just develop new skills to handle negative triggers but also helps you develop insight to recognize triggers or situations where a non-useful behavior might occur. Specific skills include building mindfulness, improving relationships through interpersonal effectiveness, managing emotions and tolerating stress.
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Family-based therapy (also called the Maudsley Method): This therapy involves family-based refeeding, which means putting the parents and family in charge of getting the appropriate nutritional intake consumed by the person with anorexia. It’s the most evidence-based method to physiologically restore health to an individual with anorexia who is under 18 years of age.
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Interpersonal psychotherapy: This therapy is aimed at resolving an interpersonal problem area. Improving relationships and communications and resolving identified problems may reduce eating disorder symptoms.
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Psychodynamic psychotherapy: This therapy involves looking at the root causes of anorexia as the key to recovery.
Medication
Some healthcare providers may prescribe medication to help manage anxiety and depression that are often associated with anorexia. The antipsychotic medication olanzapine (Zyprexa®) may be helpful for weight gain. Sometimes, providers prescribe medications to help with period regulation.
Nutrition counseling
Nutrition counseling is a strategy to help treat anorexia that involves the following:
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Teaching a healthy approach to food and weight.
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Helping restore normal eating patterns.
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Teaching the importance of nutrition and a balanced diet.
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Restoring a healthy relationship with food and eating.
Group and/or family therapy
Family support is very important to anorexia treatment success. Family members must understand the eating disorder and recognize its signs and symptoms.
People with eating disorders might also benefit from group therapy, where they can find support and openly discuss their feelings and concerns with others who share common experiences.
Hospitalization
Hospitalization might be needed to treat severe weight loss that has resulted in malnutrition and other serious mental or physical health complications, such as heart disorders, serious depression and suicidal thoughts or behaviors."
BOOKS THAT EFFECTIVELY PORTRAY ANOREXIA NERVOSA
TRIGGER WARNING:
Check a website like https://www.doesthedogdie.com/ to make sure it won't be too triggering for you!
Group
By Christie Tate
Overview
"Christie Tate had just been named the top student in her law school class and finally had her eating disorder under control. Why then was she driving through Chicago fantasizing about her own death? Why was she envisioning putting an end to the isolation and sadness that still plagued her in spite of her achievements?
Enter Dr. Rosen, a therapist who calmly assures her that if she joins one of his psychotherapy groups, he can transform her life. All she has to do is show up and be honest. About everything—her eating habits, childhood, sexual history, etc. Christie is skeptical, insisting that that she is defective, beyond cure. But Dr. Rosen issues a nine-word prescription that will change everything: “You don’t need a cure, you need a witness."
Wintergirls
by Laurie Halse Anderson
Overview
"Lia and Cassie are best friends, wintergirls frozen in fragile bodies, competitors in a deadly contest to see who can be the thinnest. But then Cassie suffers the ultimate loss—her life—and Lia is left behind, haunted by her friend's memory, and feeling guilty for not being able to help save her.
In her most powerfully moving novel since Speak, award-winning author, Laurie Halse Anderson explores Lia's struggle, her painful path to recovery, and her desperate attempts to hold on to the most important thing of all—hope."
CELEBRITIES WHO ADVOCATE
"'I thought I was just supposed to feel like I was gonna pass out at the end of a show or in the middle of it. Now I realize, no, if you eat food, have energy, get stronger, you can do all these shows and not feel it, which is a really good revelation because I’m a lot happier with who I am I don’t care as much if somebody points out that I have gained weight.'"
"At the peak of the eating disorder Hilary Duff had when she was 17, she weighed just 98 pounds. 'I was totally obsessed with everything I put in my mouth. I was way too skinny,' she revealed. 'Not cute. And my body wasn’t that healthy—my hands would cramp up a lot because I wasn’t getting the nutrition I needed,' she told Health in 2015. 'That constant pressure of wanting something different than I had? I regret that.'"