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Anorexia nervosa – causes, symptoms, diagnosis, treatment & pathology

Anorexia nervosa – causes, symptoms, diagnosis, treatment & pathology


On our Youtube channel, you’ll find a limited
selection of pathology and patient videos. With Osmosis Prime, you’ll get access to over
700 videos including complete coverage of pathology and physiology and a growing collection
of pharmacology and clinical reasoning topics. Try it free today. Anorexia nervosa, which is often just called
anorexia, is a disorder that is characterized by very low weight (typically less than 85%
of normal body weight), a constant fear of gaining even the slightest amount of weight,
and having a distorted view of their own body weight or shape, often believing that they
are overweight, while actually being underweight. Now there are two main types of anorexia. One form of the disorder is the restricting
type, where people reduce the amount of food they eat in order to lose weight. Another form of the disorder is the binge-eating
and then purging type, where individuals eat large amounts of food in one sitting and then
purge that food through vomiting or by taking laxatives. This can be confused with another eating disorder—bulimia
nervosa, but the main distinction between these two disorders has to do with an individual’s
weight. Individuals with bulimia are usually normal
weight or overweight, whereas individuals with anorexia are underweight. Because of this, people can potentially start
out with bulimia, and then develop anorexia over time. Anorexia can be further split by levels of
severity. A body mass index, or BMI, between 18.5 and
24.9 is considered healthy, someone with anorexia though that has a BMI between 17 and 18.5
is considered mild, a BMI of 16-17 is considered moderate, a BMI of 15-16 is severe, and having
a BMI of less than 15 is considered extreme. People who meet all the criteria for anorexia
except that they are within or above the normal weight range after significant weight loss
can be diagnosed with atypical anorexia nervosa. Now in addition to having a low BMI, individuals
with anorexia are typically fearful of weight gain, and often have a psychological obsession
with the caloric and fat content of food, often leading to food restrictive behaviors,
purging, exercise, and frequent weight checks. They might perform specific food rituals,
like cutting food into small pieces, or eating foods in a specific order. They might refuse to ever eat in front of
people, or cook elaborate meals for others, but then not eat themselves. Like a dinner party host who’s unwilling
to eat his/her own food. Anorexia literally starves the entire body
and can cause a number physical changes affecting every body system, which can end up being
clues to the diagnosis. There is often a loss of muscle tissue throughout
the body, reflected by a low creatinine level and symptoms of fatigue from weak muscles
throughout the body, including a weak diaphragm which can cause difficulty breathing. Even the heart can lose muscle, and this loss
of cardiac muscle tissue can lead to bradycardia—less than 60 heart beats per minute, and hypotension—a
blood pressure below 90/50, as well as orthostatic hypotension when blood pressure falls when
a person goes from a lying down position to a standing position. A weak heart can lead to congestive heart
failure and combined with low protein levels in their blood can cause significant edema
or swelling, especially in the feet. There may also be serious electrolyte abnormalities
like low potassium, magnesium, and phosphate level, as well as key vitamin deficiencies
such as thiamine also known as Vitamin B1. Women can have amenorrhea, where either the
normal menstrual cycle stops or menstruation doesn’t start by age 15. Prolonged food restriction can also make the
gastrointestinal tract unable to handle normal meals which causes terrible bloating and nausea
as well as constipation. Also, the bone marrow can start shutting down—so
you get fewer white blood cells which leads to a dampened immune response, fewer red blood
cells which leads to lower energy levels, and fewer platelets which leads to easy bleeding
and bruising. Anorexia can also cause osteoporosis where
the bones become weak and susceptible to fractures. The skin can change, with symptoms like dry
scaly skin, and also the hair on their head can become brittle and fall out easily, and
soft hairs called lanugo covering their body. Some people might also have halitosis or really
bad breath from repeated vomiting. Finally, it can affect the brain, which causes
atrophy and encephalopathy, which can cause symptoms like ataxia, confusion, and even
death. In addition to these complications, there’s
also something known as refeeding syndrome where refeeding stimulates secretion of insulin,
which causes cells to take in already low levels of potassium, magnesium, and phosphate,
which causes levels in the serum to be dangerously low, and these deficits in electrolytes can
lead to severe heart arrhythmias and even cardiac death. This is why patients with anorexia typically
get an exhaustive medical workup and are carefully monitored with ECGs as they are slowly refed
and brought back up to a healthy weight. Pinpointing the exact cause of anorexia is
tough right? Because it’s likely a complex interaction
of various factors like genetic and hormonal factors, for example abnormalities in the
signals that convey information about hunger and fullness, as well as social/environmental
factors like peer groups and popular culture. In addition, anorexia is associated with low
self-esteem, loneliness, sensitivity to peer pressure, and feeling a need for approval. Individuals with anorexia might also chronically
over-react to stressful situations, and they might exhibit perfectionist behavior, and
might feel the need to have control of specific parts of their life—like their weight. There are also higher rates of anorexia in
countries where thinness is valued, which could reflect an internalization of societal
standards of beauty. Anorexia typically starts in the teen years
or in young adulthood—a time when individuals usually start to pay attention to the media,
and rates of anorexia are higher for individuals who have higher exposure to media. Also, although anorexia is more common in
women, it’s worth mentioning that men suffer from anorexia as well, and in both genders
it can often be seen among athletes and professionals who are keenly focused on their body weight
and percent body fat, such as in some types of dancing, modeling, and wrestling. Finally, anorexia is also commonly associated
with other conditions like obsessive-compulsive disorder, depression, and anxiety, all of
which have overlapping symptoms and risk factors. As far as treatments go, medical treatment
with careful weight gain is important, there is an important role for psychotherapy and
cognitive behavioral therapy for both the individual and sometimes the family as well. These therapies focus on improving self-esteem
and teaching strategies to better cope with stress and social pressures, as well as identify
the patterns of thought that may be influencing their illness. So we’ve seen that anorexia can affect nearly
every body system in profound ways, but careful management and treatment and ultimately a
healthy pattern of eating can reverse a lot of these complications and issues associated
with anorexia.

100 Replies to “Anorexia nervosa – causes, symptoms, diagnosis, treatment & pathology”

  • Is it bradycardia if my bpm is an average of 55? Because I am very athletic but not anorexic, I eat around 3,000 calories, 5 meals a day, with snacks throughout, to compensate for lost calories during workout. I have heard that low heart rate is a result of physical activity. Should I be concerned now?

  • If you're an actual medical student who wants to go into the field this entire video was filled with completely incorrect. BMI and weight doesn't have anything to do with anything. Someone who's obese can be anorexic. I was just as anorexic at 205lbs as I am at 125lbs.

  • People Are so annoying in the comment section.
    You guys have to understand that youre maybe not underweight in the beginning, but when you dont eat, you Are gonna get underweight either way

  • I have depression and anxiety and im honestly only eating like a meal a day and that like 300 calories. and once i didnt eat for 3 months but im still not anorexic .

  • I don't think my body is fat, nor do I think I need to lose weight. but, I dont gain weight when I eat alot? I just stay the same. my ribs are also kind of poking out. but bruh, i LOVE food

  • You know what's crazy? My mother only worries about MY eating because I'm "thin". Although, when I tell my mother my sister isn't eating well she tells me "Your sister looks healthy, but if someone told me you weren't eating I'd believe it." She needs to understand that anorexia isn't a physical illness it's a MENTAL illness and you do NOT have to be "skinny" to have anorexia.

  • I was diagnosed with anorexia. My BMI is 17, but a year ago it was around 26. The issue Is, I don't fit the criteria. I don't have a fear of gaining weight (infact I'm trying to gain weight) and I know I'm thin. Have I been misdiagnosed?

  • Uhhhh quick thing my friend who Is a 13 year old girl has been diagnosed as annorexic a long time ago but it’s gotten worse and now she hasent eaten in 5 days and weighs 80 pounds what should I do

  • so i’m not underweight enough to have anorexia? that makes zero sense and for some reason makes me feel fatter 😳✌️

  • anorexia is a MENTAL illness. your weight is a factor, but anorexia is developed in the mind, and how much it's affected your body does not matter. I may or may not have a type of anorexia, but i am overweight. I'm scared of eating and gaining weight, but due to my parents not knowing what's wrong with me and thinking im still normal, i still am forced to eat. but i have neither gotten the time or opportunity to purge, but i try, i cant, but i try. this is what anorexia is. because im so obsessed with my weight, wanting to and attempting to cut out all calories, because im not happy with my look and want to reach beauty standards. ive always been obsessed with my weight , and sometimes ive gone a couple days without eating, but a couple weeks back i received some nasty insults and i have been trying my best to lose weight. i dont even have a bathroom scale, or a measured BMI, so all my assumptions about myself have come purely from my eyes. I dont see any weight loss and i cant even know.

  • I have a eating disorder, I have anorexia it's was getting worst.When I started the strict diet, I was really bad, I felt like fainting. I got use to it,now I rarely feel hungry. I don't feel like eating, and I can only eat a small amount of food, bc my stomach can't handle much.I want to get better but it is hard, I can't stop thinking about calories, fat and weight…

  • So what if…
    •I’ve skipped breakfast for the past 3 months.
    •My mother has brought up the possibility that I’m starving myself.
    •My father said that I looked way skinnier than before.
    •I always try to eat smaller portions of food.
    •I usually binge watch videos about to loose weight.
    •I have low self esteem.
    •I feel fat.
    •My stomach hurts after eating.
    •I usually drink a gallon of water in one sitting so that I can flush the food out of my system.
    •I don’t like eating snacks in front of others because I feel like they’re judging me.

  • I am anorexic even tho im a normal weight, when i started getting sick i was a bit overweight (like 2-3 kg). I dont lose weight that fast; i have to eat at home, because my mom knows i have real bad anxiety about my body
    Anorexia _doesnt mean being skinny_. pls understand

  • I just want to clarify for EVERYBODY, u do not have to be "underweight" to have anorexia… this is why many people like my self with this ED don't think they have a problem because we dont think "we're skinny enough"

  • I struggle with anorexia nervosa and I’m not underweight. People can be over weight the perfect weight or underweight and be anorexic. The most that really matters is the thought and fears of food and the affect it has on ur body not how you look or how much you weigh.

  • Sotimes I think of starving myself on purpose' I know the consequence of it and all i have seen what happens to people. I know it sounds selfish and all that, but I wanna do it because it works! I know the recovery so hard but it works all in all, in the end you're skinny

  • My DMs are open for anyone going through this. I am a 15 year old girl and I know what its like dealing with this kind of stuff. Reply if you need someone to talk to and I will send you one of my social accounts.
    Please, I know its hard to talk to people, but it doesn't make you weak to ask for help.

  • I am curious about some stuff. a girl I have been seeing, met her a few months ago. she had told me she had eating disorders in the past , both kinds. mostly in her 20s. she does have one child, was born over a month early but survived and the child is apparently doing well , and one other time she miscarried. she is 40 right now, said she can't get pregnant and said she started menopause in her late 30s. could this be due to the damage she casued from this? also, I believe someerhe along the way she may have gotten over it for a bit , but she has very thin arms and legs, albiet her belly is normal size for an average soman, on the thinner side, but she keeps knowing she needs to eat more, but yet at the same time she has said she can't get her abs better and does everything she can.I noticed over the past 3 months since meeting her.  she hardly eats anything but does eat.  she says her parents, her friends, etc.. all tell her to eat more. but that they irritate her by doing that. I keep telling her that I support her whatever she does, but that if every single person says that who cares about her, they are trying to help and worried about her, but also said, she has to want it, and that I can't do anything, and that I am sure there are people who specialize  in that.but every time she eats with me. she eats like 2-3 full bites worth of food and is done. and at first she didn't even hardly drink much water. but she went on a thing lately wehre she said she was drinking many glasses of water per day.I did not tell her this, but I suspect it is a clever way of being bullemic without inducing vomit. just a hunch. IE flushing out the system.also works constantly, walks every day, runs around, claims her arms and legs are thing because she doesn't get enough protein, and that she could drink shakes, but says they are too disgusting.she also says that chwing food is gross, and I don't know, sounds like she has made excuses as to why she doesn't eat much. oh, also that her stomach hurts and her body adapted etc..I was hoping I could get her to start getting help. but she hadn't and unforuatnely not too long ago she started having more and more stomach pains, it seems like each time it was worse and longer. and very recently she had a flue like symptoms for a few days but thought something else was wrong so she went to the hospital.has been in the hospital, or was for at least 16 days. 7 at a smaller hospital. she needed Physical therapy 7 days into it and I guess I thought she would be home after that. I did visit her. at first she didn't want visitors, including her own parents. but I calmed her down, she did say she was extremely glad I came once she realize dI came soley due to caring for her. but also she said she could not walk and neeed PT for that. even when raising the back of her bed she was in pain just moving even helping her pop up. she did actually eat more that day in the hospital than I ever seen her eat before. now she was around 22-25 lb under what she says her doctors told her is her ideal weight and been there for awhile. but before going to hospital and being flu like and tired and sick, she didn't eat for 5 days and lost 6 more lb. that scared the hell out of me and that was before she went in.than she said she was gong to have a surgery and was transferred to a much larger hospital. didn't tell me until like 6 days after and she sounded weak, but then I tried going to the hospital they gave me a room , so she was there, but then they said she was discharged. but the door was close. theys aid it was 10 minutes ago btw. seems odd. but I tried calling and her phone had some message saying it might be disonected and then I tried again and it went straight to vm without ringing but full.I have not heard from her. which is weird because this girl was absolutey thinking I was the best human on th eplanet, even a week ago. I am not sure if being in the hostpial for so long means it is very serious. but all that stuff I imagine has to do with damaging herself from all this anorexia/ and a little bulimia as well. I mean, does this all sound like it would be related to that?

  • So this means jaiden is restricting type of anorexia btw who knows jaiden animation and her song about her anorexia

  • After hearing death I really wanna go eat my breakfast but I just had a good workout and I'm not ready to take that to waste

  • This video was very use ful and explain the medicinal side of it threw what the books say (trying to learn gor my big test 😬)

  • I feel like my brother has anorexia, he keeps throwing up constantly in the bathroom and refuses foods he likes and also keeps weighting himself on the scale. I'm kinda worried about him :/ any tips how i can talk him about this? :/

  • i have low selfesteem because of my gradma she used to call me overweight like everyday when we were at her house and thats why i started to stop eatng 🙂

  • something is wrong with me idk what but everytime I eat just a little bit I feel full already and I don't have an appetite but it has only been 2 days so..

  • shit im an extr and a model, ive had mild anorexia before then I got slightly fat, now im skinny and this is happening again, but I love my weight and it needs to be low for my job ! feels weird to be this side of unhealthy weight especially as a 40 yr old man hahah ! been watching my 600 pound life for inspiration when im feeling hungry ! im on a calorie defecit of roughly 1000 calories per day in the week, then I do a 36 hour fast from midnight Saturday to midday Monday ! hmmm, looks like im getting this bloody anorexia agasin !

  • Im a male 18 years old and I m 120 pounds or under and i have a cold i hate my life i feel differently than anyone in my family i wish I was normal

  • You have to have a low bmi to have anorexia nervosa, but you can still be an atypical anorexic if you do not have a low body mass index.

  • I skip breakfast, don’t eat any snacks, skip lunch. At around 6-7pm my family eat dinner and I usually eat like 5 bites to keep me going. I usually have one day a week where I eat one apple at 12pm if I am feeling weaker than usual.

  • Idk I don’t want to eat anything cause I’m scared but I’m not that underweight I’m only 12 so I might not have it

  • If you wanna get slim by making yourself REAL skinny Don't it will just hurt you…you are beautiful the way you are don't try to fit in you are the most beautiful person behind this screen stay strong

  • ok so what if you are like me?

    I weagh 90 lbs and 5'4 but I am also naturally like this my body finds a way to burn food faster then I can eat and i was born underweight because when i was a baby i waghed like 5lbs although my on a good note my doctors did say that I shouldn't worry about symptoms because since I was born my body found a way to sustain it's self but I should still be careful because my body can still easily break from high pressure (meaning don't get in physical danger)

  • everyone: YOU DON’T HAVE TO BE SKINNY TO HAVE ANOREXIA
    yeah,, you do. Atypical Anorexia is overweight/healthy. You have be starving for a long,, long,, long,, time to be diagnosed.

  • Just a note: Anorexia is a common symptom of various illnesses (such as the flu). Anorexia is loss of appetite and NOT the same as anorexia nervosa which is the eating disorder

  • Fuck this video, anorexia does not equal underweight. A person that has a high bmi or is overweight/obese can have 'worse' anorexia than someone who is underweight.

  • how am I supposed to take this seriously if you don't even know that you don't have to be underweight to have anorexia…

  • I have a healthy bmi and it sucks bc my eating disorder brain is telling me now I have to get to the lowest weight so I'm taken seriously as a anorexic. Kinda like a I'll show them! type of thought.

  • I dont think i am anorexic bc i am a healthy weight but my friends say i have an eating disorder bc i rarely eat, exercise a lot, check my weight every day 3 times, and last time i ate (3 days ago) i cried after eating the cracker but i think im fine

  • I have a friend that has this and she gets bullied that shes fat and now she eats her lunch and we will see her pukeing in the bathroom at school forcing but I left that school

  • Wait what when I had my BMI measured in Year 6 I had a BMI of 18 and they said I was healthy? So why does it say here that below 18.5 is mild…

  • I’m 5ft 11-6ft and i weigh 106 pounds with a BMI of 14.8. I’m also very active, am I safe/healthy and if not what would be my “healthy” weight

  • I eat:

    1 yogurt
    1-2 apples
    Bread with eggs
    + Aerobic dance And yoga workout and I lose with it 300 calories
    This all in 1 day

    Do I have anorexia?

  • I have a pretty stupid question for you guys… Do I have anorexia? I mean, I know it's an eating disorder, but it doesn't quite match anything I learn about. See, weight does bother me to a pretty good extent, and I do count calories and work out for like 25/30 minutes after eating and all (sometimes around an hour), but none of that is to the most extreme extreme. Really I'm just worried about my body shape and always feel I'm fat, so I just don't eat or drink anything (except water and dinner) and if I think I over ate I make myself vomit. So I don't quite match anorexia, but I don't know of anything else it could be. Please answer me.

  • I have anorexia and I used to be very underweight until I was hospitalized and I am now recovering from it. But I still have anorexia. It hasn't gone away. But it is not as severe anymore. Anorexia Nervosa is a mental illness. It's in your head. it doesn't really have much to do with the body, even though many anorexic people are typically underweight, it does not define the illness. Everyone says it's being underweight, but that is not always true.

  • Dude… I have not eaten in almost 2 days… Because unknownly why im not hungry… And I love the feeling of losing weight… It feels so good.. Yet so painfull

  • " Nah you're too fat to have anorexia, come back to the hospital when your body is shutting down because you're dying of starvation."

  • You really shouldn't talk about the severity of anorexia purely based on reaching lower and lower bmi thresholds. It's very triggering.

  • I don't eat a lot. But I work out till I can't stand without my legs wobbling, is that bulimia or anorexia? I also don't feel well and I feel dizzy very often and my skin turns almost white sometimes because I don't eat enough but I can't eat I hate myself after I eat a normal-sized portion. I'm also really scared of gaining weight, also I try not to eat at all in a day but my parents always force me to eat even tho I can't I also weight my self like 2 or 3 times a day and I recently started to purge. Can anybody tell me if those are symptoms of bulimia or anorexia?

  • Im not saying it's harder living with an eating disorder being taller than average. But when you're tall and you realise that because of your height shorter people often weigh less than you is the most t r i g g e r i n g thing istg

  • I accidentally became Anorexic, by doing fentanyl, and purging so many times just to breath and not have my body over heat from the serotonin, or me stop breathing from the loss of electrolytes. I personally believe i saves my self because of snake juice.

  • “Osmosis: Anorexia is bad because it vomiting causes electrolyte and vitamin deficiencies which worsen ur health chronically overtime, same with obesity” 🙃 I love conspiracy theories but this is just stupid all it does it teach about the disease and how to manage the symptoms. Go to a real doctor who actually looks 30 and is 54; Dr Eric Berg. Go to him if you or a loved one are struggling with cancer, herpes, obesity yes even 600 plus, diabetes, heart disease, any mental disorder etc. I won’t guarantee that you’ll cure anything but if you do the diet PROPERLY which takes dedication… you can actually reverse “Chronic Real Fatal Diseases!”

  • I hate the old school of thought that weight determines which disorder you have, that’s invalidating people, and it’s baseless

  • I think I’m developing anorexia. I constantly feel bad after eating junk food or eating all 3 meals in a day. There’s been times where I’d run to the bathroom and contemplate whether I should throw it all back up, but I was too scared to do that. I got disgusted with the way I look and still am. 3 weeks ago I decided to reduce my calorie intake to 500-700 calories a day and I felt good about feeling hungry. I went from 75kg to 71.2kg in 5 days I also pushed myself to do 11,000 steps daily. My mum began to realise I wasn’t eating the dinner she cooked and eating my lunch then instead. I just told her I was sick and started eating normally again. I’m now 72.4kg and I feel disgusted. I eat around 1,300 calories daily atm and I hate it. I want to starve myself just to feel pretty. I want to be slim. I’ve tried so many diets and exercises but couldn’t stick to it. So I decided to restrict what I ate. I feel like starving myself for a week again. I don’t know what to do anymore I’m just so sick of the way I look and im too afraid to tell anyone the truth.

  • These last couple of months I have had this big fear of gaining weight, so under 4 months ive lost 9 kg from just eating less. Its really incedible to see how my body is slowly changing. And I am getting more and more signs of having Anorexia, and still my mind tells me that I look fat in every picture.

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