Anorexia nervosa

Anorexia nervosa

Anorexia nervosa is one of the psychological disorders whose outcome may be death. In most cases the onset of the disease usually coincides with that of adolescence. Although the age range has varied throughout the history of the disease, the onset of the disorder is between 14 and 18 years, with the risk range between 10 and 24 years, however at present cases are being described in smaller and smaller girls, this data, together with the increase of the pediatric age up to 14 years, makes it a picture that can be detected from the Pediatrician's consultation.


  • 1 Main features of anorexia
  • 2 Subtypes of anorexia
  • 3 Risk factors in anorexia
  • 4 eating habits in anorexia
  • 5 Treatment of anorexia

Main characteristics of anorexia

The fundamental characteristic of anorexia nervosa it consists of a significant loss of weight, below the minimum normal level, caused by the person himself, through an exhaustive control of food intake, associated with an intense fear of gaining weight and a severe distortion of your body image (dysmorphia), this weight loss is associated with a hormonal disorder that manifests in women as amenorrhea.

Weight loss is achieved through a decrease in total intake, ending in most cases with a very restricted diet, limited to a few foods. They change their eating habits, avoid eating with more people, however they love to prepare meals with a high caloric level so that others enjoy them. There are other ways to lose weight such as the use of self-provoked vomiting and the use of laxatives and diuretics (purges), as well as excessive exercise.

Anorexia subtypes

According to the Diagnostic and Statistical Manual of DSM V mental disorders, we can distinguish two subtypes in anorexia nervosa:

  • Restrictive rate: This subtype describes clinical pictures in which weight loss is achieved by diet, fasting or intense exercise. During episodes of anorexia nervosa, these people do not resort to binge eating or purging.
  • Compulsive / Purgative Type: This subtype is used when the individual regularly resorts to binge eating and purging (or both). Most individuals who go through binge eating episodes also resort to purging, causing vomiting or using diuretics, laxatives or enemas in an excessive manner. There are some cases included in this subtype that do not binge, but usually
    resort to purges, even after eating small amounts of food.

Risk factors in anorexia


  • Overprotection and rigidity. Interpersonal dependence.
  • Stressful family environment.
  • Normativity, importance of social image and physical appearance.
  • Obese relatives.
  • Perfectionism, self-demand and high expectations of achievement.
  • Parents with addictive disorders (bulimia), emotional or feeding.


  • Menarche, excess weight, adult appearance.
  • Meaningful people call "fat". Intense experiences of failure. Low tolerance to frustration.
  • Perfectionism and self-demand; high expectations of achievement and low self-efficacy. Execution anxiety
  • Perception of loss of control; fear of losing control Feeling helpless or dissatisfied with yourself.
  • Deficit in self-control.
  • Fear of sexual maturity.
  • Submissive or aggressive behavior; social skills deficit.


  • Importance of the physicist and social forms.
  • Competitiveness, perfectionism and expectations of achievement.

Eating habits in anorexia

  • Selective rejection of some foods
  • Food handling (hide, wash, crumble, remove fat and find a lot of waste)
  • Development of obsessive-compulsive attitudes towards food or drink (rituals, potomania)
  • Isolation during meals or standing or moving
  • Exaggerated extension of meal time
  • Altered meal and sleep schedules
  • Excessive interest in culinary issues
  • Excessive attention to the intake of the rest of the family trying to make it abundant.

Different techniques and strategies are used to modify maladaptive eating behaviors. Stimulus control methods are normally used to control binge-eating and purging behaviors in the bulimia nervosa. The insist on the importance of making three meals a day, at the same time and in the same place, it serves to reduce binge eating, since it reduces the amount of energy depletion and hunger, the latter produced by dieting and skipping meals. In addition, the environmental stimuli that cause bingeing can be gradually extinguished by this method.

Anorexia treatment

Promote the basic principles of healthy eating behavior

  • Make three meals a day
  • Do not skip meals.
  • Eat based on a consistent schedule. Never eat "on the run."
  • Eat always sitting
  • Eat slowly
  • Serve portions ranging from moderate to small
  • Do not buy food when you are hungry
  • Do not use changes in weight to assess body image
  • Set behavioral goals and adhere to them

Other procedures that encourage control over binge eating include teaching the patient to: eat more slowly, throw smaller portions, leave food on the plate and throw in excess. It may also be useful to modify the choice of food and shopping practices, such as buying food when you are hungry. Behavioral contracts between the therapist and the patient can encourage adherence to meal plans and specify behavioral objectives about eating behavior (e.g., dining at a table at least five times a week or buying only ice cream at instead of an entire ice cream bar). The use of the reinforcement to increase the frequency of desirable eating behaviors can increase the frequency of desirable eating behaviors can increase adherence to the treatment program.

Gaining weight is a treatment priority for anorexia nervosa. It has been found that contingencies of operant reinforcement constitute the effective method to increase calorie intake in patients with hospitalized anorexia (Benms, 1987). Negative consequences are programmed if the patient does not reach the objectives related to eating and gaining weight, such as loss of privileges or intravenous feeding. In the modification of the eating habits of anorexics, immediate feedback on eating behavior is required, accompanied by positive and negative reinforcement resulting from behavior change. Behavioral contracts can be developed to facilitate the gradual increase in the frequency of healthy eating behaviors, while encouraging a decrease in harmful eating behaviors. Exposure with response prevention. This procedure begins with the establishment by the therapist of an alliance with the patient and the explanation of the reasons and the format of the treatment.

Then, using the format that contains the prohibited foods, a hierarchy of food that causes fear and anxiety is built. These feared foods are normally high in carbohydrates and / or fats, they constitute the food eaten during binge eating and then, they are usually purged. Food that causes less anxiety is exposed to the patient. In the presence of a therapist, the patient is prevented from purging and is encouraged to relax and verbalize thoughts and feelings associated with eating food you fear. Patients also learn to attribute anxiety to misleading cognitions instead of food. The exposure to eating normally lasts 30 to 60 minutes. The desire to purge will generally disappear over a period of two hours. This format continues for several sessions and the patient is gradually encouraged to continue with the exposure of the food he fears, without the presence of the therapist, as homework. Exposure with response prevention is considered as a procedure of choice (Rosen and Leitenberg, 1982). Purging is considered an escape response to the fear and anxiety of gaining weight.

A version of the "is currently recommendedexposure with response prevention"more similar to live desensitization than to the flood method initially written by Rosen and other colleagues (Williamson" Barkery Norris, 1993).

As a picture says more than a thousand words, here is an infographic about Anorexia:

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