Anorexia nervosa is a mental disorder characterized by an intense fear of gaining weight and a severely distorted perception of body weight and shape. This condition not only affects appearance but can also lead to dysfunction in multiple organ systems, and in severe cases, it can be life-threatening. Understanding its symptoms helps in early detection and intervention, reducing long-term harm to health.
The symptoms exhibit a phased characteristic, initially being misidentified as normal weight loss behavior, but as the disease progresses, complex physiological and psychological changes gradually manifest. Patients often control their weight through compensatory behaviors such as restricting food intake, excessive exercise, or inducing vomiting, which can trigger various chain reactions. This article will systematically analyze the developmental trajectory and clinical manifestations of symptoms at each stage.
Early symptoms often present primarily as behavioral changes, which may include:
Psychological signs may include dependency behaviors on mirrors, such as frequently checking body shape or taking selfies for comparison. Some patients may exhibit counting behaviors, such as precisely calculating the calories of each bite of food or measuring exercise intensity by steps. If these early signs are not promptly recognized, they may rapidly develop into more severe symptoms.
Blood tests may show abnormal potassium ion concentrations or decreased white blood cell counts, with body fat percentage often falling below 15% of normal reference values. Electrocardiograms commonly reveal indicators of cardiac dysfunction, such as bradycardia or prolonged QT intervals. These physiological abnormalities may only be detected in specific tests during the early stages of symptoms and may not be easily noticeable in daily life.
The core symptoms can be categorized into three major types: behavioral, physiological, and psychological. The most apparent feature on the behavioral level is compensatory behaviors, including:
In terms of physiological symptoms, female patients often experience amenorrhea, while males may experience reduced libido and testicular atrophy. The appearance of transverse ridges on nails (Beau's lines) and enamel damage to teeth are common physical signs. The skin may appear dry and pale, with the growth of fine hair (lanugo) as a compensatory mechanism for warmth.
Cognitive distortion manifests as a pathological assessment of body shape, where individuals perceive themselves as overweight even when others consider them thin. Common compulsive weight monitoring behaviors include weighing themselves multiple times a day or using mirrors to assess body shape. Anxiety and depressive moods often accompany the condition, and some patients may develop self-harming behaviors or suicidal thoughts.
In the second stage of the disease, patients may develop more covert compensatory strategies, such as inducing vomiting privately after eating normally in public. Continued weight loss can lead to a decreased metabolic rate, with basal body temperature dropping below 35°C, resulting in cold intolerance and periodic night sweats. Bone density may decrease to a T-score below -2.5, leading to low bone mass or osteoporosis.
In the third stage, signs of multi-system failure may appear, such as a decrease in cardiac contractility index (EF value), leading to easy fatigue. Endocrine system abnormalities may cause hair loss and brittle nails. Brain imaging may show ventricular enlargement and brain tissue atrophy, reflecting the severity of brain function impairment.
The following signs indicate that the disease is in a worsening phase:
Immediate medical attention should be sought when any of the following conditions occur:
Even if diagnostic criteria are not yet met, professional assistance should be sought if the following behaviors occur:
Immediate medical attention should be sought when the following emergency signs occur:
Early diagnosis can prevent irreversible organ damage. It is recommended that when caloric intake during meals is found to be below 60% of the basal metabolic rate, or when amenorrhea persists for more than three months, a joint assessment by psychiatry and nutrition should be arranged immediately.
Treating anorexia nervosa typically requires interdisciplinary teamwork, including psychiatrists, nutritionists, and psychotherapists. Cognitive Behavioral Therapy (CBT) is considered a first-line psychological treatment that helps patients rebuild a healthy understanding of weight and diet. Severe patients may require inpatient treatment to restore weight, along with family therapy to improve the support system.
How can family members provide effective support during the patient's recovery?Family members should avoid directly correcting the patient's eating behaviors and instead express concern through "non-judgmental communication." They should encourage collaborative meal planning and participation in professional treatment. It is important to respect the medical team's recommendations and avoid causing conflicts in family interactions.
Does recovery to a normal weight in anorexia nervosa patients mean that symptoms have healed?Weight restoration is merely the starting point of recovery; psychological symptoms such as distorted body image may persist. Patients need to continue receiving psychological treatment for at least 6-12 months and have regular follow-ups to prevent relapse. Complete recovery requires comprehensive adjustments in physiological, psychological, and behavioral patterns.
Why is the common societal view that "anorexia is just a desire to be thin" incorrect?This view overlooks the biopsychosocial factors of the disorder, including neurotransmitter imbalances and compulsive thinking characteristics. Patients often develop pathological eating behaviors due to deep psychological trauma or personality traits (such as perfectionism) and require professional medical intervention rather than simple dietary adjustments.
Is anorexia nervosa in children more severe than in adolescents?Indeed, pediatric patients may face a higher risk of severe physiological complications, as their growth and development may be hindered. Clinical diagnosis must rule out other diseases, and treatment should particularly consider the developmental stage while enhancing family involvement to avoid long-term impacts on cognitive and physical development.
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