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Wanting to control your body , especially during puberty which imposes a lot of changes, is completely normal: following a small diet, doing more sport... nothing alarming about that.
On the other hand, when the pleasure of eating disappears in favor of extreme rigidity, without flexibility and that weight loss turns into an obsession, this may be one of the first symptoms of anorexia.
What is anorexia?
Anorexia is an eating disorder that is characterized by an extreme fear of gaining weight as well as very significant weight loss, linked to dietary restrictions that have lasted for some time. It is also called anorexia nervosa.
The perceived image of the body is disturbed and the person does not realize the seriousness of his physiological state, as in many TCA (eating behavior disorder).
There are two types of anorexia:
- Restrictive anorexia: Weight loss is mainly the result of restrictions, fasting and excessive physical activity.
- Anorexia bulimia: The second type includes bulimia attacks and compensatory practices: making oneself vomit, taking laxatives or diuretics.
What are the physical and mental symptoms of anorexia?
Anorexia is insidious. It responds to mechanisms that will be put in place gradually, whether it develops in infants, adolescents or adults.
In addition, there are many symptoms that are all signs that can detect the disease:
- Rapid weight loss
- Absence of periods (amenorrhea)
- Obsessive control of body image
- Changes in meals
- A thought invaded by food
- Physical hyperactivity and purgative behaviors
- The body that is damaged
- withdrawal from social life
Symptom 1: rapid weight loss
Weight loss is one of the first physical symptoms of anorexia nervosa. It is often done very quickly and dramatically. Nevertheless, for those around the anorexic person, it is not always easy to see this, because the body is sometimes hidden by loose clothing.
This loss can go up to 30% of the total weight in just a few months.
In a prepubescent child, we look at his corpulence curve: this allows us to follow the body mass index during growth. In the event of infantile anorexia , there is a cessation of weight gain and growth slows down: the curve is broken.
In adolescents, significant weight loss is observed, of at least 15% compared to the expected weight according to age and height. Finally, in adults the BMI is low (less than 18.5 kg/m2) and weight loss is greater than 15%.
The fats leave first, then the muscles melt away. Weight loss causes undernutrition. This leads to deficiencies and very serious somatic consequences on muscle functioning and in particular the heart.
Symptom 2: absence of periods (amenorrhea)
When the menstrual cycles are disturbed and the periods are spaced out or no longer occur (for at least three cycles), then we speak of secondary amenorrhea.
However, the absence of periods can be hidden by estrogen-progestogen contraception which causes withdrawal bleeding.
Amenorrhea is said to be primary when the young girl has never yet had her period and anorexia prevents the appearance of her first menstruation. Other signs of puberty are slowed down, such as breast development in girls, or genitals in boys.
Symptom 3: Obsessive control over body image
For an anorexic person , their weight will always be too high. This obsession with thinness and the perfect body, combined with a distorted self-image , gives rise to a phobic fear of getting fat.
At the neurological level, the brain of anorexics would process information with a faculty of extreme concentration and a difficulty in disengaging, which could explain the obsession with weight.
The alteration of the perception of weight and of the body, makes the person feel fatter than they are and fail to become aware of their thinness. Weighings on the scales are frequent and the person can spend a lot of time in front of the mirror detailing the areas of his body that are unbearable.
Perfectionist personality traits coupled with low self-esteem cause him to focus only on flaws. The latter are compared to an idealized image of the perfect body, often represented and put forward by society, indirectly participating in a form of social pressure.
The person suffers from a very great fear of losing control and not being able to stop eating, as may be the case with vomiting bulimia.
The omnipotence engendered around food is very intense, both disturbing and reassuring: it is a paradoxical, double-edged prison in which she locks herself up. But this will influence his eating behavior.
Symptom 4: Changes in mealtime behavior
Constantly thinking of being overweight, the anorexic will try to reduce the calorie intake as much as possible through a restrictive diet. In order to keep control of meals, when she is unable to avoid them, the contents of her plates are increasingly reduced.
He sometimes puts food aside, hides it in his towel or his clothes, throws it away or even gives it to pets. Food cut into small pieces and sorted by size is a behavior that is found regularly.
The disgust of food will cause inappetence and food avoidance: foods that were previously appreciated are now rejected. Little by little, entire categories are being eliminated, such as starchy foods.
Low calorie foods are preferred, moreover calorie counting becomes a habit. A specific diet is often requested and packaging labels are scrutinized in the image of orthorexic disorder.
A teenager who finds excuses to avoid meals or who no longer wants to eat at the table, but only alone in his room, must also alert.
It is important for relatives to maintain the link at the table during meals: indeed, it is difficult to become aware of an eating disorder by not being present at mealtimes, because anorexic individuals have learned to hide their deviant behavior.
Symptom 5: A thought invaded by food
All the intellectual activity of the anorexic person is focused on how to keep control over their diet. She is constantly thinking about food and trying to implement strategies to maintain control.
She will, for example, impose shopping lists with very specific foods or cook for the whole family. There is a form of very strong control that is prescribed for all members of the entourage, which generally leads to conflicts.
It is possible to compare the behavior of anorexic people to that of people addicted to alcohol or drugs: hiding, dissembling, lying… Addiction to food exists.
In the case of anorexia, it's an addiction to losing weight: losing weight is encouraged by the brain's reward circuits.
The longer the eating disorder sets in, the more the body adapts to the restrictions by changing some of its systems, which causes an endorphin release not at the time of eating, but during the activities of food restrictions and fasting.
Unlike individuals addicted to drugs or alcohol, who have difficulty regulating their needs, people suffering from anorexia control their impulsiveness too well under the influence of envy and this is what keeps them in phases extreme restrictions.
Symptom 6: physical hyperactivity and purgative behaviors
In order to control weight, strategies are implemented. Taking diuretics or appetite suppressants is common, as is potomania, the practice of drinking liters of water.
When the disorder is recent and the undernutrition has not yet impacted the body too seriously, the anorexic person demonstrates extreme vitality. She can overinvest in sport and this intense physical practice will provoke positive emotions in her that will reinforce her weight loss behavior.
Symptoms of anorexia in men mainly relate to physical hyperactivity. Boys are also more prone to phases of bulimia.
Quickly emptying cupboards and binge eating in a very short time may indicate binge eating, which is not to be confused with signs of binge eating.
Indeed, when bulimia attacks are associated with anorexia, purgative behaviors are established: vomiting in the toilet, enemas, taking laxatives, while hyperphagia attacks are not followed by elimination behaviors.
Symptom 7: Withdrawal from social life
Malnutrition affects the brain and causes irritability, in addition to difficulty concentrating. Hyperemotivity as well as anxiety appear.
Obsessive thoughts, a depressed mood and dark thoughts will invade the person. Emotions are directly linked to food and in the case of anorexia, their difficult management fuels the disorder: either the person eats his emotions (bulimia, hyperphagia), or he refuses to eat (anorexia). In all cases, the emotions are not experienced fully by the person taking an ED.
Accordingly, a disinterest in all previously enjoyed activities, withdrawal from social life, and isolation are symptomatic behaviors. For fear of confrontation with others, people will avoid going out and meeting people, which will lead them to withdraw and isolate themselves.
Younger children may want to spend more time with their parents and less with their friends. This isolation sometimes leads to a break with schooling or the professional world. When this is not the case, there is an over-investment and a hyper-intellectualization of studies or work.
Generally, denial overwhelms the person and it is impossible to make him listen to reason, which leads to conflict. She suffers from being misunderstood by those around her and can manipulate them to achieve her ends.
Denial, however, is an unconscious attitude: it involves refusing a real element or a set of tangible facts. It is therefore difficult for relatives to make them accept the reality of the disease.
This is a difficulty for the family and for the suffering person himself: he is asked to abandon the whole system in which he has been strategically evolving for months, even years.
Symptom 8: the body that is damaged
Often, the person affected by this ED is very cautious. This is because the blood circulation is slowed down, which causes chilliness. The body is sometimes buried under several layers of clothing to warm more than to hide.
- Headaches are common.
- The skin is dry, the nails brittle.
- Hair loss is possible, as is the appearance of a small down similar to lanugo.
In case of repeated vomiting, calluses on the back of the hands will come out. The repercussions on the teeth and gums are substantial (enamel that is destroyed, multiple cavities, loosening, irreversible wear).
Malnutrition and low calorie intake deplete the body, with a physical form that is very impacted and regular dizziness.
In the long term there is a risk of cachexia: it is the result of anemia and asthenia, both caused by anorexia; the muscle mass lost is such that the person remains in a state of immobility.
Bottom line
If you think that your child, or a loved one, suffers from anorexia, it is important to manage to maintain the link with him, not to split, not to get angry, but above all to seek an outside perspective to accompany you.
Management of anorexia should be somatic and psychological, and as with other eating disorders, it is usually multidisciplinary.
Anorexia nervosa is a treatable disorder. For this, the adhesion of the person is necessary, he must be an actor in his healing. Cognitive and behavioral therapy makes it possible to work on the vicious circle in which it has been built in order to learn to reconcile with food and with oneself.
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Ressources
- New insights into symptoms and neurocircuit function of anorexia nervosa
- Improvements in Anorexia Symptoms After Deep Brain Stimulation for Intractable Obsessive-Compulsive Disorder
- Psychological Inflexibility and Symptom Expression in Anorexia Nervosa
- The Eating Attitudes Test: an index of the symptoms of anorexia nervosa