Anorexia: A Comprehensive Analysis

Anorexia nervosa is a complex psychiatric disorder characterised by an extreme fear of weight gain, leading to restrictive eating behaviours and significant weight loss. This condition is associated with severe physiological and psychological consequences, often necessitating multidisciplinary intervention. Individuals with anorexia exhibit distorted body image perceptions, engaging in compulsive behaviours such as excessive exercise, fasting, and purging to maintain a dangerously low body weight. The disorder has a profound impact on physical health, cognitive function, and overall quality of life, necessitating early diagnosis and evidence-based treatment strategies.

In recent years, there has been increasing awareness regarding anorexia nervosa, yet its prevalence continues to rise, particularly among adolescents and young adults. The disorder is not merely an issue of willpower or dieting gone too far; it represents a severe mental health condition requiring medical, psychological, and social interventions. Given its chronic and relapsing nature, effective management necessitates a nuanced understanding of its pathophysiology, risk factors, and treatment modalities.

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Synonyms

Anorectic disorder, Eating disorder, Self-starvation, Malnutrition disorder, Restrictive eating disorder, Pathological weight loss, Food aversion syndrome, Cachexia (though more commonly used in medical contexts for severe wasting diseases), Psychogenic weight loss, Nutritional deficiency disorder

Aetiology and Risk Factors

The pathogenesis of anorexia nervosa is multifactorial, involving genetic, neurobiological, environmental, and psychological components. Several risk factors contribute to its development:

Genetic predisposition – Family studies suggest a hereditary component, with a higher prevalence among first-degree relatives of affected individuals.
Neurobiological influences – Dysregulation of neurotransmitters such as serotonin, dopamine, and norepinephrine affects appetite regulation, mood, and reward processing.
Psychological determinants – Perfectionism, obsessive-compulsive tendencies, low self-esteem, and comorbid anxiety disorders increase susceptibility.
Sociocultural pressures – Media portrayal of idealised body images, societal expectations, and peer influences exacerbate body dissatisfaction.
Traumatic experiences – Emotional distress, childhood abuse, or significant life stressors can act as triggers.
Drug history- Must rule out drugs causing anorexia such as Metformin, Digitalis, Anti-hypertensives, Metronidazole etc.
Others - Must rule out other causes alcohol addiction, excessive use of tobacco. Some time pulmonary tuberculosis may also present with only anorexia.

Pathophysiology

The pathophysiology of anorexia nervosa involves widespread metabolic and endocrinological dysregulation. Persistent caloric restriction results in hormonal imbalances, including decreased leptin, ghrelin, and insulin-like growth factor-1 (IGF-1) levels, which further perpetuate anorectic behaviours. Hypothalamic dysfunction alters hunger and satiety signals, while prolonged starvation leads to adaptive physiological changes such as bradycardia, hypotension, hypothermia, and osteoporosis. Additionally, sustained malnutrition impacts brain structure and function, contributing to cognitive rigidity and emotional dysregulation.

Emerging research has highlighted the gut-brain axis in the pathogenesis of anorexia. The gut microbiota, which plays a crucial role in appetite regulation and mood, is often disrupted in affected individuals. Dysbiosis may contribute to the perpetuation of restrictive eating patterns, reinforcing pathological behaviours.

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Clinical Manifestations

Anorexia nervosa presents with a constellation of physical, psychological, and behavioural symptoms:

Physical manifestations: Severe weight loss, lanugo hair growth, brittle nails, dry skin, muscle wasting, amenorrhoea, and gastrointestinal disturbances. Hypotension, electrolyte imbalances, and cardiac arrhythmias are common in severe cases.
Psychiatric symptoms: Intense fear of weight gain, distorted body image, mood instability, social withdrawal, and obsessive preoccupation with food and body shape. Anxiety and depressive symptoms are often comorbid.
Behavioural indicators: Ritualistic eating habits, excessive exercise, self-induced vomiting, misuse of laxatives or diuretics, and refusal to maintain a healthy body weight. Some individuals engage in food hoarding or extreme calorie counting.

Diagnostic Criteria

The diagnostic process for anorexia nervosa follows a structured approach:

Clinical history – Assessment of dietary patterns, weight fluctuations, and psychological symptoms. Family history and past psychiatric conditions are also considered.
Physical examination – Evaluation of BMI, vital signs, and systemic complications. Skin, hair, and cardiovascular assessments are critical.
Laboratory investigations – Blood tests to detect electrolyte imbalances, anaemia, thyroid dysfunction, and hepatic or renal impairment. Hormonal assays may indicate endocrine dysfunction.
Psychiatric assessment – Utilisation of DSM-5 criteria and structured interviews to confirm diagnosis. Screening for comorbid psychiatric disorders such as depression and OCD is essential.
Imaging studies – Bone density scans and ECGs to identify osteoporosis and cardiac anomalies. MRI studies may assess brain atrophy in chronic cases.

Therapeutic Interventions

Management of anorexia nervosa requires an integrative treatment model tailored to the severity of the disorder.

Allopathic Interventions

Cognitive Behavioural Therapy (CBT) – A frontline psychotherapeutic approach targeting maladaptive thought patterns.
Pharmacotherapy – SSRIs (e.g., fluoxetine 20–60 mg daily) for comorbid depression and anxiety. Atypical antipsychotics such as olanzapine may be used for weight restoration.
Nutritional rehabilitation – Supervised meal planning and weight restoration programs. Hospitalisation may be required for severely malnourished patients.

Based on Clinical practical (not theoretical)

Homeopathic Approaches

Ignatia Amara 30C – Prescribed for emotional distress and grief-related anorexia (2-3 drops twice daily).
Natrum Mur 6X – Recommended for loss of appetite and weight loss (three times daily).

Ayurvedic Protocols

Ashwagandha (500 mg twice daily) – Supports metabolic stability and psychological resilience.
Shatavari (1-2 grams daily) – Enhances digestion and hormonal balance.
Chyawanprash (1 teaspoon daily) – Strengthens immune function and overall vitality.

Unani Remedies

Safoof-e-Badam – Promotes appetite and digestive health (5g twice daily).
Majoon Falasfa – Used for neurological and gastrointestinal support (5g once daily).

Preventative Strategies

Primary and secondary prevention efforts aim to mitigate risk factors through:

Early identification and intervention for at-risk individuals.
Educational initiatives to promote body positivity and healthy eating behaviours.
Parental and peer support systems to counteract societal pressures.
Routine screening in adolescent health programmes.

Complications

The chronicity of anorexia nervosa predisposes individuals to severe medical complications:

Cardiovascular sequelae – Bradycardia, hypotension, and increased risk of heart failure.
Endocrine dysfunction – Hypothalamic amenorrhoea, osteoporosis, and infertility.
Neurological impairment – Cognitive deficits, mood disturbances, and structural brain atrophy.
Gastrointestinal dysmotility – Gastroparesis, severe constipation, and malabsorption syndromes.
Renal and hepatic dysfunction – Impaired kidney function and hepatic steatosis.

Prognosis

The long-term prognosis of anorexia nervosa is highly variable, influenced by early diagnosis, treatment adherence, and psychological resilience. While full remission is attainable with sustained therapeutic engagement, a subset of individuals experience relapsing-remitting courses, necessitating ongoing psychological and nutritional support.

Epidemiological Insights

Anorexia nervosa primarily affects adolescents and young adults, with a female-to-male ratio of approximately 10:1. The lifetime prevalence is estimated at 0.3%–1%, with a higher incidence in Western societies due to cultural and environmental factors. Emerging data indicate rising prevalence rates in non-Western regions, underscoring the globalisation of disordered eating patterns.

Advances in Research

Contemporary research in anorexia nervosa explores several promising avenues:

Genomic studies – Identifying susceptibility loci for targeted pharmacological interventions.
Gut-brain axis research – Examining microbiome alterations in relation to appetite regulation.
Neuromodulation techniques – Investigating transcranial magnetic stimulation (TMS) as an adjunct therapy.
Digital therapeutics – AI-driven applications for cognitive-behavioural interventions.

Case Studies

Case Study 1: A 19-year-old female demonstrated significant improvement through CBT combined with Ayurvedic supplementation.
Case Study 2: A 25-year-old male achieved remission following pharmacological treatment and nutritional rehabilitation.
Case Study 3: A 30-year-old woman experienced symptomatic relief through Unani interventions and holistic dietary modifications.

Conclusion

Anorexia nervosa is a multifaceted disorder requiring an integrative, patient-centred approach. Advances in neurobiological research, therapeutic interventions, and public health strategies continue to shape the landscape of eating disorder management. Heightened awareness, early intervention, and comprehensive care models remain pivotal in improving outcomes for affected individuals.