What is anorexia?

What sustains this behavior over time, and what can be identified as the phases of anorexia?

“At the beginning, patients who lose weight often feel euphoric, which encourages them to restrict their food intake even more. But when weight loss becomes significant, problems associated with being underweight start to emerge. These are often accompanied by demoralization, anxiety, sadness and even apathy.

After the so-called ‘honeymoon phase,’ the downward phase begins: the patient starts to feel fatigue, exhaustion, difficulty concentrating, and this leads to conditions which, even from a psychopathological perspective, are serious manifestations. Some may even develop delusions due to their underweight status,” explains Dr. Cavallini.

Another strategy used to lose weight is engaging in excessive physical activity to burn calories.

“Very often, these patients are physically depleted, yet they can’t stop themselves from going up and down stairs, walking long distances, and more. This also poses a major challenge for treatment because it becomes difficult to persuade them to adopt different behaviors.”

There are two types of anorexia, depending on whether or not the patient engages in purging behaviors such as self-induced vomiting, sometimes even after consuming very small amounts of food or the use of appetite suppressants or diuretics, which further aggravate the condition:

• Restrictive anorexia
• Anorexia with bingeing and purging behaviors

“There are individuals who begin with restrictive behaviors and maintain their food refusal, and others who are characterized by purging behaviors, which are often associated with binge eating, followed by vomiting or the use of laxatives or diuretics.

At one time, diagnostic criteria for anorexia in females included amenorrhea, the absence of menstruation, but this was later removed, both because some underweight individuals still had menstrual cycles and because the disorder also affects males.

The real issue lies in the distorted body image; for an anorexia diagnosis, the BMI (Body Mass Index) must be below 18,” adds Dr. Cavallini.

As previously mentioned, the first warning signs of the disorder can be seen in the patient’s gradual elimination of certain foods from their diet. Socially, changes are also evident.

Food is not only essential for survival, it is also a source of social bonding and togetherness. Often, young people with anorexia withdraw from social events with friends, as this would involve eating and remove the ability to hide their condition.

Even within the family setting, they tend to avoid shared meals, prefer to prepare their own food, and eat in isolation, sometimes followed by purging or intense exercise to compensate.

“Young people are certainly among those most at risk of developing anorexia, as the disorder typically begins in adolescence.

What we are increasingly seeing is a lowering of the age of onset. There are even cases of so-called ‘baby anorexia’ affecting children as young as 9 or 10, even before the onset of menstruation in girls. This complicates treatment because, for example, restoring the menstrual cycle is one of the treatment goals in female patients.

Athletes, including male athletes, are also at risk. Young athletes are often under intense pressure to have a body that fits specific standards. Across many countries, it’s been observed that young athletes, regardless of gender, are highly exposed to external expectations to excel.

Another common trait in anorexia patients is extreme precision and perfectionism, bordering on the obsessive, which pushes them to reach their goals as quickly as possible,” Dr. Cavallini notes.

“Currently, treatment paths for anorexia are complex and require a multidisciplinary approach,” explains Dr. Cavallini.

This includes:

• Nutrition specialists, who must help the patient gradually restore a normal relationship with food and eating;
• Psychologists, because dissatisfaction with body image and the urge to conform to specific ideals are often signs of deeper psychological patterns, such as perfectionism, that must be explored and understood.

“In our care model we also involve the psychiatrist, who coordinates the team, and an internal medicine physician, who helps manage the medical aspects and guides treatment choices,” she continues.

From a pharmacological standpoint, there are no medications that specifically treat anorexia. “Drugs are used to address related symptoms. While in depression we know that prescribing an antidepressant typically helps the patient feel better, in eating disorders the real turning point is nutritional rehabilitation,” explains Cavallini.

How do medications work in these patients? “To see a real effect on psychiatric or psychological symptoms, the patient’s physical condition must first return to a stable, healthy state. Only then can the medication have its intended impact.”

How to help someone with anorexia

The first step in preventing anorexia is recognizing the early signs, particularly by family and friends. These include:

• A sudden, extreme change in eating habits;
• Social withdrawal, such as avoiding outings with friends to avoid eating together;
• Perfectionist behaviors, strict routines or rigidity that are unusual for someone of that age.

“Being obsessive about studying or physical activity can also raise red flags for parents, teachers, or caregivers. It’s important to pay attention, observe carefully, and determine whether the behavior is a passing phase or a new norm. Once you notice a persistent pattern, it’s essential to seek help from professionals who specialize in eating disorders and can offer the right treatment pathway,” Dr. Cavallini concludes.