Acute Anorexia Nervosa

Girl's hand wrapped with IV

Acute anorexia nervosa (AN) is a severe psychiatric illness leading to serious health complications and, in some cases, even death. Unfortunately, treatment centers and hospitals are often ill-equipped to treat this advanced stage of anorexia, making it hard for many acute AN patients to find proper treatment.

What is Acute Anorexia Nervosa?

Acute anorexia nervosa (AN) is anorexia in its most severe stage. Patients with acute anorexia nervosa have a BMI of less than 15 (i.e., less than 65 percent of their ideal body weight) and meet the DSM-5 diagnostic criteria for anorexia nervosa [1].

Patients with acute anorexia nervosa can suffer from either the restricting subtype of anorexia (AN-R) or the binge-purge subtype (AN-BP). Restricting types lose weight by excessive fasting and dieting, while binge-purge types use compensatory behaviors like laxatives, diuretics, or vomiting to keep their body weight low [2]. Both types of AN may use obsessive exercise to burn calories and maintain low body weight.

Effects of Acute Anorexia Nervosa

Anorexia nervosa is the deadliest type of eating disorder and has the highest death rate of any other psychiatric disorder (four times higher than major depression) [3]. Common health problems associated with anorexia nervosa include anemia, slow heart rate, brittle bones, impaired immune functioning, amenorrhea, dental problems, low thyroid, low blood cell counts, gastrointestinal problems, and even death [4].

In addition to severe malnutrition and health complications, those with anorexia nervosa are at an increased risk of committing suicide, with suicide being the cause of one in five anorexia deaths [5].

Patients diagnosed with acute anorexia nervosa typically suffer from similar health complications as regular AN patients, but at a much higher frequency and severity. One study found that 45 percent of acute AN patients have osteopenia, 43 percent have osteoporosis, and 38 percent develop hypoglycemia (often resulting in severe episodes that can lead to loss of consciousness and even death) [6].

Patients with acute anorexia nervosa are also threatened by hair loss, muscle weakness, poor wound healing, body temperature problems, slow heart rate, heart murmurs, severe gastrointestinal problems, and cardiac arrest, just to name a few [7].

Doctor treating woman with acute anorexia nervosaAnother sometimes fatal complication of acute AN is called refeeding syndrome (RFS). Refeeding syndrome was first reported during World War II. Starved concentration camp occupants of Leningrad were liberated and began to eat again, only to mysteriously die a few days later.

This tragic phenomenon happened because their extreme electrolyte imbalances (thanks to malnutrition) caused their hearts to stop beating. Acute AN patients can suffer and die from RFS if not refed properly [8].

In short, patients with acute anorexia nervosa suffer from extreme malnutrition, are in danger of experiencing complications like refeeding syndrome, and have a significantly increased risk for numerous severe health problems and death.

Treatment for Acute AN

While the chances for recovery greatly increase the earlier an eating disorder is detected and treated, recovery is possible at any stage of the disorder, including acute anorexia nervosa [9].

Since acute AN patients are often medically unstable and are suffering from severe health complications and extreme malnutrition, treatment is typically conducted at a medical facility or medically-staffed treatment center.

The first stages of acute AN treatment focus primarily on getting the patient medically stable and refed. The treatment team usually includes physicians, clinical psychologists, registered dietitians, and therapists. They run numerous tests (blood, EKG, blood pressure, vital signs, etc.), and develop a plan to get the patient stabilized and nutritionally rehabilitated [10].

Unfortunately, many eating disorder treatment centers are not medically equipped to deal with acute AN patients, leaving severe AN cases for regular hospitals. The problem with this, however, is that most medical doctors and staff have not been specifically trained to treat eating disorders.

Though hospital staff and doctors may be able to stabilize the patient and ward off an immediate threat of death, the patient’s underlying psychological problems are not dealt with and will often resurface and lead to another relapse.

This is why it’s so important to seek out a treatment center that is designed to treat eating disorders at every level, including acute anorexia nervosa. Staffed with physicians, psychologists, dietitians, and therapists trained specifically to treat eating disorders, these centers are able to address immediate health threats, stabilize the patient, and support long-term recovery and psychological healing.


References:

[1] Gibson, D., Waters, A., Cost, J., Mascolo, M., & Mehler, P. S. (2020). Extreme anorexia nervosa: medical findings, outcomes, and inferences from a retrospective cohort. https://jeatdisord.biomedcentral.com/track/pdf/10.1186/s40337-020-00303-6.

[2] ibid.

[3] DeNoon, D. J. (2011, July 12). Deadliest Psychiatric Disorder: Anorexia. WebMD. https://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/news/20110711/deadliest-psychiatric-disorder-anorexia.

[4] Warning Signs and Symptoms. National Eating Disorders Association. (2017, February 26). https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia/warning-signs-symptoms.

[5] Eating Disorder Statistics • National Association of Anorexia Nervosa and Associated Disorders. National Association of Anorexia Nervosa and Associated Disorders. (2019, June 17). https://anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/.

[6] Gibson, D., Waters, A., Cost, J., Mascolo, M., & Mehler, P. S. (2020). Extreme anorexia nervosa: medical findings, outcomes, and inferences from a retrospective cohort. https://jeatdisord.biomedcentral.com/track/pdf/10.1186/s40337-020-00303-6.

[7] Warning Signs and Symptoms. National Eating Disorders Association. (2017, February 26). https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia/warning-signs-symptoms.

[8] Machado, J. D. C., Suen, V. M. M., Chueire, F. B., Marchini, J. F. M., & Marchini, J. S. (2009). Refeeding syndrome, an undiagnosed and forgotten potentially fatal condition. BMJ case reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028379/.

[9] Warning Signs and Symptoms. National Eating Disorders Association. (2017, February 26). https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia/warning-signs-symptoms.

[10] Gibson, D., Waters, A., Cost, J., Mascolo, M., & Mehler, P. S. (2020). Extreme anorexia nervosa: medical findings, outcomes, and inferences from a retrospective cohort. https://jeatdisord.biomedcentral.com/track/pdf/10.1186/s40337-020-00303-6.


Sarah Musick PhotoSarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.

Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.


The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published July 23, 2020, on EatingDisorderHope.com
Reviewed & Approved on July 23, 2020, by Jacquelyn Ekern MS, LPC

About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.