Anorexia nervosa is an eating disorder that has the highest mortality rate out of any mental health disorder. Anorexia nervosa is characterized by the intense fear of gaining weight, a distorted body image, inability to maintain a minimally normal weight and extreme dietary habits that prevent weight gain. There are two subtypes of anorexia nervosa known as the restricting type and the bing-eating/purging type. Most individuals associate anorexia with the restricting subtype, which is characterized by the severe limitation of food as the primary means to lose weight. The second subtype is known as binge-eating/purging subtype which is characterized by periods of binging followed by self-induced purging behaviors such as vomiting, diuretic abuse, laxative abuse or excessive exercise. There are many disorders that are known to co-occur with anorexia nervosa and many disorders that are often mistaken for anorexia nervosa. Mistaking any of the disorders that mimic anorexia for the disease could result in treatment delay, unnecessary medical costs and potential complications. The following are disorders that mimic anorexia nervosa.
Over 18,000 women with celiac disease were studied and shown to have both celiac and anorexia prior to and after a celiac diagnosis. In previous studies, it has been suggested that diseases, which are food restrictive, such as celiac disease and food allergies, are associated with anorexia. It is believed that once a restrictive diet begins, that it can trigger dysfunctional eating patterns. Celiac disease is a chronic disorder of the digestion tract due to the inability to tolerate gliadin, the alcohol-soluble fraction of gluten. Gluten is a protein commonly found in wheat, rye, and barley. When an individual consumes gluten in the form of bread, soy sauce, beer or other gluten enriched foods, an immunologically mediated (your body attacks itself) inflammatory response occurs that damages the mucosa of the intestines, resulting in poor digestion and malabsorption of food nutrients. This results in extreme abdominal discomfort, bloating, weight loss, fatigue and diarrhea.
Achalasia is a primary esophageal motility disorder that occurs due to the impairment of the lower esophageal sphincter (the muscle that relaxes and contracts when food is swallowed). Food is unable to pass from the esophagus into the stomach and as a result food is regurgitated. The most common signs and symptoms associated with achalasia are weight loss, the inability to swallow (dysphagia), chest pain, heartburn and regurgitation.
Illness anxiety disorder
Illness anxiety disorder, formerly known as hypochondriasis, is characterized by a preoccupation with having a serious, undiagnosed medical condition. Individuals will have multiple visits to a healthcare professional, complain of many vague symptoms and has a high level of anxiety about their health.
Body dysmorphic disorder
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), body dysmorphic disorder (BDD) is classified under obsessive compulsive disorders and the individual must have be preoccupied with a nonexistent or of slight flaw in their physical appearance where they think about this flaw for at least one hour a day and perform repetitive compulsive behaviors directly associated with their preoccupation for their flaw. Individuals with body dysmoprhic disorder often portray the following behaviors:
- Ritualistic behaviors to confirm their physical “defect”. This can include constant checking in the mirror, touching that specific area of the body or actively avoiding the “defects” recognition by others by covering that area of the body up with clothing, makeup or tattoos.
- The constant need for constant reassurance from others
- An enormous amount of time (1 hour or more, sometimes as much as 8 hours) daily on thoughts and behaviors relating to the “defect”
- Repeated visits to dermatologists or cosmetic surgeons for correction of this “defect”
Bulimia nervosa is an eating disorder that is most common among young adults that is characterized by recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, excessive exercise, laxative or diuretic use to avoid weight gain caused by the binging episodes. There is a binge/purge subtype of anorexia nervosa therefore these two eating disorders are often mistaken for each other. The difference in body weight is the main classification that separates anorexia nervosa from bulimia nervosa. The majority of individuals with anorexia nervosa are underweight as they have an intense fear of gaining weight and are unable to maintain a minimally normal weight where as the majority of individuals with bulimia nervosa are normal weight or overweight.