If you’ve been living with anorexia for a while, you might wonder if your condition is chronic.
No two people’s experience of an eating disorder looks the same. Eating disorder behaviors might last longer before treatment, be more severe, or respond to treatment differently. For many people with anorexia nervosa, recovery can take years.
There are several stages of recovery. The length of time and number of repetitions for each stage varies for each person. Like many mental health conditions, relapse can occur.
Some people’s anorexia can be stubborn to treatment. If the condition is resistant to improving, it’s thought of as chronic anorexia. Chronic anorexia is also known as severe and enduring anorexia nervosa (SE-AN).
Eating disorders are serious conditions, but they’re treatable for most people. If you have anorexia, starting treatment as soon as possible can have a positive impact on your long-term health.
Anorexia is an eating disorder that typically involves restricting food in an attempt to make your body smaller. This reduction in nutrient intake can have a negative effect on your body and may cause significant weight loss.
Sometimes people with anorexia exercise excessively. They may also vomit or use laxatives to purge what they’ve eaten, and sometimes binge-eat.
Anorexia can often cause someone to see their body differently than it appears to others and strongly fear weight gain.
Is anorexia a chronic illness?
Anorexia is a treatable disorder for most people, but it can become chronic. It’s the condition’s response to treatment that determines if it’s chronic.
There’s currently not one accepted definition of chronic or treatment-resistant anorexia, but there are two ways eating disorder researchers and healthcare professionals think about this topic.
Over the past decade, the term severe and enduring anorexia nervosa (SE-AN) has become more popular, according to a 2021 review. SE-AN is written about as anorexia that lingers for at least 3 to 7 years (depending on the author of the study) after treatments.
Secondly, more than 10% of people do not see an improvement in their condition with treatment. In some research, this treatment outcome is described as having chronic anorexia.
In the case of anorexia, it’s often the amount of time someone has the condition before receiving help that can increase the time needed to treat the condition. After 3 years, anorexia becomes more difficult to treat, and symptoms may become more serious. That’s why early treatment is an important first step.
Chronic anorexia is not part of an initial diagnosis. Over time, physicians may change their care approach if they believe anorexia is treatment-resistant.
Anorexia nervosa subtypes
Anorexia has two subtypes:
- restrictive: severe limitation of the amount and types of food eaten
- binge-purge: extreme food restriction, with occasional overeating followed by purging through vomiting or laxatives
Men can develop anorexia, although it’s more common in women. Men are less likely to seek treatment and may be less likely to be diagnosed, due to eating disorder stigma. Men respond equally as well as women to treatment.
There are many symptoms of anorexia that fall into two categories: behavioral and physical.
Anorexia behaviors can include:
- dressing in layers or baggy clothing
- cooking for others without eating
- avoiding social situations involving meals
- counting and measuring food characteristics like calories and grams of fat
- expressing a need for control
- exercising excessively, despite illness, injury, fatigue, or poor weather
Physical signs include:
- weight loss
- fatigue, dizziness, and fainting
- dry skin, nails, and hair
- gastrointestinal problems
- slow wound healing or a weakened immune system
- loss of menstruation
Not everyone with anorexia has the same symptoms. For a formal diagnosis, three criteria must exist as listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):
- nutrient intake low enough to impair health and cause weight loss
- intense worry about gaining weight, even when already underweight
- impaired ability to accurately assess one’s own body weight or size, or to acknowledge the seriousness of malnourishment
Low (BMI) is part of the DSM-5 guidelines for anorexia diagnosis. However, people of all sizes can have anorexia.
A doctor can diagnose anorexia, using:
- a physical exam
- lab tests, like blood work
- a psychological evaluation
- other tests, like X-rays to check for bone fractures and density
In about 50% of people diagnosed with anorexia, the condition can last for 5 years or more. Recovery is a gradual process and can take years. For some, treatment for anorexia can be lifelong.
Stages of recovery
The National Eating Disorders Association summarizes anorexia recovery in five stages.
Your journey might not look like someone else’s. The time it takes to get through each stage, and whether you revisit stages more than once, varies between individuals.
- Precontemplation stage. You may not think you need to make any changes. Your friends and family may have noticed differences in your eating patterns, but you’d rather not discuss the topic.
- Contemplation stage. You might have some anxiety about change, but you’re willing to think about getting help.
- Preparation stage. You’re ready for change but aren’t sure how to make it happen. You develop a treatment plan with your care team. They help you establish boundaries and coping strategies for thoughts and emotions that might interfere with your progress.
- Action stage. You’re actively in treatment. You take steps such as removing triggers like scales and diet food items. You’re making concrete changes to your relationship with food.
- Maintenance/relapse stage. After navigating the action stage for 6 months or more, you’re ready to practice self-care and use coping skills.
When can you stop treatment for chronic anorexia?
This is a question that you may be able to best answer by talking with your care team. Often, treatment for chronic anorexia is ongoing and may be focused more on improving your quality of life than full recovery.
How long can a person live with untreated anorexia?
Untreated anorexia nervosa can result in premature death. How long a person can live without treatment or with treatment-resistant anorexia varies based on the severity of behaviors and other factors.
Anorexia isn’t your fault. There are several influencing factors or causes:
- genetic: family history of eating disorder or mental health diagnosis
- social: isolation, trauma, weight stigma, bullying
- psychological: perfectionism, anxiety, rigidity, low self-esteem
Research has found neurological differences may affect someone’s chance of developing anorexia.
The long-term effects of anorexia depend on treatment. Beginning treatment sooner can have a more positive impact on your long-term health.
Anorexia can cause:
- organ damage
- weakened bones
- reproductive difficulties
- skin, hair, and teeth problems
- brain and nerve damage
Recovery can reverse many of these issues, but sometimes changes are permanent.
Nutrition support and medical treatment may restore much of your physical health. While therapy helps to prevent relapse, it can also reduce long-term psychological effects such as depression and low self-esteem.
Anorexia treatment uses a combined mental and physical health approach.
The goals of treatment are to help:
- reverse any medical changes caused by malnutrition
- change your relationship with food
- equip you with coping strategies to handle potential triggers
- develop a relapse plan
Sometimes treatment can include hospitalization or an outpatient nutritional therapy program to help ensure you eat enough to recover. Doctors can also monitor any accompanying issues you may have, like heart problems.
Talk therapy, also known at psychotherapy, can help you sort out negative thinking patterns that lead to unwanted behaviors. Some approaches can help you uncover the connection between your past and your present-day experience.
Although anorexia treatment usually focuses on nutrition support, medical care, and therapy, sometimes medications can help.
Some medications may also help restore weight.
A 2020 study revealed short-term treatment with olanzapine (Zyprexa) helped to increase BMI in people with anorexia. Medication can also help manage anorexia complications, such as osteoporosis and anemia.
Anorexia can feel overwhelming of isolating at times, but getting assistance from your medical team and support network can help you in coping with the condition.
Treatment may take a long-term commitment, but it can be very effective. Seeking out social support and learning more about anorexia can also help.
Treatment may include medical support, therapy, and sometimes medication. A healthcare professional can help you start the treatment process.
Anorexia can become chronic, but with support, you can build the coping skills you need to help put this condition behind you or improve your quality of life.
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