Anorexia nervosa is one of the best known and most dangerous mental disorders in the short term, with a high potential for death if not treated.

This is one of the disorders of eating behavior, and involves the obsession with reaching a figure that is considered by themselves as perfect at the same time that cognitive distortions appear that make them see themselves as excessively thick or even obese, reducing intake and performing different behaviors to reduce their weight or prevent the possibility of gaining weight despite being underweight that can generate various problems and even lead to death.

However, in recent times a variant or evolution of this disorder has been detected that may be even more dangerous, since it includes self-aggression as one of its symptoms. This is sadorexia , which we will talk about throughout this article.

What is sadorexia?

Sadorexia is a second generation eating disorder , considered a highly dangerous variant or evolution of anorexia nervosa.

In this variant, in addition to the symptoms of classic anorexia (the sufferer shows intense restriction of intake leading to progressive weight loss that goes beyond the minimum healthy weight, an intense fear of gaining weight and important distortions of the body image which generate the realization of behaviors that may be the cessation of intake or methods such as the use of excessive exercise, laxatives or provoking vomiting) the person who suffers from it performs self-injurious behaviors in order to avoid hunger or punish possible excesses .

Sadorexia is a condition that requires the existence of anorexia in the first place, and which also involves sadomasochistic symptoms. It is usually suffered by adolescent or young adult women, although there are male cases.

In addition to the above, other symptoms of both disorders include excessive and rapid weight loss that can become incompatible with life . On a physical level, dizziness, pain, fatigue and low energy level, amenorrhea or loss of menstruation, skin problems, infections, gastric, liver and kidney problems, among others, may be observed.

It is also common for her to appear clinically anxious and depressed, with high emotional lability and possible isolation from her environment, as well as concealment of her eating habits and a tendency to deceive, manipulate and lie so that her habits are not detected. In sadorexia also it may be common for the person to hide their skin from view so that the lesions are not visible .

Over time and without treatment, the body will become increasingly weak until it can suffer from arrhythmias, organ failure, catabolism (the body consumes itself), nervous disorders, coma and/or death.

Self-harm as a method

These self-injurious behaviors often include voluntarily hitting, cutting (often with sharp instruments), burning, or even breaking bones. In some cases, self-mutilation or amputation of body parts may occur.

The acts of self-aggression performed in this disorder may have various purposes, although the main one and the one that identifies sadorexia is the use of pain as a mechanism to forget the sensation of hunger and not to eat , as well as to reduce the anxiety felt when faced with the sensation of hunger. In this sense, this procedure is also popularly known as the pain diet.

In addition, some people with sadorexia also use self-harm as a method of self-punishment when they take an intake that they consider excessive . Another possible trigger is the existence of aversive feelings such as suffering, sadness or guilt, which may cause physical pain in order to distract oneself and avoid focusing on the emotional sphere.

All of these acts are very dangerous in themselves and can directly end a person’s life, or further weaken an already fragile organism (e.g. through blood loss) by reducing intake or using methods such as sport or laxatives. The appearance of infections is also facilitated , both by open wounds and by the progressive weakening of the immune system.

Causes

Sadorexia is a disorder whose study is relatively new (in fact it is not yet covered by the main diagnostic manuals and the first mention of this term dates back to 2007), and its causes are not fully known. However, it is considered not to have a single cause but rather a multifactorial origin.

It has been observed that people with this type of disorder may have different characteristics, but they are usually emotionally labile and insecure subjects . Another typical profile is found in perfectionists, demanding, hyper-responsible people with rigid and inflexible beliefs. It is not uncommon for them to have had previous traumatic experiences (e.g. bullying) and to feel rejected or singled out because of their physical appearance and/or weight.

It is proposed that a possible cause may lie in the projection on eating habits of the need for control over their lives. It is often observed that those suffering from anorexia and this type of sadistic turnaround called sadorexia often have feelings of lack of control and competence over their lives.

To all this is added an overvalued vision of the importance of the body shape and appearance , to a great extent acquired culturally and which can be introjected in such a way that in interaction with other factors it can generate from insecurities to alterations of behaviour such as those mentioned.

Treatment

Sadorexia is a condition that has only recently begun to be investigated as such, and requires multidisciplinary work and the development of more specific protocols for its treatment. However, adaptations of the treatments used in anorexia nervosa and self-injury disorders can be employed.

In order to carry out a treatment, nutritional rehabilitation is very useful, with which the aim is firstly to recover a healthy weight and body mass (especially when the underweight is severe) and to normalise eating habits.

It may be necessary to admit the patient to the hospital in order to normalize her condition and maintain control over it. It is advisable to avoid access to sharp objects that can be used for self-injury. Motivation to change should be worked on with techniques such as motivational interviewing and contribute to the patient herself being able to elaborate a balance with the advantages, disadvantages and risks of her current situation.

Body distortions should be treated with methods such as cognitive restructuring or exposure (e.g. with mirrors or virtual reality) with response prevention (in this case both self-harm and other possible measures used by the person).

Beliefs about oneself or about the importance of body image and figure can also be restructured, treating the subject’s own as a hypothesis but trying to contribute to generate alternative, more adaptive interpretations. Training in stress and anxiety management as well as in the acquisition of coping methods of these can be positive in terms of reducing self-harm.

The adaptation of dialectical behaviour therapy methods could also be considered in order to reduce self-injurious behaviour. In this sense it may be useful to work on aspects such as self-awareness, regulation of emotions and impulsivity, social skills, life goals and the search for a more realistic, positive and validating self-concept.

Other tips to accompany therapy

Family or social support may be essential , as they can help generate and maintain change and avoid relapses. It is useful to carry out psychoeducation not only with the patient but also with his or her environment to provide guidelines and encourage understanding of the process that his or her loved one is going through.

Also caution should be taken with the use of Internet networks , since there are some dangerous websites of people with this and other food pathologies in which users provide each other with advice to limit the intake, something that can worsen the situation of the person who suffers from it.

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Bermejo, B., Saúl, L.A. and Jenaro, C. (2011). Anorexia and bulimia on the web: Ana and Mia, two “bad companies” for today’s young women. Psychological Action, 8 (1), 71-84.