What Is Anorexia Nervosa?

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What Is Anorexia Nervosa?

Anorexia nervosa is an eating disorder that causes a person to restrict their food intake. They might try to avoid eating altogether, eat very small portions, and/or cut out certain foods and eat only a select few. A common feature of anorexia is an extreme fear of being overweight (even if they are underweight).

Anorexia typically begins in adolescents 15 years old or younger. The condition primarily affects girls and women. However, like other eating disorders, anorexia can affect people of all ages, genders, and racial/ethnic backgrounds. Worldwide, it's estimated that up to 4% of females and 0.3% of males experience anorexia.

Symptoms

It's important to recognize all of the warning signs and symptoms associated with anorexia. However, the symptoms often appear differently from person to person.

It should be noted that not all of these symptoms will be indicative of anorexia. Some people with anorexia may not display all, or even any, of these signs.

Symptoms may include:

  • Being underweight (sometimes severely)
  • Bingeing and purging (by vomiting or taking laxatives)
  • Constipation, bloating, and stomach pains
  • Dehydration
  • Distorted body image
  • Dizzy spells and faintness
  • Extreme tiredness (fatigue)
  • Extremely restrictive eating
  • Intense fear of gaining weight
  • Loss of periods or failure to begin a menstrual cycle
  • Loss or fluctuation of body fat and muscle
  • Poor circulation (constantly feeling cold)
  • Skin that is yellowed, dry, or covered in soft hair (lanugo)
  • Taking diet pills or aids
  • Talking about weight or food all the time
  • Suicidal thoughts or actions

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

People with anorexia may display specific behavioral symptoms, like refusing to eat in front of others, over-exercising to burn calories, or hiding their bodies in loose clothing. Some people also develop food rituals, such as cutting food into tiny pieces or rearranging food on a plate (to make it look like they've eaten more than they have).

Serious medical complications are associated with anorexia. It can cause malnutrition, low blood pressure, slowed breathing and pulse, and damage to the heart and heart function. It can also cause severe dehydration and electrolyte imbalances. In some cases, these symptoms are life-threatening.

One of the most harmful misconceptions about anorexia is that all people who struggle with it are severely underweight. While this may be true for some, many people with anorexia can appear to be in good health, when in actuality they are malnourished (deficient in important nutrients). Atypical anorexia is a term used to describe anorexia in people who aren't underweight.

Diagnosis

According to the current edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), diagnostic criteria for anorexia includes:

  • Intense fear of gaining weight: People with anorexia typically fear weight gain and dread becoming "fat." This fear often manifests itself through depriving the body of food.
  • Food intake restriction: People with anorexia tend to eat less food than the body needs to function correctly. This may lead to significantly low body weight for the person's age and height.
  • Distorted body image: This has to do with a person's perception of their body size. People with anorexia often have exaggerated views of their bodies. They generally view themselves as overweight, even if they're dangerously underweight.

Subtypes

There are two subtypes of anorexia: the restricting type and the binge-eating/purging type.

People with the restricting subtype place severe restrictions on the amount and type of food they eat. Restrictive behaviors include counting calories, skipping meals, or eliminating certain foods (such as carbohydrates). These behaviors are sometimes coupled with excessive exercise.

Those with the binge-eating and/or purging subtype also restrict their food intake. In addition, they also regularly engage in binge eating or purging behaviors, such as self-induced vomiting or misuse of laxatives or diuretics, or both binge eating and purging.

Differential Diagnosis

Restricted food intake and subsequent weight loss can also be a sign of another mental health condition. Before diagnosing anorexia, a healthcare provider must also rule out the following conditions:

There can also be medical causes for unexpected weight loss. Possible medical conditions to rule out include gastrointestinal disease and hyperthyroidism.

Some conditions, however, may also occur alongside anorexia. A healthcare provider will do a thorough review of both physical and mental health symptoms before making a diagnosis.

Causes

There isn't a definite cause of anorexia identified by experts, but research indicates a number of risk factors that people with anorexia often share.

Risk Factors

There are certain temperamental, environmental, and genetic factors that may play a role in the development of anorexia.

People with eating disorders may be perfectionists or high achievers. One study found that participants who were diagnosed with eating disorders tended to have emotional problems, distress, stress, unhappiness with their appearance, high expectations of themselves, and felt a lack of control.

People with anorexia may struggle with self-esteem. They may have other mental health conditions that contribute to their anorexia symptoms, such as obsessive-compulsive disorder (OCD) or social anxiety.

Environmental or cultural stressors may also play a role in the development of anorexia. For instance, people who play sports or do physical activities might feel more pressure to have a thin body. Societal pressure and weight stigma, especially as it's portrayed in the media when thin bodies are idealized, can also play a role in someone's fixation with having a thin body.

Environmental triggers combined with other risk factors can contribute to the development of anorexia and other eating disorders.

Research suggests that the development of anorexia is influenced by genetics as well. You may be more likely to have anorexia if someone in your family has it.

Treatment

Treatment for anorexia nervosa can occur in a variety of settings. Though it can be extremely difficult for someone with anorexia to seek help (and difficult for loved ones to intervene), encouraging them to speak to a doctor is key. This could be the first step in eventual treatment and recovery.

Hospitalization

If a person with anorexia is in severe and life-threatening danger, immediate hospitalization may be required. Hospitalization is necessary to treat anorexia-related complications like disturbance to the heart rhythm, electrolyte imbalances, dehydration, or malnourishment.

A person with anorexia may also require psychiatric hospitalization if they are refusing to eat.

In some cases, people with anorexia are fed through a tube inserted through the nose (nasogastric tube) so they can receive the nutrients they need.

There are clinics available to people with eating disorders as well. There are inpatient programs (where a person stays in the hospital for a period of time) as well as outpatient programs (where patients can go for the day).

Medication

There aren't any medications specifically approved to treat anorexia. However, if symptoms don't improve with psychotherapy or nutritional rehabilitation, healthcare practitioners might prescribe an antidepressant such as Prozac (fluoxetine), Celexa (citalopram), or Zoloft (sertraline) to treat any underlying symptoms of depression or anxiety in people with anorexia.

Psychotherapy

Cognitive behavioral therapy (CBT) is often recommended for people with eating disorders. Using CBT strategies, a therapist can help a person with anorexia recognize their maladaptive thought patterns surrounding food, eating, and body image. The goal of CBT is to learn new and healthy coping mechanisms instead of reverting to eating disordered behavior.

For adolescents with anorexia, family-based treatment (FBT) may be recommended. With help from a qualified therapist, FBT teaches parents or caregivers how to support a child or teen during mealtimes and encourage them to eat. The goal of FBT is to provide additional support to families coping with anorexia.

Group therapy is also effective for the treatment of eating disorders. Group sessions allow a person with anorexia to share their experiences and listen to others, which may help improve their self-awareness and insight into their own behaviors as well as develop strong interpersonal relationships.

Nutritional counseling may be provided by an inpatient or outpatient program, or a person with anorexia may see a nutritional counselor who has experience treating eating disorders. A counselor will help them understand what their basic nutritional needs are and how to fulfill them each day. The counselor may also review bodily functions like hunger, satiety, and fullness.

History of Anorexia Nervosa

The criteria in the previous edition of the diagnostic manual, the DSM-IV (published in 1994), was problematic because as many as three-quarters of patients diagnosed with an eating disorder fell into the catch-all category of eating disorder not otherwise specified (EDNOS). The broad ambiguity of the category made it hard for researchers and clinicians to adequately define and treat the condition.

The DSM-5, published in 2013, attempted to relax some of the criteria for various eating disorders and broaden the categories in order to reduce the number of patients in the EDNOS group (now called other specified feeding and eating disorder, or OSFED).

For anorexia nervosa, there were two primary changes in criteria from the DSM-IV to the DSM-5:

  • Amenorrhea (loss of a menstrual period) was eliminated as a criterion. This is important because it allows males or those who don't menstruate to meet the criteria for anorexia nervosa. It also allows the official inclusion of the small minority of females who continue menstruating despite extreme weight loss and malnutrition.
  • The low weight criterion was revised to allow more subjectivity and clinical judgment. This is also an important revision because anorexia nervosa can occur in individuals who are not what would be considered objectively low weight on a BMI chart. The new criteria allows professionals to take into account an individual's unique growth trajectory and weight history

Related Conditions

For patients who do not meet the full criteria for anorexia nervosa, other specified feeding and eating disorder (OSFED) may be an appropriate diagnosis. Being diagnosed with OSFED as opposed to anorexia nervosa does not make a person's condition any less serious.

It is important to note that people may meet the criteria for different eating disorders at different times, as symptoms can change. There is not a distinct line between healthy and disordered eating, but many shades of gray in the middle.

Coping

While it can be overwhelming to experience anorexia (or to have a loved one experience it), there are ways of coping that can help support mental health. Research has found that social support positively contributes to recovery from eating disorders. If you have anorexia, you shouldn't have to go through it alone.

It can be tough to ask for help or to let someone else know you have an eating disorder, but you can start by simply asking to meet up with a friend or catching up over the phone.

It's OK if you're not ready to provide loved ones with all the details of your diagnosis. But letting a loved one know you're going through a difficult time and would appreciate their support can go a long way.

Make sure you're doing things that you enjoy as much as possible. Make time to watch your favorite movies, or to take a road trip to your favorite place.

If you feel yourself becoming stressed and you're concerned your disordered eating behavior will be triggered, try to disrupt the behavior with an activity like going for a quick walk. Doing anything that takes you out of your thoughts, even for a second, can help calm your nervous system and relax the urgency you feel to act on something like skipping a meal.

It's important that you are kind to yourself. People with eating disorders tend to have perfectionist tendencies, so try to notice when your negative self-talk happens and try not to engage with it for too long.

Research shows that people with eating disorders who show themselves compassion—particularly when it comes to body image—may lessen their eating disordered behavior compared to people who don't show themselves the same self-compassion.

Anorexia Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

If you or a loved one are coping with an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237. 

For more mental health resources, see our National Helpline Database.

A Word From Verywell

Remember that anorexia looks different in everyone. Symptoms of this condition can be relieved with adequate treatment. Getting help early improves the chance of a complete and lasting recovery. If you or someone you know is suffering from some or all of the above criteria, it is important they see a physician, dietician, and/or a mental health professional for an assessment.

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By Susan Cowden, MS
Susan Cowden is a licensed marriage and family therapist and a member of the Academy for Eating Disorders.