Anorexia Nervosa

Anorexia Nervosa is a type of eating disorder. Eating disorders are mental health conditions that cause extreme and dangerous eating behaviors, leading to serious physical health problems and sometimes death.

In most cases, anorexia nervosa isn’t about food. It’s an extremely unhealthy and potentially life-threatening way to cope with negative emotions. For people with anorexia, thinness often equates to self-worth.

Like other eating disorders, anorexia can take over your life. Unlike people with bulimia nervosa and binge-eating disorder, those with anorexia do not eat enough to sustain essential bodily functions. But with treatment, individuals with anorexia can improve their quality of life, return to healthy eating habits, and reverse the complications of anorexia.

How common is anorexia nervosa?

Approximately 0.9% of women in the United States are affected by anorexia at some point in their lives. Anorexia is especially common among young adults and adolescents, and nearly half of anorexia patients have a co-occurring mental health disorder, such as an anxiety disorder.

Although the exact cause of anorexia remains unknown, research suggests that environmental, social, and cultural factors play an essential role in developing eating disorders. According to a recent study, biological and genetic factors may also contribute to the development of anorexia nervosa.

Recognizing the Symptoms of Anorexia

The symptoms of anorexia include emotional and behavioral symptoms involving an unrealistic perception of body weight and an intense fear of weight gain, binge eating, or a loss of control over food. Some of the symptoms of anorexia include:

• Depression, mood swings, and low self-esteem
• Confusion or slow thinking
• Poor memory or impaired judgment
• Feeling cold, faint, dizzy, tired, or weak
• Dry, blotchy, or yellow skin
• Fine hair all over the body (lanugo)
• Weak muscles or swollen joints

People with anorexia may also experience behavioral changes, such as:

• Preoccupation with physical appearance, body weight, and/or food intake
• Not eating or eating very little
• Refusing to eat in front of friends or family members
• Refusing to go out with friends
• Lying about the amount of food they ate
• Pushing food around on their plate or hiding food

Medical Complications Related to Anorexia

Anorexia is associated with numerous medical complications. At its most severe, anorexia can be deadly. Death may occur suddenly—even when someone is not at a dangerously low body weight—due to abnormal heart rhythms or an electrolyte imbalance. Other medical complications related to anorexia include:

• Anemia
• Heart problems, such as heart failure
• Bone or muscle loss
• Gastrointestinal issues, such as constipation and bloating
• Kidney problems
• Low blood pressure and/or fainting spells
• Irregular periods in women or decreased testosterone in men

In addition to physical health complications, people with anorexia also experience co-occurring psychiatric disorders, including:

• Depression, anxiety disorders, and other mood disorders
• Personality disorders
• Obsessive-compulsive disorder (OCD)
• Substance use disorder
• Self-injury, suicidal thoughts, and/or suicide attempts

How is anorexia diagnosed?

Meeting with an eating disorder specialist for a full psychological and physical exam is the best way to assess whether you or your loved one has anorexia. Your doctor will review your medical history and evaluate the diagnostic criteria for anorexia as defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The criteria for the diagnosis of anorexia nervosa include:

• Restriction of food intake relative to the individual’s height, weight, age, gender, physical health, and development that leads to low body weight.
• Intense fear of weight gain and persistent behaviors to prevent weight gain despite being underweight.
• Distortion of body shape and body weight, or a lack of understanding of the seriousness of how low the person’s body weight is.
• Restriction of food intake without the use of any means of eliminating the food or binge episodes.

The DSM-5 lists further specifications about the severity of the condition, determined by the individual’s body mass index (BMI).

The DSM-5 defines atypical anorexia nervosa as having met the full criteria for anorexia except for meeting a normal or above normal weight, making atypical anorexia challenging to diagnose its clinical presentation. Individuals with atypical anorexia are often turned away from doctors because they do not appear sick.

Treatment Options for Anorexia Nervosa

The main goals of treatment are to restore the body to a healthy weight and encourage healthy eating habits. For many people, overcoming anorexia is a lifelong challenge. The treatment options for anorexia include:

• Psychotherapy: Working with an experienced mental health professional can help individuals learn to change unhealthy thoughts and behaviors related to eating, self-esteem, and body image. Effective treatments for anorexia include cognitive-behavioral therapy (CBT), family therapy, behavioral therapy, and group therapy.

• Nutrition therapy: Nutritional counseling and weight restoration monitoring help combat low weight and promote healthy eating habits. Family therapy is especially important for families with young adults and adolescents, as it enlists the help of family members to encourage healthy eating patterns and provide emotional support.

• Medication: Although there is no medication to treat anorexia, antidepressants—such as selective serotonin reuptake inhibitors—may be prescribed to treat anxiety and depression related to anorexia.

• In-patient treatment: Depending on the severity of your weight loss, your primary care physician may recommend medical care to treat anorexia. Individuals with dangerously low body weight may be put on a feeding tube and intravenous fluids. If you refuse to eat, your primary care physician may recommend hospitalization at the emergency medicine department for intensive treatment.

According to the Johns Hopkins University School of Medicine, many people with anorexia work toward full recovery with treatment and gain the ability to eat and exercise in healthy ways. Others may get better after the first treatment but may relapse and require further treatment.

Finding a Therapist for Anorexia Nervosa

According to the Philadelphia College of Osteopathic Medicine, only one of 10 people with eating disorders seek treatment. If you’re concerned a loved one may be struggling with anorexia, urge them to talk to a mental health professional. If you’re experiencing any of the symptoms of anorexia, or if you think you may have an eating disorder, seeking help is critical to your mental health and physical well-being.

If you’re considering seeking help for anorexia, bulimia, or another eating disorder, consider reaching out to a mental health professional through WithTherapy.

WithTherapy’s matching service will connect you to a mental health professional that you feel comfortable with, regardless of your personal preferences and requirements. One of the licensed mental health professionals on the WithTherapy platform will help you identify the underlying cause of your eating disorder and develop a healthy relationship with food and body image.

Find a Therapist for Anorexia Nervosa