Anorexia Nervosa: What to Know

Medically Reviewed by Jabeen Begum, MD on April 04, 2024
Written by Frances Gatta, Amy Gopal
15 min read

Anorexia nervosa, also called anorexia, is a potentially life-threatening eating disorder that can affect people of all ages, genders, ethnic or racial groups, and body sizes and weights. People with anorexia may have trouble maintaining a healthy weight for their body frame, height, and age. This disorder can lead to a distorted body image and serious health consequences.

The term anorexia means "loss of appetite." But this definition is misleading. People with anorexia nervosa do get hungry but starve themselves on purpose.

If you have anorexia, you may have an intense fear of gaining weight or becoming "fat." You may have a false sense of body image or think your self-worth depends on your body size. As a result, you may try to correct this perceived "flaw" by strictly limiting your food intake and exercising too much to lose weight. But extreme weight loss can lead to dangerous health problems and even death.

About 9% of people in the U.S. will have an eating disorder at some point in their lives. But not everyone who has anorexia is underweight. One study found less than 6% of people with eating disorders were underweight. In recent years, experts have called on medical professionals to recognize that people with larger bodies can have anorexia, too.

Anorexia vs. bulimia

Bulimia nervosa is an eating disorder like anorexia. The main symptom of anorexia is self-starvation to reach a particular body size. In contrast, people with bulimia tend to indulge in on-and-off binge eating, or they overeat food because they feel they can’t control how much they eat. They then purge (try to get rid of all the food they’ve eaten) to avoid gaining weight. Purging may involve using laxatives or diuretics, or vomiting food that was eaten.

A person with anorexia could also binge and purge, but doctors will diagnose someone with anorexia if they've lost 15% or more of their ideal body weight. Those with bulimia may appear to have a normal weight.

Anorexia nervosa usually begins around the time of puberty, but it can happen at any time. 

Your doctor might consider you to have anorexia if you limit food intake to such an extreme that it leads to significantly low body weight. But not everyone with anorexia is clinically underweight or thin. People with atypical anorexia can be at a clinically "normal" weight or overweight. You may have an intense fear of gaining weight and too much concern about your body weight or shape.

Eating disorders such as anorexia nervosa are more common among certain groups of people. Some factors that contribute to your risk include:

Sex. About 9 out of 10 people with anorexia are those assigned female at birth. But the rates of those assigned male at birth are increasing.

Race. If you're a person of color, you may be less likely than a White person to be asked about symptoms. You're also about half as likely to be diagnosed or get treatment.

Sexual orientation and gender identity. If you're a young LGBTQ+ person, you may have a higher chance of having an eating disorder and attempting suicide than others your age who are heterosexual or cisgender.

Anorexia nervosa is also common in gender minority groups, including transgender men and transgender women. Research suggests that stress due to body dissatisfaction may increase the odds of developing this condition. Transgender people may also be more likely to develop an eating disorder if they have other mental health problems such as perfectionism, anxiety, and low self-esteem.

Disabilities or other health conditions. If you have a physical disability, it may affect your body image and lead to an eating disorder like anorexia. Other health conditions including psychiatric disorders, autism, and ADHD can also increase your risk for an eating disorder. If you have a diet-related health condition, such as diabetes or irritable bowel disease, you may also be at risk.

Occupation and sports. The risk for an eating disorder goes up if you're an actor, model, dancer, or athlete in sports where appearance and weight are seen as important, such as wrestling, boxing, gymnastics, and figure skating.

Performance stress. You may be a high achiever, performing very well in school, sports, work, and other activities. You may have perfectionist qualities with obsessive, anxious, or depressive symptoms.

Even though doctors don’t know why people get anorexia, they do know that some things can make someone more likely to have it. They can include:

  • Being assigned female at birth (eating disorders also affect people assigned male at birth, but it's less likely)
  • Higher childhood body mass index (a measure of body fat based on height and weight)
  • Heredity and genes (eating disorders tend to run in families)
  • Abnormal functioning of brain chemicals and circuits that control hunger and eating
  • Social pressure to be thin
  • Difficulty expressing feelings
  • History of being teased because of weight or size
  • History of sexual or physical abuse (or trauma)
  • Perfectionism, or setting unrealistic standards
  • Unhappiness with body image
  • A lack of social or family support
  • Low self-esteem
  • Depression, anxiety, stress, anger, or loneliness
  • Anxiety disorder
  • A belief that a thinner body is ideal, sometimes because of social standards (such as pictures in magazines or on social media)
  • Dieting a lot
  • Social problems in general, including withdrawal
  • A history of psychiatric disorders
  • Premature birth, low birth weight, or being part of a multiple birth
  • Starting a new school or job (or other life transitions including changing to another culture)
  • Having diabetes

The exact cause of anorexia nervosa is not known. Still, research suggests that a combination of certain personality traits, emotions, thinking patterns, as well as biological and environmental factors might be responsible.

Psychological causes

Psychological causes can include using limited eating to gain a sense of control when other areas of your life or a loved one's are very stressful or when you feel overwhelmed. Feelings of inadequacy, low self-esteem, anxiety, anger, or loneliness also might lead to anorexia. In addition, people with eating disorders might have troubled relationships or a history of being teased about their size or weight. Pressure from peers and a society that associates thinness with beauty also can play a role in the development of anorexia nervosa.

Physical causes

Physical causes can include changes in hormones that control how your body and mind maintain mood, appetite, thinking, and memory. The fact that anorexia nervosa tends to run in families also suggests that it might partially be hereditary.

Cultural/environmental causes 

Cultural and environmental causes can also play a part. The media and social media can influence how a person wants to look or thinks they should look.

Anorexia comes with physical, emotional, and behavioral symptoms that can impact daily living and functioning and lead to serious health problems in the long term.

Physical anorexia symptoms

Physical symptoms that happen over time include:

  • Rapid weight loss over several weeks or months
  • Low tolerance of cold weather or feeling cold
  • Brittle hair and nails
  • Dry or yellowing skin
  • Anemia
  • Constipation
  • Swollen joints, arms, and legs
  • Tooth decay
  • Tiredness
  • Discolored fingers
  • Trouble sleeping
  • Belly pain or stomach cramps
  • Dizziness or fainting
  • Fine hair growth on the body
  • Irregular heart rhythms
  • Low blood pressure
  • Dehydration
  • Missing menstrual periods
  • Hardened knuckles from trying to force oneself to vomit
  • Frequent illness 

Other anorexia symptoms

Other symptoms of anorexia include:

  • Dieting/limited eating despite being thin or having a very low weight
  • Substantial focus on food, calories, nutrition, or cooking
  • Preparing meals for others but not eating
  • Avoiding mealtimes (especially in public)
  • Intense fear of gaining weight
  • Food rituals such as eating in secret or rearranging food on the plate
  • Limiting foods based on certain types
  • Feeling fat, even if underweight
  • Dressing in layers to hide weight loss or stay warm
  • Inability to realistically assess one's own body weight
  • Striving for perfection and being very self-critical
  • Undue influence of body weight or shape on self-esteem
  • Depression, anxiety, or irritability
  • Using laxatives, diuretics, or diet pills
  • Compulsive exercising, even while sick or injured
  • Feeling indifferent
  • Constantly looking at the mirror
  • Reduced desire to have sex
  • Denying not feeling hungry
  • Feeling worthless or hopeless
  • Social withdrawal

Identifying anorexia can be challenging. Secrecy, shame, and denial are characteristics of the disorder. As a result, the illness can go undetected for a long time.

Anorexia tests

Physical exam

If anorexia symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical exam. They may check your height, weight, temperature, heart rate, blood pressure, stomach, skin, and nails. They may also listen to your heart and lungs. They’ll likely ask you questions about your eating and exercise habits, how often you have your period if you have periods, the medicines you might be taking, and any mental health problems you might have.

Lab tests

Although there are no lab tests to specifically diagnose anorexia, your doctor might use blood or urine tests to check your blood count, protein, and electrolyte levels and rule out any physical illness as the cause of the weight loss.

Organ function tests

Your doctor can also examine how well your organs are working. Imaging tests can check bone density, and a doctor may use an echocardiogram to check your heart.

Mental evaluation

If no physical illness is found, your doctor might refer you to a psychiatrist, psychologist, or health care professional who is specially trained to diagnose and treat mental illnesses.

Psychiatrists and psychologists may use specially designed interview and assessment tools to diagnose someone with anorexia nervosa. They may try to confirm if you limit how many calories you eat, if you’re afraid of having a bigger body size, and if you have an inaccurate view of yourself and believe your looks determine your worth.

You may need emergency care if conditions such as dehydration, malnutrition, kidney failure, or an irregular heartbeat put you at risk of dying.

Emergency or not, treatment of anorexia is challenging because you may not see the need for care, or you may fear it as you know it may mean gaining weight. Like all eating disorders, anorexia requires a comprehensive treatment plan that is adjusted to meet the needs of each person.

The goals of treatment can be to:

  • Help you reach a healthier weight
  • Help you deal with emotional issues such as low self-esteem
  • Help you process your thinking patterns
  • Develop long-term behavioral changes

Treatment most often involves a combination of the following:

Psychotherapy.  Also called talk therapy, psychotherapy is individual counseling that focuses on changing your thinking (cognitive therapy) and behavior (behavioral therapy). Treatment includes practical techniques for developing healthy attitudes toward food and weight, plus positive strategies for responding to challenging situations.

Medication. Your doctor may prescribe antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), to help control anxiety and depression associated with an eating disorder. Some antidepressants may also help with sleep and boost your appetite. Your doctor may also suggest other types of medications to help control anxiety and distorted attitudes toward eating and body image.

Nutrition counseling. You may see a dietitian or nutritionist to learn about nutrition and healthy eating patterns.

Group or family therapy.  Families also need to learn about anorexia and its symptoms. You might benefit from group therapy, where you or your family members can find support. Everyone can openly discuss their feelings and concerns with others who share common experiences and problems.

Medical care.  You may need ongoing medical care to monitor your hydration and nutrient levels. In severe cases, you may need to be fed through a feeding tube or an IV. Some people with anorexia need to briefly stay in the hospital to treat severe weight loss and malnutrition. Being in a hospital or going to a residential treatment center can also help with other serious complications such as heart disorders, serious depression, and suicide risk. Some clinics specialize in treating eating disorders specifically and can give you tailored care.

There are a few stages to recovery. If you know about these steps, it can help you recover or support someone who may have anorexia:

Precontemplation

The person may not think they have a problem. If a friend or loved one is in this stage, you may try gently educating them about how harmful anorexia can be.

Contemplation

Contemplation happens when people realize they have a problem and consider getting help. They may be scared of treatment even though they recognize there is an issue. You may refer them to a professional, or if they're already seeing one, the professional may share resources.

Preparation

Someone may be ready for treatment but not sure how to get it. You may ask the person to let you know how you can best support them during treatment.

Action

Here, the person you're concerned about finally starts treatment. They can let you know how to support them, like removing scales from your home.

Maintenance

When someone keeps up with changes for 6 months or longer, they're in the maintenance phase. They can still relapse, but hopefully, you both have tools to keep them on track or know where to go if you need help.

Eating disorders are serious. When it comes to the most life-threatening mental illnesses, they're second in line behind opioid overdose. About 10,000 people die each year from eating disorders. And 26% of people with an eating disorder attempt suicide. People with anorexia can die suddenly from nutritional imbalances or heart issues.

Although treatment is possible, the risk of relapse is high. A survey of caregivers to children with anorexia found that 72% of children partly or fully recovered, while only 20% recovered fully.

Like other eating disorders, anorexia gets worse the longer it's left untreated. The sooner it's diagnosed and treated, the better the outcome. Complications of anorexia can include:

  • Heart problems
  • Bone loss
  • Anemia
  • Muscle loss
  • Loss of periods (amenorrhea)
  • Lower testosterone levels
  • Gastrointestinal issues like nausea, bloating, or constipation
  • Nutritional abnormalities such as low sodium
  • Kidney issues
  • Organ damage (some irreversible)
  • Mental health disorders such as depression, anxiety, mood and personality disorders, alcohol use disorder, and substance use disorder
  • Suicide attempt
  • Death

Anorexia and refeeding syndrome

Anorexia can also lead to refeeding syndrome, a serious and life-threatening condition that happens when a person with undernutrition starts taking in nutrients they need too quickly.

Refeeding syndrome happens within 4 days after a person starts eating well. They may show symptoms such as:

  • Sudden heart failure and seizures
  • High blood pressure
  • Difficulty breathing
  • Tiredness
  • Weakness
  • Confusion
  • Irregular heartbeat
  • Muscle weakness
  • Lung failure
  • Body swelling (edema)
  • Gastrointestinal issues

Get medical help immediately if you notice any of these symptoms. You may have to stay in the hospital as you get treatment for refeeding syndrome if:

  • You're seriously malnourished.
  • You’ve had refeeding syndrome in the past.
  • You’ve lost too much weight in a short time.
  • You drink a lot of alcohol.
  • You take diet pills, insulin, medicines that help you poop (laxatives), and medicines that help remove extra water from your body (diuretics) in a way that you shouldn’t.
  • Your electrolyte levels weren’t within the healthy range before you started refeeding.

The best way to treat anorexia is through professional help with a care team that includes doctors, dietitians, therapists, and other health professionals.

But you can also help your loved one with these strategies:

Get educated. Start by learning about anorexia, especially the differences between the myths and facts.

Talk to them. Discuss your worries with them. And don’t wait until their symptoms become severe. The sooner you talk about it, the sooner they can get help.

Get medical help. Encourage them to see a primary care doctor or a psychiatrist. They can prevent their anorexia from getting worse.

Give them support. Tell them you love them. People with anorexia often have a hard time trusting others. Go out of your way to show them that they can trust you.

Praise and compliment them. It’s good for them to hear that someone thinks they are great, just as they are.

Build a support network. Share your concerns with other people who care about them. The best thing for both of you is to have support.

Be their role model. Eat and exercise in positive ways. They need to see you practice strong habits. It could inspire them to follow your lead.

If you suspect that you have an eating disorder, seek help immediately. Eating disorders can become increasingly dangerous the longer they go untreated. In severe cases, they can be fatal.

Here are a few resources that may be able to help:

National Association of Anorexia Nervosa and Associated Disorders. Call the helpline at (888)-375-7767. Visit the website to learn about support groups and local resources.

National Alliance for Eating Disorders. Call the helpline at (866)-662-1235. Visit the website for more information and support.

988 Suicide & Crisis Lifeline. Dial or text 988 to connect to someone who can help if you're in a crisis. Online chat is also available at the 988lifeline.org website.

Living with anorexia can be challenging for your mental, emotional, and physical health, even when receiving treatment. Here are things you can do to help you follow through with your treatment and recover fully. 

Prioritize your treatment plan. Try to follow your treatments, nutrition plans, and therapy sessions as much as possible. Talk with your doctor about any concerns affecting your ability to follow through with treatment.

Spend time with family and friends. Being with the people who care about you may help you feel supported, improve your mental and emotional state, and encourage you to continue your treatment. 

Get enough sleep. Sleep for at least 7-9 hours every night to support an alert and healthy body and mind during the day. Speak with your doctor if you have trouble sleeping even after following sleep hygiene practices. Set yourself up for success by going to bed at the same time every day, by having a relaxing bedtime ritual, and by limiting alcohol, heavy meals, screen time, and caffeine before bedtime.

Join a support group. Support groups where you can talk to and share resources with people facing anorexia can help you feel less alone. You can find these support groups online: National Alliance for Eating Disorders, National Association of Anorexia Nervosa and Associated Disorders, Eating Recovery Center, and F.E.A.S.T.

Consider food supplements. Ask your doctor about taking supplements to get the nutrients you may be missing.

Limit how often you check your reflection. You can protect your mental well-being and avoid habits that contribute to anorexia by removing unnecessary mirrors from your home.

Avoid weighing or measuring yourself. Don’t check your body size and weight with measuring tapes or body weight scales. If needed, you can throw out or donate these measuring tools.

There’s no tried-and-true way to prevent anorexia, but prevention may be possible through family and community efforts. Some examples include:

  • Avoid making comments on others’ eating habits.
  • Work with your doctor, nutritionist, or other professionals to develop healthy relationships with food, eating, exercise, body size, and weight.
  • Teach children and teens to focus on activities that make them happy and feel fulfilled, such as hobbies or volunteering.

Anorexia nervosa is an eating disorder that can negatively affect your physical, emotional, and behavioral health. Left untreated, anorexia can lead to life-threatening health problems. If you have symptoms of an eating disorder, see a doctor for a proper diagnosis and talk to your loved ones about it for support. Recovery may not be as straightforward as you expect. Still, it’s possible when you stay committed to your treatment and speak with your doctor, loved ones, and support group members about any struggles you may have.

What is the difference between anorexia and bulimia?

Anorexia and bulimia are both eating disorders. While anorexia involves not eating enough, bulimia causes you to overeat, usually a large amount of food within 2 hours. After a binge, those with bulimia will try to purge the food by vomiting or abusing laxatives.

Which long-term health effect is highly associated with anorexia nervosa?

Bone problems are a common health effect of anorexia nervosa. For example, about 90% of people with anorexia have osteopenia, a condition characterized by loss of bone calcium. People with anorexia may also have bone loss and bone fractures, and children may be unable to grow strong bones.