Anorexia nervosa, also called anorexia, is a potentially life-threatening eating disorder.People with anorexia have excessive weight loss or trouble staying at the right body weight for their body frame, height, and age. They may also have a false sense of body image.
The term anorexia means "loss of appetite." But this definition is misleading. People with anorexia nervosa do get hungry. If you have anorexia, you may have intense fears of gaining weight or becoming fat. You may see yourself as fat even when you're thin. You may think your self-worth depends on being thin. As a result, you may try to correct this perceived "flaw" by strictly limiting food intake and exercising excessively to lose weight.
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.
Extreme weight loss can lead to dangerous health problems and even death.
Who Gets Anorexia?
Eating disorders like anorexia are more common if you're assigned female at birth compared to those assigned male at birth, though the rates in the latter group are increasing. 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.) If you're a young LGBTQ+ person, you may have higher chances of having an eating disorder and attempting suicide compared to others your age who are heterosexual or cisgender. If you have a disability, you may be more likely to have an eating disorder, too.
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.
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. Anorexia usually begins around the time of puberty, but it can happen at any time.
Nine out of 10 people with anorexia were assigned female at birth. Your doctor might consider you to be anorexic if you restrict food intake to such an extreme that it leads to significantly low body weight, though not everyone with it 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 an excessive concern with body weight or shape.
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
- 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 transition including changing to another culture)
- Having diabetes
What Causes Anorexia?
The exact cause of anorexia is not known, but research suggests that a combination of certain personality traits, emotions, and thinking patterns – as well as biological and environmental factors -- might be responsible.
Psychological causes can include eating as a way to gain a sense of control when other areas of their lives are very stressful or when they feel overwhelmed. Feelings of inadequacy, low self-esteem, anxiety, anger, or loneliness also might contribute to the development of the disorder. 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 in which thinness and physical appearance equal beauty also can play a role in the development of anorexia.
Physical causes can include changes in hormones that control how the body and mind maintain mood, appetite, thinking, and memory. The fact that anorexia tends to run in families also suggests that it might partially be hereditary.
Cultural/environmental causes can play a part as well. The media and social media can influence how a person wants to look -- or how they think they should look.
The symptoms of anorexia often include the following:
- Rapid weight loss over several weeks or months
- Dieting/limited eating even when thin or when weight is very low
- 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 like eating in secret or rearranging food on plate
- Limiting foods based on certain types
- Feeling fat, even if underweight
- Dressing in layers to hide weight loss or stay warm
- Refusing feelings of hunger
- 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
- Infrequent or irregular, or even missed menstrual periods
- Laxative, diuretic, or diet pill use
- Frequent illness
- Compulsive exercising
- Feeling worthless or hopeless
- Social withdrawal
- Exercising while sick or injured
- Physical symptoms that happen over time, including:
- Low tolerance of cold weather or feeling cold
- Brittle hair and nails
- Dry or yellowing skin
- Swollen joints
- Tooth decay
- Belly pain or stomach cramps
- Dizziness or fainting
- Fine hair growth on body
How Is Anorexia Diagnosed?
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.
If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical exam. Although there are no lab tests to specifically diagnose anorexia, the doctor might use blood or urine tests to rule out physical illness as the cause of the weight loss. These also can look at how your organs are functioning. Imaging tests can check bone density. An echocardiogram may be used to check your heart.
If no physical illness is found, your doctor might refer you to a psychiatrist, psychologist, or a 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 evaluate a person for an eating disorder.
You may need emergency care if dehydration, malnutrition, kidney failure, or an irregular heartbeat are an imminent risk to life.
Emergency or not, treatment of anorexia is challenging because you may not see the need for care -- or be afraid of it because 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
- Equip you to deal with emotional issues such as low self-esteem
- Assist you in processing your thinking patterns
- Develop long-term behavioral changes
Treatment most often involves a combination of the following:
- Psychotherapy. This is a type of 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, as well as approaches for changing the way you respond to difficult situations.
- Medication. Your doctor may prescribe an antidepressant medication 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 stimulate your appetite. Other types of medications also might be offered to help control anxiety and/or distorted attitudes toward eating and body image.
- Nutrition counseling. You may see a dietitian or nutritionist to learn about nutrition and healthy eating patterns, and give you insight on nutrition.
- Group and/or family therapy. It is important that family members understand the eating disorder and recognize its symptoms. You might benefit from group therapy, where you or your family members can find support and 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 be hospitalized briefly to treat severe weight loss that caused malnutrition. Being hospitalized, or going to a residential treatment center, can also help you with other serious mental or physical health complications such as heart disorders, serious depression, and the risk of suicide. Some clinics specialize in treating eating disorders specifically and can give you tailored care.
What Is the Outlook for People With Anorexia?
Eating disorders are serious. When it comes to the deadliest 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 a person with anorexia found 72% of children partly or fully recovered. And 20% said their child fully recovered.
Complications of anorexia can include:
- Heart problems
- Bone loss
- Muscle loss
- Loss of periods (amenorrhea)
- Lower testosterone levels
- Gastrointestinal issues like nausea, bloating, or constipation
- Nutritional abnormalities like low sodium
- Kidney issues
- Organ damage (some irreversible)
- Mental health disorders
- Substance use disorder
- Suicide attempt
Anorexia, like other eating disorders, gets worse the longer it's left untreated. The sooner it's diagnosed and treated, the better the outcome.
How to Support Someone With Anorexia
Anorexia is best treated with professional help by a care team that can include doctors, dietitians, therapists, and other health professionals.
Stages of Anorexia Recovery
There are a few stages to recovery. When you know these, it can help you support someone who may have anorexia:
Pre-contemplation. 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. This happens when a person realizes they have a problem and considers 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 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. This is when the person you're concerned about actually gets treatment. They can let you know how you can support them, like removing scales from your home.
Maintenance. When someone keeps up with changes for 6 months or longer, they're in 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.
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 the way 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. They could inspire them to follow your lead.
How to Get Help for Anorexia
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.
These are a few resources that may be able to help:
National Eating Disorders Association. Call or text the helpline at (800) 931-2237, or visit the website to chat online.
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.
211. Call 211 to speak to someone who can give you a referral for help. Visit the website to learn more.
National Suicide Prevention Lifeline. Dial 988 or 800-273-8255 to connect to someone who can help if you're in a crisis.
Project Heal. Contact this organization to figure out how to work with your insurance company.