Anorexia Nervosa

What is anorexia nervosa?

Anorexia nervosa is an eating disorder and mental health disorder in which a person limits their calorie intake to an extreme. People experiencing anorexia engage in extreme dieting behaviors to keep their body weight as low as possible. This leads to malnutrition and often (not always) a severely low BMI.

In medical language, “anorexia” means not wanting to eat. Adding “nervosa” to anorexia makes it a mental health condition. This means it’s based in your nervous system — in your brain, nerves, impulses and thoughts. It develops from negative thoughts and feelings about eating, weight and body image.

Thoughts and worries about these things, and attempts to control them, are common. But with anorexia nervosa, they oppress you and motivate you to an extreme. This can have serious consequences for both your mental and physical health. Without recognition and treatment, it can be life-threatening.

Types of anorexia

There are two types of anorexia nervosa, based on the eating behaviors involved:

• Restrictive anorexia involves severe calorie restriction alone.
• Binge-purge anorexia involves calorie restriction, but also episodes of binge eating and purging, similar to bulimia nervosa. Purging might mean vomiting, using laxatives or extensive exercising.

Atypical anorexia is anorexia in someone who isn’t (yet) underweight, making it harder to recognize.

Symptoms of anorexia

Signs and symptoms of anorexia nervosa can be physical, behavioral or mental. They might include:

• Significant weight loss over several weeks or months
• Below average weight compared to height (≤18.5 BMI)
• Unexplained changes in a child’s height/weight balance as they grow
• Intense focus on food types and quantities and/or calorie counting
• Frequent critical thoughts and comments about body weight and image
• Overusing medications like appetite suppressants, laxatives or diuretics
• Compulsive, extended exercise sessions, especially after eating
• Consistently going to the bathroom right after eating

In advanced stages of anorexia, you might also have symptoms of undernutrition. These might include:

• Abnormal heart rhythms (arrhythmias)
• Dizziness, lightheadedness or fainting
• Fatigue and physical weakness
• Feeling cold all the time
• Feeling irritable
• Hair loss
• Irregular periods or absent periods
• Swelling in your limbs

What causes anorexia?

There’s no single cause of anorexia nervosa, but several factors may be involved, including biological, psychological and social factors:

• Brain differences. Scientists have observed differences in brain structure and function in people with anorexia. For example, they have different levels of neurotransmitters like serotonin and dopamine, which can affect appetite, mood, impulse control and your brain’s reward system.
• Genetics and family. Having a first-degree relative with an eating disorder significantly raises your risk of also having one. Part of this may be in the genes you inherit from your parents at birth. Part of it may also be in the values and habits you inherit by growing up in your family.
• Peer pressure. Social and professional peer pressure can both be strong forces, especially if your social or professional standing depends on your body image. Athletes, dancers, models and actors base their careers on it. Teenagers can be very judgmental of themselves and each other.
• Psychology. Having low self-esteem or feeling that your self-worth depends on controlling your body weight can lay the groundwork for an eating disorder. Sometimes, these feelings stem from a history of trauma or mood disorders, like anxiety and depression.

What are the complications of anorexia nervosa?

Malnutrition and starvation can affect nearly every organ and tissue in your body. Severe organ damage may be irreversible, even after you’ve recovered from anorexia. Anorexia can also be devastating to your relationships and your mental and emotional health. These effects can take time to heal, even after treatment begins.

Untreated anorexia can lead to:

• Loss of bone mass (osteoporosis) and erosion of tooth enamel
• Rapid breakdown of skeletal muscle (rhabdomyolysis)
• Kidney and liver damage
• Heart failure or cardiac arrest
• Delayed puberty and growth in children
• Infertility in adults
• Declining mental health, self-harm and suicidal thoughts

If you’re having suicidal thoughts, call the Suicide and Crisis Lifeline at 988. Someone will be available to talk with you anytime, day or night.

How is anorexia diagnosed?

Healthcare providers diagnose anorexia nervosa based on the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The three criteria include:

1. Self-induced calorie restriction, leading to significant weight loss or a failure to gain weight in growing children. Typically, a low body weight based on age, sex, height and stage of growth.
2. Abnormal obsession with body weight and intense fear of gaining weight or becoming “fat.”
3. A distorted self-image or an inability to acknowledge the seriousness of their condition.

If you have signs and symptoms of anorexia, a provider will do a physical exam and take a complete medical history, including your mental health history. Then, they’ll ask you detailed questions about your eating habits, exercise routines, use of weight loss medications, and related feelings and beliefs.

Your provider might order tests to evaluate the physical effects that anorexia is causing. Tests might include:

• Bone density test
• Complete blood count
• Electrocardiogram (EKG)
• Electrolyte panel
• Kidney function tests
• Liver function tests
• Thyroid blood tests
• Urinalysis

How is anorexia treated?

Treatment for anorexia nervosa is specific to the person being treated. The goals of treatment include:

1. Restoring good nutrition
2. Stabilizing weight loss
3. Eliminating disordered eating behaviors
4. Treating underlying psychological concerns

The biggest challenge in treating someone with anorexia is helping them recognize and accept that they have a serious illness. Many people with anorexia deny that they have an eating disorder and only seek help when it becomes life-threatening. This is why early recognition and treatment are so important.

Your healthcare provider will design a custom treatment plan, which may include:

• Nutrition therapy
• Psychotherapy
• Medication
• Hospitalization

Hospitalization may be necessary to treat severe malnutrition or other serious health complications. You may also stay in the hospital for severe mental health issues. Medications sometimes play a role in treating these complications. But the long-term treatment for anorexia nervosa is psychotherapy.

Therapy

Psychotherapy, or talk therapy, helps change thinking and behavior patterns associated with eating disorders. It can help you develop healthier attitudes toward food, weight and body image. It can also help you learn better coping mechanisms and techniques for dealing with stress and negative thoughts.

Some people with anorexia have coexisting mental health conditions that contribute to their eating disorder. It’s important to treat these conditions alongside anorexia. But even if you don’t have another disorder, anorexia itself is a mental health issue. Treatment must address the root cause in your mind.

There are many types of psychotherapy, including:

• Acceptance and commitment therapy. This method focuses on developing the motivation to change your behaviors, regardless of your thoughts and feelings.
• Cognitive behavioral therapy (CBT). This method focuses on addressing distorted views and attitudes about weight, shape and appearance, and making behavioral changes.
• Cognitive remediation therapy. This method involves exercises and activities to help improve your cognitive and executive function and your ability to take charge of your life.
• Dialectical behavior therapy (DBT). Specific skills you’ll learn in DBT include building mindfulness, improving relationships, managing emotions and tolerating stress.
• Family therapy. Family support is very important to anorexia treatment success. Family-based therapy for anorexia (the Maudsley Method) puts your family in charge of your nutrition.
• Interpersonal psychotherapy (IPT). IPT involves improving your relationships and communication, which may reduce your eating disorder symptoms.
• Psychodynamic psychotherapy. This therapy involves looking at the root causes of anorexia as the key to your recovery.

What are the possible complications of anorexia treatment?

The most serious complication of treating anorexia is refeeding syndrome. This can happen when someone severely malnourished begins feeding again. Your body needs certain nutrients to be able to metabolize your food. When its stores are low, it draws those nutrients from your bloodstream.

This shift of nutrients from your blood into your cells can cause a wide range of complications and can even be fatal. This is why it’s important to begin refeeding under medical care. Healthcare providers take care to replace your lowest nutrients first and carefully monitor you during the refeeding process.

How long does it take to recover from anorexia?

Recovery from anorexia is a journey that’s different for everyone. Some parts of your treatment plan may take longer than others. What’s important to remember is that recovery is possible. No matter where you or your loved one is in your or their journey, it’s essential to continue working toward recovery.

When should I see a healthcare provider about anorexia?

Talk to a healthcare provider if you notice signs of eating disorders in yourself or someone you care for. It’s always better to seek help sooner rather than later. Even if you or your loved one doesn’t (yet) meet the criteria for anorexia nervosa, intervening sooner may stop the seeds of disease from growing.

Is anorexia preventable?

We don’t know all the reasons why anorexia occurs, and we can’t control all of the factors that might contribute to it. But we can make a difference in how we raise our children and the examples we set.

We can:

• Teach healthy eating behaviors and attitudes.
• Help children develop a healthy body image.
• Recognize and address bullying and prevent it in our own kids.

What is the prognosis for someone with anorexia?

The outlook for someone with anorexia nervosa varies, depending on factors like:

• How long they’ve lived with the condition
• How severe their condition is
• What kind of treatment they receive
• How well they follow their treatment plan

Anorexia gets worse the longer it goes untreated, and so do the physical and mental health effects that come with it. Longstanding habits are harder to change. People with anorexia also tend to deny that they have a problem. They might resist treatment or might not stick to their treatment plan long term.

Without treatment, anorexia nervosa is potentially life-threatening. Eating disorders like anorexia are among the deadliest mental health conditions, for both physical and mental health reasons. People with anorexia are five times more likely to die prematurely and 18 times more likely to die by suicide.

With the right support and treatment, recovery is possible. But it often takes time — and the risk of relapse remains. Long-term care and the support of loved ones can make a big difference.