Anorexia nervosa is a serious and potentially life-threatening — but treatable — eating disorder. It's characterized by extreme food restriction and an intense fear of gaining weight. Treatment usually involves several strategies, including psychological therapy, nutritional counseling and/or hospitalization.
Anorexia, formally known as anorexia nervosa, is an eating disorder. People with anorexia limit the number of calories and the types of food they eat. Eventually, they lose weight or cannot maintain an appropriate body weight based on their height, age, stature and physical health. They may exercise compulsively and/or purge the food they eat through intentional vomiting and/or misuse of laxatives.
Individuals with anorexia also have a distorted self-image of their body and have an intense fear of gaining weight.
Anorexia is a serious condition that requires treatment. Extreme weight loss in people with anorexia can lead to malnutrition, dangerous health problems and even death.
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Anorexia can occur in people of any age, sex, gender, race, gender, ethnicity, sexual orientation and economic status and individuals of all body weights, shapes and sizes. Anorexia most commonly affects adolescents and young adult women, although it also occurs in men and is increasing in numbers in children and older adults.
Eating disorders affect at least 9% of the worldwide population, and anorexia affects approximately 1% to 2% of the population. It affects 0.3% of adolescents.
Anorexia nervosa and bulimia nervosa are both eating disorders. They can have similar symptoms, such as distorted body image and an intense fear of gaining weight. The difference is that they have different food-related behaviors.
People who have anorexia severely reduce their calorie intake and/or purge to lose weight. People who have bulimia eat an excessive amount of food in a short period of time (binge eating) followed by certain behaviors to prevent weight gain. Such behaviors include:
People with bulimia usually maintain their weight at optimal or slightly above optimal levels whereas people with anorexia typically have a body mass index (BMI) that is below 18.45 kg/m2 (kilogram per square meter).
You cannot tell if a person has anorexia just by their appearance because anorexia also involves mental and behavioral components — not just physical. A person does not need to be underweight to have anorexia. Larger-bodied individuals can also have anorexia. However, they may be less likely to be diagnosed due to cultural stigma against fat and obesity. In addition, someone can be underweight without having anorexia. Remember, anorexia also includes psychological and behavioral components as well as physical.
There are several emotional, behavioral and physical signs and symptoms of anorexia. If you or someone you know experiences the signs and symptoms of anorexia below, it’s important to seek help.
Emotional and mental signs of anorexia include:
Behavioral signs of anorexia include:
The most well-known physical sign of anorexia is low body weight for a person’s height, sex and stature. However, it’s important to remember that someone can have anorexia without being underweight. In addition to weight-related signs of anorexia, there are also physical symptoms that are actually side effects of starvation and malnutrition.
Physical signs of anorexia include:
Physical symptoms of anorexia that are side effects of starvation and malnutrition include:
Anorexia and all eating disorders are complex conditions. For this reason, the exact cause of anorexia is unknown, but research suggests that a combination of certain genetic factors, psychological traits and environmental factors, especially sociocultural factors, might be responsible.
Factors that may be involved in developing anorexia include:
It’s important to note that there’s no single path to an eating disorder or anorexia. For many people, irregular eating behaviors (also called “disordered eating”) represent an inappropriate coping strategy that becomes permanent over time. This pathway to disordered eating is true for some, but not all, who develop anorexia.
A healthcare provider can diagnose a person with anorexia based on the criteria for anorexia nervosa listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association. The three criteria for anorexia nervosa under the DSM-5 include:
Even if all of the DSM-5 criteria for anorexia aren’t met, a person can still have a serious eating disorder. DSM-5 criteria classifies the severity of anorexia according to body mass index (BMI). Individuals who meet the criteria for anorexia but who aren’t underweight despite significant weight loss have what’s known as atypical anorexia.
Diagnostic guidelines in the DSM-5 also allow healthcare providers to determine if a person is in partial remission (recovery) or full remission as well as to specify the current severity of the condition based on body mass index (BMI).
If signs and symptoms of anorexia are present, a healthcare provider will begin an evaluation by performing a complete medical history and physical examination. The provider or a mental health professional will likely ask questions about the following topics:
It’s important to remember that a person with anorexia or any eating disorder will have the best recovery outcome if they receive an early diagnosis. If you or someone you know is experiencing signs and symptoms of anorexia, be sure to talk to a healthcare provider as soon as possible.
Although there are no laboratory tests to specifically diagnose anorexia, a healthcare provider may use various diagnostic tests, such as blood tests, to rule out any medical conditions that could cause weight loss and to evaluate the physical damage weight loss and starvation may have caused.
Tests to rule out weight-loss causing illness or to assess anorexia side effects may include:
The biggest challenge in treating anorexia is helping the person recognize and accept that they have an illness. Many people with anorexia deny that they have an eating disorder. They often seek medical treatment only when their condition is serious or life-threatening. This is why it’s important to diagnose and treat anorexia in its beginning stages.
The goals of treatment for anorexia include:
People with eating disorders, including anorexia, often have additional mental health conditions, including:
These conditions can further complicate anorexia, so if an individual has one or more of these conditions, their healthcare team will likely recommend treatment for the condition(s) as well.
Treatment options will vary depending on the individual’s needs. A person may receive treatment through residential care (outpatient care) or hospitalization depending on their current medical and mental health state. Treatment for anorexia most often involves a combination of the following strategies:
Psychotherapy is a type of individual counseling that focuses on changing the thinking (cognitive therapy) and behavior (behavioral therapy) of a person with an eating disorder. Treatment includes practical techniques for developing healthy attitudes toward food and weight, as well as approaches for changing the way the person responds to difficult situations. There are several types of psychotherapy, including:
Some healthcare providers may prescribe medication to help manage anxiety and depression that are often associated with anorexia. The antipsychotic medication olanzapine (Zyprexa®) may be helpful for weight gain. Sometimes, providers prescribe medications to help with period regulation.
Nutrition counseling is a strategy to help treat anorexia that involves the following:
Family support is very important to anorexia treatment success. Family members must understand the eating disorder and recognize its signs and symptoms.
People with eating disorders might also benefit from group therapy, where they can find support and openly discuss their feelings and concerns with others who share common experiences.
Hospitalization might be needed to treat severe weight loss that has resulted in malnutrition and other serious mental or physical health complications, such as heart disorders, serious depression and suicidal thoughts or behaviors.
The most serious complication of treating anorexia is a condition called refeeding syndrome. This life-threatening condition can occur when a seriously malnourished person begins to receive nutrition again. Basically, their body cannot properly restart the metabolism process.
People experiencing refeeding syndrome can develop the following conditions:
Since refeeding syndrome can have serious and life-threatening side effects, it’s essential for people with anorexia to receive medical treatment and/or guidance.
People who have one or more of the following risk factors for developing refeeding syndrome may need to be treated in a hospital:
Every person’s anorexia recovery journey is different. The important thing to remember is that it is possible to recover from anorexia. Treatment for anorexia often involves many components, such as psychological therapy, nutritional counseling and addressing the cause of the person’s anorexia, if possible, and each of these components can take different amounts of time.
No matter where you or a loved one are in their journey of recovery, it’s essential to continue working toward recovery.
Anorexia can affect anyone, no matter their gender, age or race. However, certain factors put some people at greater risk for developing anorexia, including:
Although it might not be possible to prevent all cases of anorexia, it’s helpful to start treatment as soon as someone begins to have symptoms.
In addition, teaching and encouraging healthy eating habits and realistic attitudes about food and body image also might help prevent the development or worsening of eating disorders. If your child or family member decides to become vegetarian or vegan, for instance, it’s worth seeing a dietitian versed in eating disorders and touching base with your pediatrician or healthcare provider to make sure that this change occurs without a loss in nutrients.
The prognosis for anorexia varies depending on certain factors, including:
Anorexia, like other eating disorders, gets worse the longer it’s left untreated. The sooner the disorder is diagnosed and treated, the better the outcome. However, people with anorexia often will not admit they have a problem and might resist treatment or refuse to follow the treatment plan.
Anorexia is a serious and potentially life-threatening eating disorder if it’s left untreated. Eating disorders, including anorexia, are among the deadliest mental health conditions, second only to opioid addiction. Individuals with anorexia are 5 times more likely to die prematurely and 18 times more likely to die by suicide.
The good news is that anorexia can be treated, and someone with anorexia can return to a healthy weight and healthy eating patterns. Unfortunately, the risk of relapse is high, so recovery from anorexia usually requires long-term treatment as well as a strong commitment by the individual. Support of family members and friends can help ensure that the person receives and adheres to their needed treatment.
The medical complications and health risks of malnutrition and starvation, which are common in people who have anorexia, can affect nearly every organ in your body. In severe cases, vital organs such as your brain, heart and kidneys can sustain damage. This damage may be irreversible even after a person has recovered from anorexia.
Severe medical complications that can happen from untreated anorexia include:
In addition to physical complications, people with anorexia also commonly have other mental health conditions, including:
If these mental health conditions are left untreated, they could lead to self-injury, suicidal thoughts or suicide attempts.
If you’re having suicidal thoughts, call the Suicide and Crisis Lifeline at 988. Someone will be available to talk with you 24/7.
It can be uncomfortable and scary, but it’s important to tell a loved one and/or your healthcare provider if you have anorexia.
If you have already been diagnosed with anorexia, there are some things you can do to manage your condition and stay committed to recovery, including:
There are multiple things you can do to help and support someone with anorexia, including:
If you or someone you know is experiencing signs and symptoms of anorexia, be sure to talk to a healthcare provider as soon as possible.
Someone with anorexia should go to the emergency room (ER) if they’re experiencing any of the following physical symptoms:
If you’re having thoughts of harming yourself, get to the nearest hospital as soon as possible or call the Suicide and Crisis Lifeline at 988. Someone will be available to talk with you 24/7.
If you recognize suicidal behaviors in someone with anorexia, get them care as soon as possible.
A note from Cleveland Clinic
Anorexia is a serious and potentially life-threatening condition. The good news is that recovery is definitely possible. If you or someone you know is experiencing signs and symptoms of anorexia, it’s essential to seek help and care as soon as possible. It’s never too late to seek treatment, but getting help early improves the chance of a lasting recovery.
Last reviewed by a Cleveland Clinic medical professional on 11/17/2021.
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