Anorexia nervosa (or anorexia for short) may be one of the most widely recognized types of eating disorders, but it’s often one of the most misunderstood.
Some may think anorexia is only about a person’s obsession with thinness or struggles with food. But like all eating disorders, anorexia is a serious and complex mental illness that anyone can develop. And with a range of potential symptoms, anorexia may be hard to spot.
So, what exactly is anorexia? What causes it? What are the signs and symptoms of anorexia? And how is this condition treated?
We’ve been helping heal eating disorders at Melrose Center for more than 35 years. Below, we answer all these questions and more.
Anorexia nervosa is a serious mental health condition, and it’s not a choice.
A person with anorexia significantly restricts their food intake and typically has an intense fear of gaining weight or “becoming fat”. They may believe they are extremely overweight even if they’ve lost a lot of weight. And while other people may see them as very thin, a person struggling with anorexia cannot see their body as it really is. About 4% of females and 0.3% of males will develop anorexia at some point in their lives.
Types of anorexia nervosa
There are different subtypes of anorexia. Each of these subtypes have different symptoms and behaviors, which is part of the reason why anorexia is so often misunderstood.
A person with this type of anorexia restricts their food intake and does not consume enough food throughout the day to support their body’s energy needs. Often, a person with restrictive anorexia has many “food rules” about how food is prepared, and specific times during the day when they can and can’t eat.
Bingeing and purging anorexia
A person with this type greatly restricts what they eat, but they also binge eat and purge. Purging can take different forms, including self-induced vomiting, misusing laxatives or diuretics, and overexercising.
Atypical anorexia nervosa
People with this type of anorexia have significant weight loss but are within a “normal” weight range. This eating disorder still comes with the dangerous characteristics and complications of anorexia, even though a person isn’t considered underweight from a medical perspective. Atypical anorexia nervosa is what’s known as an other specified feeding or eating disorder (OSFED).
Anorexia symptoms: Behavioral, physical and mental signs
Anorexia can affect every area of someone’s life. The eating disorder seems to take control and every waking minute is focused on food, body, weight or shape.
Behavioral symptoms of anorexia nervosa
A person with anorexia may change how they eat, exercise and interact with others in an effort to control their weight. Behaviors associated with anorexia can include:
- Rigid, restrictive eating
- Exercising too much
- Frequently skipping meals or refusing to eat
- Denial of hunger or making excuses for not eating
- Eating primarily “safe” foods, usually those lower in fat and calories
- Fixation about how food is prepared, which sometimes includes cooking elaborate meals for others but not eating them
- Not wanting to eat with others or avoiding eating in social gatherings or at restaurants
- Secrecy or lying about how much food has been eaten
- Irritability when asked about eating patterns or low body weight
- Bingeing and purging
- Social withdrawal
Physical symptoms of anorexia nervosa
When a person has anorexia, they don’t get the nutrients they need. Over time, their body becomes weaker – inside and out. For example, anorexia can affect organ function and change how a person looks. Physical symptoms that can be caused by anorexia, include:
- Dizziness or feeling lightheaded
- Low body weight or thin appearance
- Significant weight loss, or for adolescents, not gaining enough weight to support growth and development
- Soft, downy hair covering the body and face (lanugo)
- Hair that thins, breaks or falls out
- Periods that are irregular or absent in females
- Low testosterone levels in males
- Lower body temperature or constantly feeling cold
- Slowed heart rate or low blood pressure
- Irregular heart rhythms
- Abnormal blood counts
- Unusually dry skin or brittle nails
- Dry or yellowish skin
- Weak muscles
- Digestive problems like constipation
Mental health concerns often co-occur with anorexia
People with anorexia often have other mental health conditions such as anxiety disorders like obsessive-compulsive disorder (OCD) or mood disorders like depression. About 56% of people diagnosed with anorexia have also been diagnosed with another mental illness, according to the National Institute of Mental Health. Anorexia can make mental health issues worse since a person’s mind and body aren’t getting enough nutrition to be at their best.
What causes anorexia? It’s likely a combination of factors
The exact cause of anorexia is unknown. As with many diseases, doctors believe a combination of biological, psychological and environmental factors can play a role.
Biological causes of anorexia nervosa
- Genetics – Our genes can make us 40-60% more vulnerable to eating disorders, according to new research.
- Heredity – You’re more likely to develop an eating disorder if someone in your immediate family has one.
Psychological causes of anorexia nervosa
- Personality traits – Certain traits can make it more likely for someone to develop anorexia.
- Perfectionism can lead to impossibly high standards about appearance and behaviors
- Rigidity can make it easier to stick to food restrictions, even when hungry
- Anxiousness can contribute to a fear of gaining weight
- Internalizing problems and keeping negative emotions to yourself can make things seem worse than they actually are
- Other mental illness – People with other types of mental illness may have behaviors and attitudes that could lead to anorexia.
Environmental causes of anorexia nervosa
- Societal attitudes – In the U.S., a thin body is often linked to health and attractiveness.
- Influence of peers – A person’s social group or surroundings may make them feel pressure to look a certain way. Peers may also share opinions about food and eating behaviors that can increase the risk of developing anorexia.
- Family – Parents and other family members can unintentionally influence a person’s attitudes about food, weight and eating.
- Media and social media – Shared videos and photos often show uncommon body types (and many have been digitally altered). If a person compares their body to those shown in media and social media, it can make them feel unhappy with their appearance.
- Trauma – People who’ve experienced trauma such as physical or emotional abuse are more likely to develop anorexia or other eating disorders.
Anorexia risk factors to know about
Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations and socioeconomic statuses. However, people who have certain characteristics may be at higher risk of developing anorexia.
People who are female are 13 times more likely to develop anorexia than those who are male (but anorexia is becoming more common in boys and men). The number of young women aged 15 to 19 years old with anorexia has continually increased since 1930.
Identifying as LGBTQ+
Anorexia and other eating disorders are more common in adults and adolescents who identify as LGBTQ+ (lesbian, gay, bisexual, transgender or queer) or gender nonconforming.
Being a teenager or young adult
People are most likely to develop anorexia during adolescence or young adulthood, but people of any age can develop anorexia. A concerning trend is that more young people under the age of 15 years old are developing anorexia, according to recent research.
There’s evidence that dieting is linked to eating disorders, including anorexia. Often, what starts as a way to lose a few pounds, progresses into chronic dieting and a hyper-focus on food, weight and calories.
Sports and activities can put a high value on looking a certain way, being a certain size or engaging in certain behaviors to improve performance. Often, athletes receive mixed messages about food and the fuel their body needs to support their activities. This can contribute to disordered eating.
Being bullied or teased, especially about weight or body shape
If someone is teased or bullied about their size or weight, they are more likely to develop anorexia. Sometimes bullying behaviors are very obvious – for example, kids teasing a classmate about their size. But sometimes they can be harder to spot, and the person who’s making the damaging comments may not intend to be mean. Even a seemingly innocent comment about body weight or size from a family member, teacher or coach may make a person feel bad about their appearance.
The potential health risks of anorexia
Untreated anorexia can lead to many medical complications, including malnutrition, osteoporosis, infertility, brain volume loss, hair loss, dry skin, brittle nails, depression and anxiety. In children and youth, anorexia can also delay or stop puberty, and slow overall growth.
If a person with anorexia becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. This damage may not be fully reversible.
Up to one in five people with chronic anorexia may die as a result of anorexia – this can be due to starvation or malnutrition. But it’s also because people with anorexia are more likely to die by suicide.
How anorexia nervosa is diagnosed
Anorexia has both physical and mental symptoms. So when diagnosing anorexia, the doctor will evaluate both physical and mental health. To evaluate physical health, the doctor will likely do a physical exam, lab work and an EKG to check heart function. To assess mental health, the doctor will use screening inventories to explore a patient’s history, relationship with food and body image.
People can recover from anorexia. And the sooner they get treatment, the better the outcomes tend to be.
Since anorexia affects all aspects of a person – including their mind, body and behaviors – treatment is usually provided by a team of medical care providers with different areas of expertise. For example, psychologists and psychiatrists help work through emotions and attitudes that may be triggering certain behaviors, medical providers treat the physical symptoms of anorexia, and registered dietitians provide guidance on healthy eating and snacking. Each person will receive a personalized treatment plan depending on their particular needs.
Common anorexia treatments
There are many different treatments for anorexia, but the following are some of the most common. A person’s treatment plan will typically include more than one type of therapy and treatment.
- Family-based treatment (FBT) –This is a clinically proven treatment for children and adolescents living at home with their families. With this treatment, parents or caregivers take a leading role in helping the child change eating behaviors, gain weight and return to normal growth patterns.
- Cognitive behavior therapy enhanced (CBT-E) – CBT-E is a highly individualized treatment where a patient has weekly sessions with a therapist to work through what’s causing their eating problems, how to change their behaviors and deal with setbacks. People often have 20-40 sessions of CBT-E.
- Group therapy – Group therapy allows people with anorexia to share their experiences while also learning from others with similar experiences. During therapy, they’ll learn methods for managing emotions such as feelings of isolation and distress, and skills for strengthening interpersonal relationships. Plus, the personal connections they make in group therapy can also be part of their support system moving forward.
- Nutrition therapy and health education – A key aspect of anorexia treatment is changing your relationship with food. A dietitian will work with you to help you redevelop the body’s natural feelings of hunger and fullness, and provide guidance on making healthy meals and snacks.
- Medical treatment – You may also receive medical treatment for symptoms of anorexia. For example, you may need frequent testing and exams. Sometimes medication may be needed to help manage discomfort, as well as digestive and other physical issues.
Anorexia treatment programs
There are different levels of treatment, depending on how severe the symptoms are.
- Outpatient care – Many people start with outpatient care for anorexia. With this type of care, a person spends a few hours a week in the clinic meeting with different members of their treatment team.
- Day program (partial hospitalization) – Doctors may recommend that people with more severe symptoms go to a day program for anorexia. Usually, people are in the program for 4-6 weeks.
- Residential treatment – Some people who have severe symptoms, may benefit from the 24/7 support and medical care offered through a residential treatment program for anorexia.
Do you think you or a loved one has anorexia? Get help today
An eating disorder isn’t a choice. It’s a serious condition that can affect every aspect of a person’s life. The sooner you reach out, the sooner you or your loved one can start healing. And Melrose Center is here.
If you think you have an eating disorder:
- Answer the five questions on our eating disorder self-assessment
- Talk to someone you trust – for example, a friend, a doctor or a therapist
- Call Melrose Center at 952-993-6200 to set up an assessment at one of our five Twin Cities metro locations
If you think a loved one has an eating disorder:
- Tell them you love them
- Share with them your concerns and the changes you’ve seen in their behavior
- Avoid talking about their body or weight
- Urge them to talk to a doctor
- Go with them to the appointment