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Anorexia Nervosa

Signs, Symptoms, Causes, and Treatment

Types of Anorexia Nervosa

It's only human to wish you looked different or could fix something about yourself. But when a preoccupation with being thin takes over your eating habits, thoughts, and life, it's a sign of an eating disorder. When you have anorexia, the desire to lose weight becomes more important than anything else. You may even lose the ability to see yourself as you truly are.

Anorexia is a serious eating disorder that affects women and men of all ages. It can damage your health and even threaten your life. But you're not alone. There's help available when you're ready to make a change. You deserve to be happy. Treatment will help you feel better and learn to value yourself.

What is anorexia nervosa?

Anorexia nervosa is a complex eating disorder with three key features:

  • refusal to maintain a healthy body weight
  • an intense fear of gaining weight
  • a distorted body image

Because of your dread of becoming fat or disgusted with how your body looks, eating and mealtimes may be very stressful. And yet, what you can and can’t eat is practically all you can think about.

Thoughts about dieting, food, and your body may take up most of your day—leaving little time for friends, family, and other activities you used to enjoy. Life becomes a relentless pursuit of thinness and going to extremes to lose weight.

But no matter how skinny you become, it’s never enough.

While people with anorexia often deny having a problem, the truth is that anorexia is a serious and potentially deadly eating disorder. Fortunately, recovery is possible. With proper treatment and support, you or someone you care about can break anorexia’s self-destructive pattern and regain health and self-confidence.

Maria’s Story

Seventeen-year-old Maria has been on one diet or another since she was in junior high. She recently lost 10 pounds from an already slender frame after becoming a strict vegetarian. Her parents are concerned about the weight loss, but Maria insists that she’s just under stress at school. Meanwhile, her vegetarian diet is becoming stricter by the day.

Maria obsessively counts calories, measures food portions, and weighs herself at least twice a day. She refuses to eat at restaurants, in the school cafeteria, or anywhere else in public, and she lives on salad dressed with vinegar, rice cakes, and sugar-free Jello. Maria also has a large stash of fat-free candy in her room. She allows herself to indulge as long as she goes for a run right afterwards.

Types of anorexia nervosa

There are two types of anorexia. In the restricting type of anorexia, weight loss is achieved by restricting calories (following drastic diets, fasting, and exercising to excess). In the purging type of anorexia, weight loss is achieved by vomiting or using laxatives and diuretics.

Are you anorexic?

  • Do you feel fat even though people tell you you’re not?
  • Are you terrified of gaining weight?
  • Do you lie about how much you eat or hide your eating habits from others?
  • Are your friends or family concerned about your weight loss, eating habits, or appearance?
  • Do you diet, compulsively exercise, or purge when you’re feeling overwhelmed or bad about yourself?
  • Do you feel powerful or in control when you go without food, over-exercise, or purge?
  • Do you base your self-worth on your weight or body size?

Anorexia is not about weight or food

Believe it or not, anorexia isn’t really about food and weight—at least not at its core. Eating disorders are much more complicated than that. The food and weight-related issues are symptoms of something deeper: things like depression, loneliness, insecurity, pressure to be perfect, or feeling out of control. Things that no amount of dieting or weight loss can cure.

What need does anorexia meet in your life?

It’s important to understand that anorexia meets a need in your life. For example, you may feel powerless in many parts of your life, but you can control what you eat. Saying “no” to food, getting the best of hunger, and controlling the number on the scale may make you feel strong and successful—at least for a short while. You may even come to enjoy your hunger pangs as reminders of a “special talent” that most people can’t achieve.

Anorexia may also be a way of distracting yourself from difficult emotions. When you spend most of your time thinking about food, dieting, and weight loss, you don’t have to face other problems in your life or deal with complicated emotions.

Unfortunately, any boost you get from starving yourself or shedding pounds is extremely short-lived. Dieting and weight loss can’t repair the negative self-image at the heart of anorexia. The only way to do that is to identify the emotional need that self-starvation fulfills and find other ways to meet it.

The difference between dieting and anorexia
Healthy Dieting Anorexia

Healthy dieting is an attempt to control weight.

Anorexia is an attempt to control your life and emotions.

Your self-esteem is based on more than just weight and body image.

Your self-esteem is based entirely on how much you weigh and how thin you are.

You view weight loss as a way to improve your health and appearance.

You view weight loss as a way to achieve happiness.

Your goal is to lose weight in a healthy way.

Becoming thin is all that matters; health is not a concern.

Signs and symptoms of anorexia

Living with anorexia means you’re constantly hiding your habits. This makes it hard at first for friends and family to spot the warning signs. When confronted, you might try to explain away your disordered eating and wave away concerns. But as anorexia progresses, people close to you wont be able to deny their instincts that something is wrong—and neither should you.

As anorexia develops, you become increasingly preoccupied with the number on the scale, how you look in the mirror, and what you can and can’t eat.

Anorexic food behavior signs and symptoms

  • Dieting despite being thin – Following a severely restricted diet. Eating only certain low-calorie foods. Banning “bad” foods such as carbohydrates and fats.
  • Obsession with calories, fat grams, and nutrition – Reading food labels, measuring and weighing portions, keeping a food diary, reading diet books.
  • Pretending to eat or lying about eating – Hiding, playing with, or throwing away food to avoid eating. Making excuses to get out of meals (“I had a huge lunch” or “My stomach isn’t feeling good.”).
  • Preoccupation with food – Constantly thinking about food. Cooking for others, collecting recipes, reading food magazines, or making meal plans while eating very little.
  • Strange or secretive food rituals – Refusing to eat around others or in public places. Eating in rigid, ritualistic ways (e.g. cutting food “just so”, chewing food and spitting it out, using a specific plate).

Anorexic appearance and body image signs and symptoms

  • Dramatic weight loss – Rapid, drastic weight loss with no medical cause.
  • Feeling fat, despite being underweight – You may feel overweight in general or just “too fat” in certain places such as the stomach, hips, or thighs.
  • Fixation on body image – Obsessed with weight, body shape, or clothing size. Frequent weigh-ins and concern over tiny fluctuations in weight.
  • Harshly critical of appearance – Spending a lot of time in front of the mirror checking for flaws. There’s always something to criticize. You’re never thin enough.
  • Denial that you’re too thin – You may deny that your low body weight is a problem, while trying to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized clothes).

Purging signs and symptoms

  • Using diet pills, laxatives, or diuretics – Abusing water pills, herbal appetite suppressants, prescription stimulants, ipecac syrup, and other drugs for weight loss.
  • Throwing up after eating – Frequently disappearing after meals or going to the bathroom. May run the water to disguise sounds of vomiting or reappear smelling like mouthwash or mints.
  • Compulsive exercising – Following a punishing exercise regimen aimed at burning calories. Exercising through injuries, illness, and bad weather. Working out extra hard after bingeing or eating something “bad.”

Anorexia nervosa causes and risk factors

There are no simple answers to the causes of anorexia and other eating disorders. Anorexia is a complex condition that arises from a combination of many social, emotional, and biological factors. Although our culture’s idealization of thinness plays a powerful role, there are many other contributing factors, including your family environment, emotional difficulties, low self-esteem, and traumatic experiences you may have gone through in the past.

Psychological causes and risk factors for anorexia

People with anorexia are often perfectionists and overachievers. They’re the “good” daughters and sons who do what they’re told, excel in everything they do, and focus on pleasing others. But while they may appear to have it all together, inside they feel helpless, inadequate, and worthless. Through their harshly critical lens, if they’re not perfect, they’re a total failure.

Family and social pressures

In addition to the cultural pressure to be thin, there are other family and social pressures that can contribute to anorexia. This includes participation in an activity that demands slenderness, such as ballet, gymnastics, or modeling. It also includes having parents who are overly controlling, put a lot of emphasis on looks, diet themselves, or criticize their children’s bodies and appearance. Stressful life events—such as the onset of puberty, a breakup, or going away to school—can also trigger anorexia.

Biological causes of anorexia

Research suggests that a genetic predisposition to anorexia may run in families. If a girl has a sibling with anorexia, she is 10 to 20 times more likely than the general population to develop anorexia herself. Brain chemistry also plays a significant role. People with anorexia tend to have high levels of cortisol, the brain hormone most related to stress, and decreased levels of serotonin and norepinephrine, which are associated with feelings of well-being.

Major risk factors for anorexia nervosa

  • Body dissatisfaction
  • Strict dieting
  • Low self-esteem
  • Difficulty expressing feelings
  • Perfectionism
  • Troubled family relationships
  • History of physical or sexual abuse
  • Family history of eating disorders

Effects of anorexia

One thing is certain about anorexia. Severe calorie restriction has dire physical effects. When your body doesn’t get the fuel it needs to function normally, it goes into starvation mode and slows down to conserve energy. Essentially, your body begins to consume itself. If self-starvation continues and more body fat is lost, medical complications pile up and your body and mind pay the price.

Some of the physical effects of anorexia include:

  • Severe mood swings; depression
  • Lack of energy and weakness
  • Slowed thinking; poor memory
  • Dry, yellowish skin and brittle nails
  • Constipation and bloating
  • Tooth decay and gum damage
  • Dizziness, fainting, and headaches
  • Growth of fine hair all over the body and face

physical effects  of anorexia

Source: National Women's Health Information Center

Getting help for anorexia

Deciding to get help for anorexia is not an easy choice to make. It’s not uncommon to feel like anorexia is part of your identity—or even your “friend.”

You may think that anorexia has such a powerful hold over you that you’ll never be able to overcome it. But while change is hard, it is possible.

Steps to anorexia recovery

  • Admit you have a problem. Up until now, you’ve been invested in the idea that life will be better—that you’ll finally feel good—if you lose more weight. The first step in anorexia recovery is admitting that your relentless pursuit of thinness is out of your control and acknowledging the physical and emotional damage that you’ve suffered because of it.
  • Talk to someone. It can be hard to talk about what you’re going through, especially if you’ve kept your anorexia a secret for a long time. You may be ashamed, ambivalent, or afraid. But it’s important to understand that you’re not alone. Find a good listener—someone who will support you as you try to get better.
  • Stay away from people, places, and activities that trigger your obsession with being thin. You may need to avoid looking at fashion or fitness magazines, spend less time with friends who constantly diet and talk about losing weight, and stay away from weight loss web sites and “pro-ana” sites that promote anorexia.
  • Seek professional help. The advice and support of trained eating disorder professionals can help you regain your health, learn to eat normally again, and develop healthier attitudes about food and your body.

If you or a loved one has anorexia...

Call the National Eating Disorders Association’s toll-free hotline at 1-800-931-2237 for free referrals, information, and advice.

Anorexia treatment and therapy

Since anorexia involves both mind and body, a team approach to treatment is often best. Those who may be involved in anorexia treatment include medical doctors, psychologists, counselors, and dieticians. The participation and support of family members also makes a big difference in treatment success. Having a team around you that you can trust and rely on will make recovery easier.

Treating anorexia involves three steps:

  • Getting back to a healthy weight
  • Starting to eat more food
  • Changing how you think about yourself and food

Medical treatment for anorexia

The first priority in anorexia treatment is addressing and stabilizing any serious health issues. Hospitalization may be necessary if you are dangerously malnourished or so distressed that you no longer want to live. You may also need to be hospitalized until you reach a less critical weight. Outpatient treatment is an option when you’re not in immediate medical danger.

Nutritional treatment for anorexia

A second component of anorexia treatment is nutritional counseling. A nutritionist or dietician will teach you about healthy eating and proper nutrition. The nutritionist will also help you develop and follow meal plans that include enough calories to reach or maintain a normal, healthy weight.

Counseling and therapy for anorexia

Counseling is crucial to anorexia treatment. Its goal is to identify the negative thoughts and feelings that fuel your eating disorder and replace them with healthier, less distorted beliefs. Another important goal of counseling is to teach you how to deal with difficult emotions, relationship problems, and stress in a productive, rather than a self-destructive, way.

Getting past your fear of gaining weight

Getting back to a normal weight is no easy task. The thought of gaining weight is probably extremely frightening—especially if you’re being forced—and you may be tempted to resist. But research shows that the closer your body weight is to normal at the end of treatment, the greater your chance of recovery, so getting to a healthy weight should be a top treatment goal.

Try to understand that your fear of gaining weight is a symptom of your anorexia. Reading about anorexia or talking to other people who have lived with it can help. It also helps to be honest about your feelings and fears—including your family and your treatment team. The better they understand what you’re going through, the better support you’ll receive.

Helping an anorexic person

Encouraging an anorexic friend or family member to get treatment is the most caring and supportive thing you can do. But because of the defensiveness and denial involved in anorexia, you’ll need to tread lightly. Waving around articles about the dire effects of anorexia or declaring “You’ll die if you don’t eat!” probably won’t work. A better approach is to gently express your concerns and let the person know that you’re available to listen. If your loved one is willing to talk, listen without judgment, no matter how out of touch the person sounds.

It’s deeply distressing to know that your child or someone you love may be struggling with anorexia. There’s no way to solve the problem yourself, but here are a few ideas for what you can do now to help make a difference for someone you love.

Tips for helping a person with anorexia

  • Think of yourself as an “outsider.” In other words, someone not suffering from anorexia. In this position, there isn’t a lot you can do to “solve” your loved one’s anorexia. It is ultimately the individual’s choice to decide when they are ready.
  • Be a role model for healthy eating, exercising, and body image. Don’t make negative comments about your own body or anyone else’s.
  • Take care of yourself. Seek advice from a health professional, even if your friend or family member won’t. And you can bring others—from peers to parents—into the circle of support.
  • Don’t act like the food police. A person with anorexia needs compassion and support, not an authority figure standing over the table with a calorie counter.
  • Avoid threats, scare tactics, angry outbursts, and put-downs. Bear in mind that anorexia is often a symptom of extreme emotional distress and develops out of an attempt to manage emotional pain, stress, and/or self-hate. Negative communication will only make it worse.

More help for anorexia nervosa

Resources & References

General information about anorexia nervosa

Anorexia Nervosa – Covers the signs, causes, risk factors, diagnosis, and treatment of anorexia. Includes information on nutritional and dietary therapies. (University of Maryland Medical Center)

Negative Voices – Description of the negative, self-critical “voices” that tell anorexics that they’re powerless and worthless. Includes tips on dealing with them. (The Something Fishy Website on Eating Disorders)

Distorted Perceptions – Article on the distorted perceptions that anorexics have about themselves and their bodies. (The Something Fishy Website on Eating Disorders)

Anorexia signs and symptoms

Noticing the Signs and Symptoms – Detailed list of the signs and symptoms of anorexia nervosa, including physical, emotional, and behavioral red flags. (The Something Fishy Website on Eating Disorders)

Killer Workout – Questions and answers on activity anorexia, in which weight loss is achieved through strenuous compulsive exercise. Includes a discussion of symptoms. (Psychology Today)

Anorexia treatment

Treatment – Provides numerous resources and tips on eating disorder treatment, including questions to ask, insurance tips, and a guide to your options. (National Eating Disorders Association)

Online resources for finding anorexia treatment providers

Eating Disorder Treatment Finder – Searchable directory of anorexia treatment providers, including doctors, therapists, dieticians, support groups, and inpatient or residential programs. (The Something Fishy Website on Eating Disorders)

EDReferral.com – Comprehensive, easy-to-search database of anorexia and eating disorder treatment providers. (The Eating Disorder Referral and Information Center)

Information & Referral Helpline – Eating disorders helpline offers advice and referrals. Includes an online directory of treatment providers and support groups. (National Eating Disorders Association)

Authors: Melinda Smith, M.A. and Jeanne Segal, Ph.D. Last updated: September 2014.