Table of Contents

What is Anorexia Nervosa?

Anorexia nervosa, often referred to simply as “anorexia”, is a disorder which involves severely limiting how much one eats because of an irrational fear of gaining weight. It is the least common eating disorder but is usually what comes to mind when people think about an eating disorder. The image evoked is typically that of an emaciated, young, white female of middle to upper socioeconomic status, but the reality is that eating disorders can affect anyone—all age groups, genders, racial identities, etc.

Eating disorders can affect individuals of all body sizes, and anorexia is no exception—it may occur in people with smaller or larger bodies. The primary behavior associated with anorexia is restrictive eating. In recent years, the prevalence of anorexia among males has been increasing, particularly among those who identify as LGBTQ. Eating disorders are most common in Westernized cultures, where the idealization of thinness is widespread.

All eating disorders carry significant medical risks, but anorexia has the highest mortality rate of any mental illness, surpassed only by opioid overdose deaths.

Although disordered eating behaviors are the most visible symptoms, eating disorders are fundamentally psychiatric illnesses rooted in a combination of biological, psychological, and social factors. Effective treatment must address these behaviors—starting with nutritional rehabilitation as the most urgent intervention—but also consider the underlying issues that contribute to the development and persistence of the disorder.

What are the Signs and Symptoms of Anorexia?

Without treatment, anorexia takes a toll on both mental and physical health; that’s why it’s important to know the signs, and to monitor anyone who is showing those signs.

Mental health symptoms tend to revolve around a person’s distorted body image and a fear of gaining weight. This causes the person to engage in unhealthy behaviors around food, such as severely restricting what and how much they eat. These rigid and obsessive behaviors lead to physical signs of anorexia such as excessive weight loss and thinness.

Psychological and Emotional Symptoms of Anorexia:

  • Obsessions about food
  • Strong fear of gaining weight
  • Negative body image/dysphoria or distortion
  • Social isolation/withdrawal
  • Irritability
  • Flat affect
  • Numb mood
  • Low self-esteem

Behavioral Symptoms of Anorexia:

  • Dieting or fasting in extreme ways
  • Eating only a few specific foods, typically those lower in calories or perceived as “healthy”
  • Refusing to eat or making excuses to avoid eating
  • Ordering or preparing food, but not eating it
  • Leaving during or right after eating to go to the restroom
  • Lying about how much they ate
  • Chewing and then spitting out the food
  • Excessive and/or compulsive exercising
  • Vomiting and/or abusing laxatives in efforts to avoid weight gain
  • Wearing baggy clothing to hide low weight (if the individual can recognize their thinness)

Physical Symptoms of Anorexia:

  • Weight changes
  • Dizziness, feeling faint
  • Low blood pressure
  • Fatigue
  • Feeling cold
  • Dehydration
  • Irregular heart rate
  • Yellowish or dry skin
  • Thinning or brittle hair

Attempts at Losing Weight or Counteracting the Effects of Eating

Those with anorexia engage in various methods in an attempt to control the body. Some of these means are ineffective but engaged in nonetheless, often out of desperation.

Food restriction can provide a false sense of control. People may feel stronger and/or superior to others by denying themselves food. Low intake will lead to weight loss, but the fear of regaining weight is very strong. It becomes an all-encompassing focus.

The more malnourished a person becomes, the less rational is their thinking. They don’t want others observing their behavior or trying to get them to eat more. Unfortunately, a person’s food restriction is sometimes viewed as “healthy” or “disciplined” because of the types of food they limit themselves to or how strict they are with themselves. The person may be complimented and admired, which reinforces the strength of the disorder.

Regardless of what foods are consumed, if the amount isn’t adequate, it can’t be deemed “healthy eating.” And it isn’t willpower allowing them to maintain this behavior—it’s fear.

Also, food restriction/dieting can lead to binge eating. This is the body’s normal counterbalance to low food intake. An individual may try to compensate for over-eating or eating even small amounts by inducing vomiting, abusing laxatives, diuretics, diet aids, enemas or exercising excessively. These are all forms of purging.

How is Anorexia Diagnosed?

A health care provider will render a diagnosis if the criteria for the disorder are met. This information is contained in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) screening for eating disorders:

  • Restriction of food intake
  • Intense fear of gaining weight or becoming fat
  • Disturbance in the way in which one’s weight or shape is experienced, undue influence of weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of low body weight

What Causes Anorexia?

There is no single cause for anorexia. Instead, there are several biological and social risk factors that make individuals more likely to develop the disorder:

  • Enduring criticism about weight or eating habits
  • Having a long history of dieting
  • Living with an anxiety disorder
  • Having unresolved trauma, particularly sexual abuse
  • Having a close biological relative with the disorder
  • Having personality traits such as perfectionism
  • Experiencing racism and/or homophobia

Individuals may experience many of these risk factors without developing anorexia or an eating disorder. Likewise, someone does not need these risk factors to develop the disorder.

Lifestance Health specializes in Anorexia Nervosa treatment with multiple locations in 33 states. Services and available treatments vary by location.

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How is Anorexia Treated?

Initial treatment of anorexia depends on the severity of the disorder at the time of treatment. Anorexia may be treated with a combination of types of therapy and medication, depending on the individual’s needs.

Some individuals may require inpatient treatment with 24-hour care, others may need intensive outpatient programs, while people in the early stages of anorexia may be able to start with outpatient resources. It is important to have an eating disorder expert assess a person’s condition and help determine what type of care is needed.

Cognitive behavioral therapy (CBT) can be considered the gold standard of care for individuals with eating disorders, but the exact types of therapy an individual needs may depend on their comfort level, causes of anorexia, and any other related disorders they may have.

Types of therapy for anorexia include:

Online Therapy for Anorexia

Many types of therapy that may help an individual with anorexia can be done virtually. Online therapy for anorexia increases access for individuals who may not be able to go to in-person sessions. LifeStance offers both in-person and online therapy for people with anorexia.

Medications for Anorexia

There are no approved medications specifically for anorexia. However, many individuals take medications as part of their comprehensive mental health care plans. This is because many people who live with anorexia also live with other mental health disorders that can worsen the symptoms of anorexia. A psychiatrist or advanced nurse practitioner may prescribe medication to treat other mental health conditions, which can lessen the severity of anorexia symptoms.

References

Eating Disorder Statistics (2024). National Association of Anorexia Nervosa and Associated Disorders. https://anad.org/eating-disorder-statistic/

Evidence-Based Eating Disorder Treatment (February 16, 2024). Reviewed by Danielle Kelvas, MD. https://bulimia.com/eating-disorders/treatment-evidence-based-approaches/

Gerhardt, Linda (n.d.). Anorexia Statistics and Studies. Center for Discovery Eating Disorder Treatment. https://centerfordiscovery.com/blog/anorexia-statistics-and-studies/

Feltner C, Peat C, Reddy S, et al. Screening for Eating Disorders in Adolescents and Adults: An Evidence Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022 Mar. (Evidence Synthesis, No. 212.) Appendix A Table 1, Summary of DSM-5 Diagnostic Criteria for Eating Disorders. Available from: https://www.ncbi.nlm.nih.gov/books/NBK578994/table/appa.tab1/

Frequently Asked Questions About Eating Disorders (n.d.). Johns Hopkins Medicine: Psychiatry and Behavioral Sciences Eating Disorders Program. https://www.hopkinsmedicine.org/psychiatry/specialty-areas/eating-disorders/faq

Pearce JM. Richard Morton: origins of anorexia nervosa. Eur Neurol. 2004;52(4):191-2. doi: 10.1159/000082033. Epub 2004 Nov 10. PMID: 15539770.

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Clinically Reviewed By:

Andrea Uribe, DO
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Andrea Uribe, DO, treats patients suffering from anxiety, depression, mood and bipolar disorders, disruptive behavior, autism, OCD, ADHD, and more. She has served DuPage County since 2007 and is double board-certified in both adult and child and adolescent psychiatry. Her years of experience includes private practice, community health, and educating primary care providers to foster their knowledge of treating psychiatric conditions in outpatient practice. She is also a member of the American Academy of Child and Adolescent Psychiatry.

Dr. Uribe earned a Bachelor of Science from Loyola University Chicago and her Doctor of Osteopathic Medicine from the Western University of Health Sciences in Pomona, California. Following this, she was an intern and resident in general psychiatry at Allegheny General Hospital, Drexel University, and then completed her fellowship in child and adolescent psychiatry at Lurie Children s Hospital of Chicago. As a local mom, Dr. Uribe is committed to helping families succeed. In her personal life, she enjoys spending time with her husband, two sons, and mini schnauzer. She also sings in a local choir.

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Michael Pertschuk, MD
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I have worked in outpatient, residential and inpatient settings treating eating disorders, mood disorders and ADHD. My research interests include body image issues and medical complications of mental health problems, especially eating disorders. I am a Clinical Professor of Psychiatry at Drexel University, Philadelphia. My medical degree is from the University of Pennsylvania and I have a Masters Degree in psychology also from Penn. I am married with grown children and live with my wife and several cats.

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Lisa Fix, LCPC
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Lisa Fix, LCPC
Hello. I am a licensed clinical professional counselor with over 30 years of experience. I had a difficult upbringing and needed to do my own work in therapy, so I know what it can be like to be in the “other chair.” I will meet you where you are and strive for you to feel seen and heard.
I received a Master of Science degree in Clinical Psychology from Illinois State University. I am qualified to work with a full gamut of issues including depression, anxiety, stress, grief, adjustment problems, relationship/family issues and struggling with sense of self.
My specialization is eating disorders, having worked at a hospital-based treatment center for 20 years. I also enjoy working with “emerging adults” which I did for 14 years at a university counseling center. I can help with parenting, mid-life issues and aging. I conceptualize a person’s care in a holistic way and my approach is integrative in that I pull from different modalities which are evidence-based for your unique presentation. I am trauma-informed, use the HAES paradigm, subscribe to body neutrality, am an LGBTQ ally and have worked with people from many walks of life, ethnicities and spiritual traditions. I think you will find me compassionate, easy-going, supportive and safely challenging. You can always ask me questions and I will switch gears if you feel you aren’t getting what you need from our work together. I am committed to helping you reach your goals.