Learn about anorexia: Symptoms and treatments
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In this article:
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Anorexia is an eating disorder characterized by severe restriction of calorie intake, low body weight and an intense fear of getting fat. It’s a serious medical condition that can lead to life-threatening complications, including death.
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There are a variety of causes and risk factors for anorexia. These include a family history of eating disorders, distorted body image, mental health issues, trauma and societal pressures.
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Treatment for anorexia aims to restore a healthy body weight and establish nutritious eating habits. It can include cognitive behavioral therapy, family-based therapy, medication and nutritional rehabilitation.
Learn about anorexia: Symptoms, causes and treatment
Anorexia is an eating disorder that typically involves restricting food intake and a low body weight based on their growth history. It’s a serious illness that can lead to life-threatening medical complications, including death. In recognition of Eating Disorders Awareness & Screening Week February 24 – March 2, we’re providing this overview of anorexia.
What is anorexia?
Anorexia (or anorexia nervosa) is a condition that occurs when a person severely limits how much food they eat. This usually results in a very low body weight.
People with anorexia have a distorted body image, called dysmorphia. They think they’re fat, even when they’re extremely underweight. They also have an intense fear of gaining weight.
There are two types of anorexia nervosa eating disorders:
- Restrictive: You severely limit the amount of food you eat.
- Binge-purge: You limit your calorie intake, but you also eat large amounts of food in a short time. Afterward, you intentionally vomit or use laxatives or diuretics.
“People with anorexia typically skip meals, track calories and gravitate toward low-calorie choices, like broth, vegetables, rice cakes, coffee and water,” says Grace Ling, MS, RD, CDCES, a registered dietitian at Swedish First Hill Diabetes Education and Nutrition Center. “Some also use supplements that promise weight loss.”
Not everyone with anorexia appears emaciated, however. People who aren’t underweight may still have atypical anorexia. “Some people with anorexia are technically within a ‘normal’ weight range,” Ling notes. “They can still suffer the same complications of malnutrition.”
Anorexia affects 0.3% to 1% of people in the United States, and atypical anorexia affects 3% of people. It’s most common in girls ages 12-18, but men can have it. “Males with eating disorders tend to have an obsessive focus on strength, muscle or healthy eating, called orthorexia,” says Nicolle Pacifico, Ph.D., a clinical psychologist in Behavioral Health Services at Providence Medical Foundation.
Rates of anorexia have increased over the past 20 years. This is partly due to greater awareness and diagnoses. But it’s also related to social media, societal pressures on beauty and worsening mental health, Dr. Pacifico adds.
Symptoms of anorexia
There are many signs of anorexia. Not everyone has all of them, but most have a combination.
Physical
Being severely underweight or failing to gain weight when growing taller is the main sign of anorexia. Other physical symptoms may include:
- Bloating, stomach pain or cramps
- Constipation
- Dehydration
- Dizziness or fainting
- Dry skin and brittle nails
- Fatigue and weakness
- Feeling cold all the time
- Fine body hair (lanugo)
- Low blood pressure
- Menstrual irregularities or loss of menstrual period
Psychological
- Anxiety or depression
- Distorted body image
- Intense fear of gaining weight
- Obsessive interest in food, calories and dieting
- Self-criticism
Behavioral
- Abnormal or ritualized eating behaviors
- Dressing in loose clothing or layers
- Excessive exercising
- Going to the bathroom right after eating
- Making frequent comments about feeling fat
- Purging through vomiting or using laxatives or diuretics
- Refusing to eat around others
- Skipping meals
- Socially isolating
- Taking appetite suppressants or diet pills
Health risks and complications of anorexia
Over time, severe calorie restriction causes malnutrition and starvation. This can lead to many serious conditions, including death. Health risks include:
- Anemia
- Brain damage
- Digestive complications including hypoglycemia, gastroparesis and constipation
- Electrolyte imbalance
- Heart problems like arrhythmia, abnormally slowed heart rate, low blood pressure and cardiac arrest
- Infertility
- Kidney and liver damage
- Lowered metabolic rate
- Osteopenia or osteoporosis
- Seizures
- Self-injury, suicide or thoughts of suicide
Causes and risk factors
Anorexia is a complex condition that has various causes and risk factors. This includes genetic factors, psychological and environmental influences, and societal and cultural pressures.
Genetic factors
- Brain issues: Changes in brain chemistry may play a role in eating disorders.
- Family history: Having a parent or sibling with an eating disorder makes you 10 times more likely to develop one.
- Mental health or body weight struggles: A family background of these can increase your risk for anorexia.
Psychological and environmental influences
- History of dieting
- Participation in weight-based or appearance-based activities such as ballet, figure skating, gymnastics, modeling or wrestling
- Perfectionism and the need to be in control
- Trauma such as abuse or sexual assault
- Weight bullying or shaming
Societal and cultural pressures
- Advertising images that glorify thin bodies
- Celebrities who flaunt unrealistic figures
- Cultures that idealize thinness
- Peer pressure to look a specific way
- Social media’s focus on bodies
Diagnosing anorexia and when to seek help
Of all mental illnesses, anorexia has the second-highest death rate. It’s important to get diagnosed as early as possible.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for anorexia are:
- Restricted food intake that leads to weight loss or failure to gain weight and a significantly low body weight based on age, sex and height
- Intense fear of gaining weight
- Distorted body image
“A person’s inability to admit to having a problem can be a major barrier to early diagnosis,” Dr. Pacifico says. “Many individuals with anorexia deny the severity of their condition due to their body dysmorphia.”
To diagnose anorexia, doctors review your health history and do a physical exam. They also may perform different tests. These may include:
- Blood test
- Electrocardiogram
- Electrolyte panel
- Kidney, liver and thyroid function tests
- Psychological evaluation
- Urinalysis
If you’re concerned about an eating disorder, talk to your doctor right away. If you’re thinking about suicide, call 911 or go to your nearest emergency room. In the U.S., call or text 988 to reach the Suicide and Crisis Lifeline.
Treatment options for anorexia
Treatment for anorexia can be challenging because people often don’t think they have a problem. Typically, your doctor, a psychologist or psychiatrist and a registered dietitian will work together to create a treatment plan. Options include:
- Cognitive behavioral therapy (CBT) to clarify distorted views and change behavior
- Family-based therapy (FBT) to equip parents and family members to support the person with anorexia
- Medication to help manage anxiety, depression or other mental health issues
- Nutritional counseling and rehabilitation to help restore healthy eating habits and normal digestive function
“FBT is one of the most effective treatments for teens because it empowers parents to help challenge distorted thinking patterns and restore healthy eating behaviors,” Dr. Pacifico says.
Many treatment programs for anorexia are outpatient. But you may need to be in the hospital or in a residential treatment program if you have severe malnutrition, serious medical complications or suicidal thoughts.
Treatment aims to restore normal body weight and establish a healthy relationship with food and eating. The best recovery outcomes for anorexia happen with early diagnosis and treatment. However, 20-50% of patients relapse.
“Eating disorders often serve as a way to cope with trauma or emotional distress,” Ling says. “It can be extremely challenging to let go of these behaviors and try to develop alternative coping methods.”
Dr. Pacifico adds, “Continued exposure to stress due to low self-esteem, negative body image or social media influences can trigger a return to disordered eating behaviors. While many people can achieve full recovery and lead healthy lives, anorexia often requires long-term management.”
Support and recovery for individuals with anorexia
Although preventing anorexia can be challenging, families can foster healthy communication around body image, food and self-worth, while also being aware of signs of eating disorders.
Dr. Pacifico suggests, “Providing greater access to mental health care and creating stigma-free environments for those struggling with eating disorders is essential for early intervention and prevention.”
Every person’s journey with anorexia is different. Support and resources are available for patients and families. Sources include:
Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.)
National Association of Anorexia Nervosa and Associated Disorders (ANAD)
National Eating Disorders Association (NEDA)
The compassionate teams at Providence also can answer your questions and provide comprehensive treatment for anorexia.
Contributing caregivers
Nicolle Pacifico, Ph.D., is a clinical psychologist in Behavioral Health Services at Providence Medical Foundation in Yorba Linda, California.
Grace Ling, MS, RD, CDCES, is a registered dietitian at Swedish First Hill Diabetes Education and Nutrition Center in Seattle, Washington.
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Related resources
Recognizing an eating disorder
How eating disorders can be harmful
This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
