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Anorexia Nervosa

Topic Overview

What is anorexia nervosa?

Anorexia nervosa (say "an-uh-RECK-see-uh nur-VOH-suh") is a type of eating disorder. People who have anorexia have an intense fear of gaining weight. They severely limit the amount of food they eat and can become dangerously thin.

Anorexia affects both the body and the mind. It may start as dieting, but it gets out of control. You think about food, dieting, and weight all the time. You have a distorted body image. Other people say you are too thin, but when you look in the mirror, you see your body as overweight.

Anorexia usually starts in the teen years. It's much more common in females than males. Early treatment can be effective. The earlier it is treated, the better the chances someone can recover from anorexia. Untreated anorexia can lead to starvation and serious health problems, such as bone thinning (osteoporosis), kidney damage, and heart problems. Some people die from these problems.

If you or someone you know has anorexia, get help right away. The longer this problem goes on, the harder it is to overcome. Over time and with treatment, a person with anorexia can feel better and stay at a healthy weight.

What causes anorexia?

Eating disorders are complex, and experts don't really know what causes them. But they may be due to a mix of genetics, family behaviors, social factors, and personality traits. You may be more likely to have anorexia if:

  • Other people in your family have an eating disorder, such as anorexia or bulimia nervosa.
  • You have a job or do a sport that stresses body size, such as ballet, modeling, or gymnastics.
  • You are the type of person who tries to be perfect all the time, never feels good enough, or worries a lot.
  • You are dealing with stressful life events, such as divorce, moving to a new town or school, or losing a loved one.

What are the symptoms?

People who have anorexia often strongly deny that they have a problem. They don't see or believe that they do. It's usually up to their loved ones to get help for them. If you are worried about someone, you can look for certain signs.

People who have anorexia:

  • Weigh much less than is healthy or normal.
  • Are very afraid of gaining weight.
  • Refuse to stay at a normal weight.
  • Think they are overweight even when they are very thin.
  • Deny the seriousness of their low body weight.
  • Base their self-esteem on how they view their body weight and shape.

Their lives become focused on controlling their weight. They may:

  • Obsess about food, weight, and dieting.
  • Strictly limit how much they eat.
  • Exercise a lot, even when they are sick.
  • Vomit or use laxatives or water pills (diuretics) to avoid weight gain.

How is anorexia diagnosed?

If your doctor thinks that you may have an eating disorder, he or she will compare your weight with the expected weight for someone of your height and age. He or she will also check your heart, lungs, blood pressure, skin, and hair to look for problems caused by not eating enough. You may also have blood tests or X-rays.

Your doctor may ask questions about how you feel. It is common for a treatable mental health problem such as depression or anxiety to play a part in an eating disorder.

How is it treated?

All people who have anorexia need treatment. Even if you, your child, or someone else you care about has only a couple of the signs of an eating disorder, get help now. Early treatment gives the best chance of overcoming anorexia.

Treatment can help you get back to and stay at a healthy weight. It can also help you learn good eating habits and learn to feel better about yourself. Because anorexia is both a physical and emotional problem, you may work with a doctor, a dietitian, and a counselor.

If your weight has dropped too low, you will need to be treated in a hospital.

Anorexia can take a long time to overcome, and it is common to fall back into unhealthy habits. If you are having problems, don't try to handle them on your own. Get help now.

What should you do if you think someone has anorexia?

It can be very scary to realize that someone you care about has an eating disorder. But you can help.

If you think your child has anorexia:

  • Talk to him or her. Tell your child why you are worried. Let him or her know you care.
  • Make an appointment for you and your child to meet with a doctor or a counselor.

If you're worried about someone you know:

  • Tell someone who can make a difference, like a parent, teacher, counselor, or doctor. A person with anorexia may insist that help isn't needed, but it is. The sooner the person gets treatment, the sooner he or she will be healthy again.

Cause

The cause of anorexia nervosa is not fully understood. It is thought to develop from a mix of physical, emotional, and social triggers.

  • Extreme dieting changes how the brain and metabolism work, and it stresses the body. These changes may make you more likely to develop an eating disorder.
  • Genetics play a big part in anorexia and bulimia. Compared with people who don't have these disorders, people who have eating disorders are more likely to have a family history of an eating disorder, obesity, or a mood disorder (such as anxiety or depression).
  • A combination of certain personality traits (such as low self-confidence along with perfectionism) and cultural and social pressures can play a part in anorexia.
  • For some teens, anorexia may be a way of coping with stress and the challenges of the teen years. Stressful life events, such as moving, divorce, or the death of a loved one, can trigger anorexia.

Symptoms

Feelings and actions

Common feelings and actions that are linked to anorexia nervosa include:footnote 1

  • Having an intense fear of gaining weight.
  • Restricting food or types of food, such as food that contains any kind of fat or sugar.
  • Weighing much less than is normal or expected for your age, gender, stage of development, or physical health. (In a child or teen, losing or not gaining weight during a growth spurt is a concern.)
  • Seeing your body as overweight, in spite of being underweight. This is called having a distorted body image.
  • Exercising too much.
  • Being secretive around food and not recognizing or wanting to talk about having a problem with eating or weight loss.

Some people who have anorexia may also have times where they binge eat and make themselves vomit or use laxatives or diuretics to lose weight. Breakdown of the enamel on the teeth is a common symptom of long-term vomiting.

Physical signs

Common physical signs of malnutrition from anorexia include:footnote 2

  • A low body weight.
  • Constipation and slow emptying of the stomach.
  • Thinning hair, dry skin, and brittle nails.
  • Shrunken breasts.
  • Stopping or never getting a monthly menstrual period.
  • Feeling cold, with a lower-than-normal body temperature.
  • Low blood pressure.

Food rituals

People who have anorexia often form rituals associated with eating. These may include:

  • Having special ways of eating food, hoarding food, collecting recipes, and preparing elaborate meals for other people but not eating the meals themselves.
  • Spending a lot of time cutting and rearranging food on their plates to make it look as though they have eaten. They may also hide food or secretly get rid of it during meals.

Suicidal feelings

In some cases, people who have eating disorders can feel suicidal.

If someone you know shows warning signs of suicide, make sure that the person is not left alone. Seek help from a mental health professional immediately.

If you are having suicidal thoughts, talk to someone about it. Call a local suicide hotline, your local health department, or the national suicide hotline (1-800-273-TALK or 1-800-273-8255), or seek help at a local hospital emergency room.

What Happens

Anorexia almost always begins with a plan to follow a strict weight-loss diet. Over time, severely limiting foods leads to malnutrition and unhealthy weight loss.

As malnutrition sets in, the brain and metabolism change. This limits the appetite, how your body uses food, and your ability to think clearly and make good decisions. As the illness gets worse, irrational behaviors begin, such as making rules about food or making yourself vomit out of fear of gaining weight.

Starvation and malnourishment from anorexia can cause complications, such as osteoporosis or an irregular heartbeat. Often other mental health conditions occur along with anorexia, such as depression.

Early treatment works best

After anorexia starts, returning to normal eating is very hard without help. When left untreated, anorexia can last for a lifetime.

Early treatment of anorexia offers the best chance of recovery. People who have anorexia tend to strongly deny that they have a problem and are secretive about their eating. So their family members or loved ones usually have to get help for them.

What Increases Your Risk

The risk for anorexia nervosa increases if you:

For some people, limiting what they eat can meet a need for personal control and self-esteem. Some teens may fall into this pattern as a way to cope with big changes and challenges.

A parent may have cause for concern if:

  • A child expresses concerns about weight at a very young age.
  • A teen becomes more strict with a diet.
  • A teen intensifies his or her exercise routine.

When To Call a Doctor

Call your doctor immediately if you (or someone you care about) have been diagnosed with anorexia nervosa and:

  • Are not able to pass urine.
  • Have a pounding heartbeat, skipping heartbeats, or a slower-than-normal heart rate.
  • Have been fainting.
  • Have severe belly pain; are vomiting up blood; or have black, sticky (tarry) stools. These signs may mean that there is bleeding in the digestive tract.
  • Have severe pain anywhere in the body, such as the joints or torso.

Call your doctor if you (or someone you care about):

  • Have signs of anorexia, including rapid weight loss, eating very little, and being overly concerned about weight and appearance.
  • Have lost a lot of weight and cannot stop losing weight.
  • Are fearful of gaining even a small amount of weight, and this interferes with eating healthy meals.
  • Notice that you are secretive or lie about your eating habits.
  • See yourself as fat and feel that you must diet, even when other people say you look too thin.
  • Have been making yourself vomit or are abusing laxatives or diuretics (bulimia).
  • Are female and are not having menstrual periods when you should.
  • Feel the need to exercise a lot, and do not give yourself healing or rest time when you are injured or exhausted.
  • Have been diagnosed with anorexia and feel dizzy.

Watchful waiting

Watchful waiting is a wait-and-see approach. Watchful waiting is not a safe way to handle a possible eating disorder.

Getting early treatment improves your chances of overcoming anorexia.

Who to see

The following health professionals can help diagnose or treat an eating disorder:

For severe anorexia, starvation, or life-threatening mental health problems, getting treatment in a hospital or an eating disorder treatment center is needed.

Exams and Tests

There is no single test that can diagnose anorexia. But this illness has a visible effect on your health and eating habits.

If your doctor thinks that you may have an eating disorder, he or she will check you for signs of malnutrition or starvation. Your doctor may also ask questions about your mental well-being. It is common for a treatable mental health problem (such as depression, anxiety, or obsessive-compulsive disorder) to happen with an eating disorder.

Common exams and tests for a possible eating disorder include:

  • A medical history of your physical and emotional health, present and past.
  • A physical exam, including checking your heart, lungs, blood pressure, weight, mouth, skin, and hair for problems from malnutrition.
  • Screening questions about your eating habits and how you feel about your health.
  • A mental health assessment, to check for depression or anxiety.
  • Blood tests, to check for signs of malnutrition.
  • X-rays, which can show whether your bones have been weakened (osteopenia) by malnutrition.

If your doctor thinks that you may have organ damage, doing heart or kidney tests can be helpful.

Treatment Overview

All people with anorexia need treatment. In most cases, this involves seeing a doctor and having regular counseling sessions. A hospital stay is needed for those who are seriously underweight or who have severe medical problems. The goals of treatment are to restore a healthy weight and healthy eating habits.

If you have an eating disorder, try not to resist treatment. Although you may be very afraid of gaining weight, try to think of weight gain as a life-saving measure. With help, you can learn to eat well and keep your weight at a healthy level.

Your recovery

Ideally, you can take charge of anorexia with the help of a team that includes a mental health professional (such as a psychologist or licensed counselor), a medical health professional (such as a doctor or nurse), and a registered dietitian.

If your medical condition is not life-threatening, your treatment likely will include:

  • Medical treatment. If malnutrition or starvation has started to break down your body, medical treatment will be a top priority. Your doctor will treat the medical conditions that have been caused by anorexia, such as osteoporosis, heart problems, or depression. As you begin to get better, your doctor will continue to follow your health and weight.
  • Nutritional counseling. A registered dietitian will help you take charge of your weight in a healthy way. You will learn healthy eating patterns and gain a good understanding of nutrition.
  • Therapy. Talking with a psychologist or mental health professional will help you cope with the emotional reasons behind anorexia. For example, you may discuss life stresses, unhelpful beliefs about food and weight, or certain personality traits that may be, in part, causing anorexia.

An important part of your recovery will include:

For the teen with anorexia, family involvement is a key part of treatment. Family therapy helps parents support their child, both emotionally and physically.

Any brothers or sisters also need support during treatment. Family, group, and individual counseling are all effective and are often combined.

If you need more help

Ongoing (chronic) forms of anorexia may require treatment for many years, including hospitalizations when needed. Ongoing treatment usually includes psychological counseling. A counselor will help you make your own plan to use new coping and stress management skills and prevent relapse. Your counselor can help you at those times when it is hard to follow healthy ways of thinking about food and your body.

Some people fully recover from anorexia. Many people with anorexia have ups and downs over the years. Try thinking of treatment as an ongoing process.

When you need emergency care

Being severely underweight can cause dehydration, starvation, and electrolyte imbalance, any of which can be life-threatening.

If anorexia causes life-threatening medical problems, you need urgent medical treatment. A hospital stay is needed for those who are seriously underweight or who have severe medical problems. This can include several weeks in the hospital followed by outpatient treatment to monitor your progress. Treatment includes:

  • Treating starvation.This can include treating medical problems it has caused, such as dehydration, electrolyte imbalance, or heart problems. If you can't eat, you are given your nutrition in fluid form.
  • Nutritional rehabilitation. The medical team helps you work toward a healthier weight carefully and gradually, learn when your body is hungry and full, and start healthy eating patterns.

Insurance coverage varies for inpatient treatment of eating disorders. Check with your insurance carrier to learn about your coverage.

What to think about

Anorexia can be a lifelong illness. Many people who have anorexia recover, some improve, and some have problems with anorexia throughout their lives.

  • People with anorexia who are young and who start treatment early in their illness usually do well.
  • Anorexia is more difficult to treat when it has gone untreated for a long time.

Many people don't get treatment for mental health problems. You may not seek treatment because you think your symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.

If you need help deciding whether to see your doctor, read about some reasons why people don't get helpand how to overcome them.

Prevention

There is no known way to prevent anorexia nervosa. Early treatment may be the best way to prevent the disorder from progressing. Knowing the early signs and seeking treatment right away can help prevent complications of anorexia.

For family members of children and teens

There are many ways adults can help children and teens form a healthy view of themselves and learn to approach food and exercise with a positive attitude. Doing this may prevent some children and teens from having this disorder.

Home Treatment

Continuing good care at home will help you recover from anorexia nervosa. Set goals with your doctor, mental health professional, and registered dietitian. Include goals in the areas of:

Ask your family members to also support your emotional and physical goals for healing. If someone close to you has trouble understanding eating disorders, share what you have learned in treatment.

You may have used anorexia to deal with the stresses of life. Learning how to cope with stress without anorexia is an important part of recovery. Relieving stress in a healthy way can help you recover, improve your quality of life, and stay healthy.

For family members

All families have patterns that can get in the way of change. To make healthy change easier, have everyone in the family take a look at how they handle their loved one's eating disorder.

Keep in mind that severe weight loss makes a person unable to think clearly or function well in daily life. This is a sign that a loved one needs medical care.

Medications

There are no medicines to treat anorexia nervosa. But if you are depressed or anxious, your doctor may prescribe an antidepressant medicine.

An antidepressant may help if you also have depression, an anxiety disorder, or obsessive-compulsive disorder.

If you have anorexia and are taking medicine, you must have regular checkups. Being malnourished or severely underweight can change the amount of medicine in your body. Too much or too little can be dangerous.

During a checkup, your doctor will note your heart rate, temperature, and blood pressure. You may also have blood tests to check the amount of medicine in your blood.

References

Citations

  1. Agras WS (2008). The eating disorders. In DC Dale, DD Federman, eds., ACP Medicine, section 13, chap. 9. Hamilton, ON: BC Decker.
  2. Guarda AS, Joffe A (2011). Anorexia nervosa and bulimia nervosa. In M Augustyn et al., eds., The Zuckerman Parker Handbook of Developmental and Behavioral Pediatrics for Primary Care, 3rd ed., pp. 107-114. Philadelphia: Lippincott Williams and Wilkins.

Other Works Consulted

  • American Academy of Pediatrics (2010). Clinical report: Identification and management of eating disorders in children and adolescents. Pediatrics, 126(6): 1240-1253.
  • Anderson AE, Yager J (2009). Eating disorders. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 2128-2149. Philadelphia: Lippincott Williams and Wilkins.
  • Coughlin JW, et al. (2014). Behavioral disorders affecting food intake: Eating disorders and other psychiatric conditions. In AC Ross et al., eds., Modern Nutrition in Health and Disease, 11th ed., pp. 1319-1329. Philadelphia: Lippincott Williams and Wilkins.
  • Fitzpatrick KK, Lock J (2011). Anorexia nervosa, search date April 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
  • Sadock BJ, et al. (2007). Eating disorders. In Kaplan and Sadock's Synopsis of Psychiatry, Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 727-735. Philadelphia: Lippincott Williams and Wilkins.
  • Sadock BJ, Sadock VA (2010). Eating disorders. In Kaplan and Sadock's Pocket Handbook of Clinical Psychiatry, 5th ed., pp. 259-268. Philadelphia: Lippincott Williams and Wilkins.
  • Steering Committee on Practice Guidelines, American Psychiatric Association (2006). Treating Eating Disorders: A Quick Reference Guide. Arlington, VA: American Psychiatric Publishing.
  • Yager J, et al. (August 2012). Guideline Watch: Practice Guideline for the Treatment of Patients With Eating Disorders, 3rd ed. Arlington, VA: American Psychiatric Association. Also available online: http://psychiatryonline.org/content.aspx?bookid=28&sectionid=39113853.

Credits

ByHealthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
John Pope, MD, MPH - Pediatrics
W. Stewart Agras, MD, FRCPC - Psychiatry

Current as ofDecember 7, 2017

Current as of: December 7, 2017

Author: Healthwise Staff

Medical Review: Kathleen Romito, MD - Family Medicine & John Pope, MD, MPH - Pediatrics & W. Stewart Agras, MD, FRCPC - Psychiatry