Anorexia Nervosa: Symptoms, Causes, and Treatment

Anorexia nervosa is an eating disorder where people severely limit food to avoid weight gain, often seeing themselves as overweight even when underweight. It involves extreme dieting, excessive exercise, and sometimes purging. This can lead to dangerous weight loss, organ damage, and emotional distress. Treatment focuses on restoring healthy eating, addressing underlying issues, and medical monitoring.

In plain words

Anorexia nervosa is a serious eating disorder. People with anorexia eat very little because they fear gaining weight. They often see themselves as overweight, even when they are underweight. This can lead to dangerous weight loss and health problems. Treatment includes therapy, nutrition help, and medical care.

What is Anorexia Nervosa: Symptoms, Causes, and Treatment?

Anorexia nervosa is an eating disorder where people severely limit food to avoid weight gain, often seeing themselves as overweight even when underweight. It involves extreme dieting, excessive exercise, and sometimes purging. This can lead to dangerous weight loss, organ damage, and emotional distress. Treatment focuses on restoring healthy eating, addressing underlying issues, and medical monitoring.

Symptoms

Early symptoms

  • Extreme food restriction: Eating very small amounts, cutting out entire food groups, or constantly counting calories even when underweight. May follow strict food rules and rituals. (1) (5)
  • Intense fear of weight gain: Feeling terrified about gaining weight even when underweight. May check body constantly or avoid scales completely. Sees self as overweight despite evidence. (1) (4)
  • Exercising excessively: Working out for hours daily despite bad weather, injury, or exhaustion. Becomes very upset if exercise routine is interrupted. (5) (4)
  • Body image distortion: Sees parts of the body as fat even when underweight. Obsessively checks mirror, pinches skin, or measures body parts. (1) (5)
  • Social withdrawal: Avoiding meals with others, making excuses not to eat, or disappearing after meals. May stop seeing friends to avoid food situations. (4)
  • Hiding weight loss: Wearing baggy clothes to hide thinness or weight loss. May insist on wearing certain outfits no matter the weather. (5)

Serious or emergency symptoms

  • Dangerously low weight: Body mass index (BMI) under 17.5 or rapid, extreme weight loss. Visible bone structure, muscle wasting, and no body fat. Requires immediate medical assessment for hospitalization. (5)
  • Fainting or dizziness: Feeling lightheaded when standing up, passing out, or irregular heartbeat. Can signal dangerously low blood pressure or heart issues. Get emergency care if fainting happens more than once. (5)
  • No menstrual periods: Missing 3+ periods when not pregnant (amenorrhea). Shows severe hormonal changes affecting reproductive health. Talk with a doctor right away about restoring healthy weight. (3) (1)
  • Thoughts of suicide: Feeling hopeless or thinking about ending life. Anorexia has one of the highest death rates of any mental illness. Call emergency services or a suicide hotline immediately. (7)

Causes

Primary causes

  • Biological factors: Genetics may make some people more vulnerable. Changes in brain chemicals affecting mood, appetite, and stress response could play a role. (3) (5)
  • Psychological factors: Perfectionism, anxiety, obsessive tendencies, or feeling out of control may lead to extreme dieting as a coping strategy. Low self-worth tied to body shape. (5)
  • Social and cultural pressures: Societal focus on thinness as an ideal. Pressure from some sports, dance, or modeling professions that emphasize weight. (3)

Risk factors

Being female and young

Most common in women ages 15-25, though anyone can develop it. About 1 in 4 cases are male, with higher risk in gay and transgender youth. (3) (1)

Family history

Having a close relative with an eating disorder increases risk. Shared genes and home environment likely both contribute. (3)

Trauma or stress

Physical or emotional abuse, death of a loved one, bullying about weight, or other major stressors may trigger restrictive eating behaviors. (3)

Diagnosis

Doctors check weight history, eating habits, exercise routines, body image concerns, and mental health. A full medical exam looks for signs of malnutrition like slow heart rate or low blood pressure. Blood and urine tests check organ function. Mental health professionals assess thoughts, moods, and eating behaviors using standard questionnaires. Diagnosis requires significantly low weight, intense fear of gaining weight, and body image distortion.

Complete physical exam

Checks heart rate, blood pressure, temperature, skin/hair changes, and body mass index (BMI) to assess malnutrition effects. (6) (1)

Blood and urine tests

Measures electrolyte levels, liver/kidney function, and hormone levels to detect complications from starvation. (6)

Bone density scan (DEXA)

Checks for osteoporosis risk if underweight for a long time, especially if periods have stopped. (1)

Psychological evaluation

Assesses thoughts about food, weight, and self-image using standard questions about eating behaviors and mental health. (4)

Treatment

Medication options

SSRI antidepressants

May reduce anxiety and depression linked to anorexia, but won't treat the eating disorder alone. Works best combined with psychotherapy. (2) (6)

Atypical antipsychotics

Sometimes used in low doses to reduce obsessive thoughts about food and body image. May help with weight restoration. (6)

Lifestyle and self-care

  • Specialized eating disorder therapy: Cognitive behavioral therapy (CBT) tailored for anorexia helps challenge harmful thoughts, develop healthy coping, and gradually normalize eating. (2) (6)
  • Family-based treatment (FBT): For adolescents, parents take charge of meals at first while kids relearn hunger cues. Known as the most effective treatment for teens. (2) (6)
  • Nutrition counseling: A registered dietitian with eating disorder experience helps plan balanced meals and snacks to reach a healthy weight safely. (6)
  • Support groups: Connecting with others in recovery provides encouragement. Groups may focus on body positivity, meal support, or relapse prevention. (2)

Always discuss dosing and treatment changes with your own prescriber.

Possible complications

  • Heart problems: Slow irregular heartbeats (bradycardia/arrhythmia), low blood pressure, and weakened heart muscle from malnutrition can lead to heart failure. (3) (7)
  • Bone loss (osteoporosis): Low estrogen and poor nutrition reduce bone density, raising fracture risk even at young ages. May become permanent if untreated. (3) (7)
  • Infertility and pregnancy risks: Stopped menstrual cycles mean no ovulation. Even after recovery, may have trouble conceiving. Risks include miscarriage and low birth weight. (7)
  • Electrolyte imbalances: Low potassium, sodium, or magnesium from vomiting or starvation can cause seizures, kidney failure, or sudden cardiac death. (3)

When to see a doctor

Routine follow-up

  • Talk with your doctor if you notice signs like rapid weight loss, obsessive calorie counting, disappearing after meals, or excessive exercise habits. (7)

Seek emergency care

  • Get emergency care for chest pain, fainting, irregular heartbeat, seizures, or thoughts of self-harm. These signal life-threatening complications of anorexia. (7)

Frequently asked questions

What is Anorexia Nervosa?

Anorexia nervosa is a serious eating disorder where people severely restrict food due to intense fear of weight gain and body image concerns. It leads to dangerous weight loss, health problems, and emotional distress. People with anorexia often see themselves as overweight even when underweight. (1) (3)

What are the first signs of Anorexia Nervosa?

Early signs include extreme food restriction, obsessive calorie counting, excessive exercise, wearing baggy clothes to hide weight loss, social withdrawal around meals, and frequent comments about feeling 'fat' despite being underweight. (1) (5)

What causes Anorexia Nervosa?

Anorexia likely stems from a mix of genetic, psychological, and social factors. Having a family history, perfectionist tendencies, anxiety, low self-esteem, or exposure to weight-focused environments (like certain jobs or sports) all play potential roles. (3) (5)

How is Anorexia Nervosa treated?

Treatment usually combines psychotherapy (like cognitive behavioral therapy), nutrition counseling, medical monitoring, and sometimes medications for mood. Family-based treatment works well for teens. Severe cases may need hospitalization to stabilize health. (2) (6)

Can Anorexia Nervosa be cured?

Many people recover fully with treatment, though it may take years of work. Some have periods of relapse during stress. The earlier treatment starts, the better the long-term outcome. Support groups and ongoing therapy help maintain recovery. (2)

References

  1. NHS — Anorexia Nervosa source 1
  2. NHS — Treatment for Anorexia source 2
  3. MedlinePlus — Anorexia Nervosa source 3
  4. NIMH — Eating Disorders source 4
  5. Mayo Clinic — Anorexia Nervosa Symptoms and Causes source 5
  6. Mayo Clinic — Anorexia Nervosa Diagnosis and Treatment source 6
  7. Cleveland Clinic — Anorexia Nervosa source 7