Anorexia nervosa—usually just called anorexia—is a serious eating disorder. Individuals with anorexia do not eat enough and have an intense fear of being fat. Although the term anorexia nervosa means “no appetite, caused by nervousness,” most people with anorexia do feel hunger but take extreme steps to ignore it, often to the point of starvation.
Anorexia usually, but not always, begins in adolescence, often as puberty starts and body shapes change. It is more common in adolescent girls and young women but young men can also develop it.
There are two types of anorexia:
- restrictive anorexia. A person with this type limits how much food she or he takes in by eating as little as possible.
- binging and purging anorexia. Individuals with this type eat food but then vomit or use laxatives to get rid of the food.
Many individuals go back and forth between these two patterns. Individuals with anorexia also tend to exercise excessively to burn off the calories they take in.
Although this problem has existed for centuries, it has become more common in recent years, especially in cultures where being thin is considered attractive.
What causes anorexia isn’t known. It is likely a combination of biological, psychological, and social factors such as peer and societal pressure to be thin, fear of becoming an adult, family conflicts, depression, and obsessive-compulsive tendencies.
Signs of anorexia
In the United States and other developed countries, it is common for teens to worry about their weight and appearance. But worrying about weight doesn’t mean someone has an eating disorder. Individuals with anorexia take these worries to the extreme.
Possible signs of anorexia include:
- severely limiting calories, often skipping meals
- continued weight loss, or low body weight
- intense exercise
- a drive for perfection
- difficulty concentrating, making decisions, or thinking
- depression or social withdrawal
- fainting, dizziness, lack of energy
- feeling cold when others feel warm
A health professional, such as a pediatrician or a psychiatrist, can diagnose anorexia based on an individual’s symptoms and whether she or he fits several specific medical and psychological criteria:
- significant weight loss, defined as more than 15% below ideal body weight
- lack of menstrual periods
- distorted body image (feeling fat in spite of being thin)
- intense fear of gaining weight or becoming fat
The health professional will also look for other signs of anorexia, such as
- low blood pressure
- dry skin
- enlarged salivary glands
- lanugo, a very fine type of body hair
- lack of menstrual periods in a woman
- dental problems (stomach acids from repeated vomiting can damage teeth)
Medical complications of anorexia can include stress fractures, bone loss (osteopenia), growth delay, short stature, and heart problems.
Some people with anorexia have a single, relatively brief episode. For others, the problem lasts for years. For the majority of people with anorexia, the condition fades away by late adolescence. But a significant number of people have continuing problems with diet and body image into adulthood.
Severe weight loss or starvation is a medical emergency. Early treatment is important. Individuals with severe anorexia may need to be hospitalized.
Anorexia nervosa is usually treated with a combination of psychotherapy, support, education, medication, and medical and nutritional counseling.
A general goal is to help the person achieve a minimum healthy weight. Another priority is to correct any problems with body fluids and salts.
Treatment often requires coordinating help from a number of professionals, especially in the most serious cases. Comprehensive eating disorder programs often work best because they bring together all these treatment elements.
Supportive psychotherapy and clinical management can help the person recognize her or his distorted beliefs about body image that are central to the disorder. This is a major task of treatment.
Nutritional counseling from a trained nutritionist can plan a healthy eating program that promotes slow weight gain.
Cognitive behavior therapy can help an individual recognize flawed thoughts about body image, food and dieting, and helps control anxiety about eating.
Family therapy may help identify and change negative interactions in the family, such as unproductive power struggles about food.
Medication. No medications are known to make individuals with anorexia want to eat or gain weight. Antidepressants and other medications may offer some relief for those who have symptoms of depression, anxiety, or obsessive-compulsive disorder. If an individual’s thinking about food becomes distorted enough that it is considered psychotic, an antipsychotic medication such as olanzapine (Zyprexa) may help.