Anorexia Nervosa

Anorexia nervosa (AN) is an eating disorder characterized by the refusal to maintain weight at or above the normal range for an individual’s age and height.

Characteristics of the disorder also include an intense fear of weight gain or behaviors that prevent weight gain, a severe distortion in how the individuals perceive their body weight or shape, and they may deny the seriousness of their low body weight.

Anorexia usually develops in adolescence and often continues into adulthood.  Individuals with this disorder lose weight by restricting food and/or exercising excessively.  Some may also make themselves vomit or abuse laxatives after meals. 

There are two types of anorexia: restrictive type and binge-eating / purging type.

Restricting Type

The individual severely limits food intake and does not regularly binge-eat.

Binge-Eating / Purging Type

The individuals regularly practice the bulimic behaviors of binge-eating (uncontrolled episodes of overeating) and purging (making themselves vomit and/or taking large amounts of laxatives, diet pills or diuretics).

The occurrence of anorexia has increased over the years.  It is most common in adolescents and young adults with the majority being female.  However, there are a growing number of males being diagnosed with anorexia. 

In the United States anorexia occurs across all socioeconomic groups and in a variety of ethnic and racial groups. 

Research is still being done on the cause of anorexia, but the most common understanding of how this disorder develops includes a combination of biological, psychological and social factors. Studies show that anorexia runs in families. People with anorexia tend to have a genetically close family member, like a parent or sibling, who also has an eating disorder. 

Our Western society is a culture that has unrealistic physical standards for woman to be thin, and flawlessly beautiful.  These standards cannot be met, because the images we see are not real, and yet many young girls try very hard to look like the women in magazines or in the movies.

In other situations the individuals are trying to meet the expectations of others and lose weight for a sport or activity, like ballet, gymnastics, or running. This can lead to unhealthy dieting and exercising. 

There are also certain psychological characteristics that can put a person at an increased risk for developing anorexia.  Common traits are: they hold in their feelings, they are perfectionist, and rigid.  In times of stress, most people will turn to thoughts and behaviors that come naturally because it is comfortable and it makes them feel secure.  Individuals with these characteristics may turn to routines of structure and rigidity in many areas of life, including their eating habits.

These characteristics, paired with the family history of an eating disorder and the pressure to unrealistically transform their physical appearance, can lead to the development and then the maintenance of anorexia.

Adolescents may be particularly vulnerable because the teen years are already a time of increased stress, change and pressure. Recognize however, that treatment tends not to focus on the cause of the disorder, but rather the physical condition of the patient and the unhealthy thoughts and behaviors.

The following are common symptoms of anorexia. However, each individual may experience the disorder differently.

  • Expresses feeling fat, even when very thin
  • Preoccupation with food, weight, or shape
  • Unusual eating behaviors or rituals
  • Excessive exercise
  • Individuals who make themselves throw up may show dental erosion or have scars on the back of their hand from putting their hands down their throat.

Common physical symptoms associated with anorexia − often the result of starvation or malnourishment:  

  • Absence of menstrual cycle
  • Skin may be dry or have a yellow tint
  • Breasts become smaller
  • Adolescents often look physically younger than their age
  • They can often be hyperactive
  • The body grows lanugo (fine soft hair that grows on the arms and legs)
  • Fatigue (may be a sign of fluid or electrolyte imbalance, or dehydration)
  • Intolerance to cold temperatures
  • Dizziness or fainting spells
  • Abdominal pain
  • Constipation

Persons with anorexia may also have severe body distortions, restricted emotions, and show little insight to their disorder.  They may be perfectionist, not able to handle negative emotions, rigidly controlling of their impulses, competitive and feel an extreme sense of guilt and responsibility. 

Although the course of the disorder can vary from person to person, it is often common for individuals to relapse and deal with this disorder throughout their lives. 

The rate of death for anorexia is higher than any other psychiatric disorder.  The incidents of suicide are high and there are many medical complications that can occur from malnutrition and starvation.    

However, the research does show that early treatment for adolescents can result in positive outcomes.  It is important to seek consultation and treatment if you notice any of these signs so that treatment can begin as soon as possible.

Specific treatment for anorexia nervosa will be determined by the adolescent's physician based on:

  • Age, overall health and medical history
  • Severity and types of symptoms
  • Tolerance for specific procedures or therapies
  • Expectations for the course of the condition
  • Ability of the family to participate in treatment

Parents and family play a vital role in the treatment process.  Anorexia is usually treated with a combination of individual therapy, family therapy, behavior modification and nutritional rehabilitation. Treatment should always be based on a comprehensive evaluation of the adolescent and family.

The frequent occurrence of medical complications and the possibility of death during the course of treatment require both your child's physician and a nutritionist to be active members of the management team. Treatment can occur in a variety of settings, including outpatient, day treatment programs, residential, or inpatient.  The decision will be based on the individual’s medical status, psychological needs, behaviors, and social circumstances. The professional in charge of the treatment will guide you to the best option.

Last Updated 06/2016