Anorexia

Anorexia Nervosa: Signs, Health Risks, and Treatment

Anorexia nervosa is a serious and potentially life-threatening eating disorder. It's marked by restriction of food intake, an intense fear of gaining weight, and a distorted view of one's body shape or size. People with anorexia often see themselves as larger than they are, even when they're significantly underweight or medically unwell.

Anorexia is one of several conditions within the broader category of eating disorders. It can affect people of any age, gender, body size, race, or background. Anorexia has one of the highest mortality rates of any mental health condition, which makes early recognition and professional treatment especially important.

Recovery from anorexia is possible. With specialized care that addresses the medical, nutritional, and psychological sides of the illness, many people go on to rebuild a healthy relationship with food, their bodies, and themselves.

What Is Anorexia Nervosa?

Anorexia nervosa is more than dieting or a desire to be thin. It's a complex mental health condition in which food restriction, weight, and body shape become central to a person's sense of self-worth and control.

Clinicians diagnose anorexia when a person shows three core features:

• Restriction of food intake that leads to a significantly low body weight for their age, sex, development, and health

• An intense fear of gaining weight or becoming fat, or persistent behavior that prevents weight gain

• A disturbance in how they experience their body weight or shape, an outsized influence of weight on self-worth, or a lack of recognition of how serious their low weight is

Types of Anorexia

There are two recognized subtypes:

Restricting type. Weight loss happens mainly through dieting, fasting, or excessive exercise.

Binge-eating/purging type. Along with restriction, the person has recurring episodes of binge eating or purging behaviors, such as self-induced vomiting or misuse of laxatives. This subtype shares some features with bulimia nervosa. The key difference is that people with anorexia are at a significantly low body weight.

Some people have all the psychological features of anorexia but aren't underweight. This is sometimes called atypical anorexia, and it can cause the same serious medical complications. Low weight isn't required for an eating disorder to be dangerous.

Signs and Symptoms of Anorexia

Anorexia can be hard to spot, especially early on. Many people hide their behaviors, and weight loss can happen gradually.

Behavioral signs may include:

• Skipping meals, eating very small portions, or cutting out entire food groups

• Rigid food rules, rituals, or preoccupation with calories, ingredients, and nutrition

• Excessive or compulsive exercise, even when sick or injured

• Avoiding eating in front of others or social events that involve food

• Frequent weighing, body checking, or wearing loose clothing to hide weight loss

• Denying hunger or the seriousness of low weight

Emotional and psychological signs may include:

• An intense fear of weight gain

• A self-worth tied closely to weight, shape, or control over eating

• Perfectionism, anxiety, or irritability, especially around meals

• Social withdrawal and loss of interest in activities

Physical signs may include:

• Significant weight loss, or failure to make expected weight gains in children and teens

• Fatigue, dizziness, or fainting

• Feeling cold all the time

• Thinning hair, dry skin, or fine body hair growth

• Irregular or missed menstrual periods

• Difficulty concentrating or sleeping

What Causes Anorexia?

There's no single cause of anorexia. It usually develops from a combination of factors.

Biological factors. Anorexia tends to run in families, and research suggests genetics play a meaningful role. Differences in brain chemistry and how the brain processes hunger, reward, and anxiety may also contribute.

Psychological factors. Traits such as perfectionism, high anxiety, a strong need for control, and harsh self-criticism are common among people with anorexia. Many also struggle with distorted body and self-image.

Environmental and social factors. Cultural pressure around thinness, dieting, weight-focused sports or careers, bullying, trauma, and major life transitions can all play a role.

Health Risks of Anorexia

Starvation affects nearly every organ system. Medical complications can include:

• Slow heart rate, low blood pressure, and heart rhythm problems

• Dangerous electrolyte imbalances

• Bone loss and increased fracture risk

• Hormonal changes, including loss of menstrual periods and fertility problems

• Digestive problems such as bloating and constipation

• Anemia and weakened immune function

• Changes in brain structure and function

Some of these risks can appear even in people who don't look underweight. Anyone showing signs of anorexia should have a full medical evaluation.

Refeeding, the process of restoring nutrition, must be managed carefully by medical professionals, because restoring nutrition too quickly can cause serious complications.

Co-Occurring Conditions

Anorexia often occurs alongside other mental health conditions, including depression, anxiety disorders, and obsessive-compulsive disorder. Effective treatment addresses these conditions together, since each can make the others harder to manage.

How Anorexia Differs From Other Eating Disorders

Anorexia is sometimes confused with other eating disorders. Avoidant/restrictive food intake disorder (ARFID) also involves restricted eating, but it isn't driven by fear of weight gain or concerns about body shape. Instead, ARFID restriction usually stems from sensory sensitivities, low interest in food, or fear of choking or vomiting.

Unlike binge eating disorder, which involves recurring episodes of eating large amounts of food with a loss of control, anorexia centers on restriction. Some people move between different eating disorder diagnoses over time, which is one reason ongoing professional care matters.

Treatment for Anorexia

Anorexia treatment usually involves a multidisciplinary team. That team often includes a physician, psychiatrist, therapist, and registered dietitian who specializes in eating disorders.

Medical Monitoring and Nutritional Rehabilitation

Restoring physical health is the foundation of treatment. Medical monitoring tracks heart function, electrolytes, and other vital signs. A dietitian guides nutritional rehabilitation, helping the person restore weight and regular eating patterns safely.

Therapy

Several therapy approaches have strong evidence for anorexia:

• Family-based treatment (FBT).

  Also called the Maudsley approach, FBT is a leading treatment for children and teens. Parents take an active role in restoring their child's nutrition and health, with guidance from a therapist. Broader

  family therapy can also help families heal and communicate during recovery.

• Enhanced cognitive behavioral therapy (CBT-E).

  This form of cognitive behavioral therapy is designed specifically for eating disorders. It helps people change the thoughts and behaviors that keep the disorder going.

• Other adult approaches.

  These include the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) and specialist supportive clinical management (SSCM).

Medication

There's no FDA-approved medication specifically for anorexia. However, a psychiatrist may prescribe medication to treat co-occurring conditions such as depression, anxiety, or OCD.

Levels of Care for Anorexia

The right level of care depends on medical stability, weight, and how much support a person needs to eat regularly and interrupt eating disorder behaviors.

• Medical inpatient care

  stabilizes serious medical complications.

• Residential treatment programs

  provide 24-hour support in a structured setting.

• Partial hospitalization programs (PHP)

  offer full-day treatment while the person lives at home.

• Intensive outpatient programs (IOP)

  provide several hours of treatment per week.

• Outpatient therapy

  offers ongoing support as recovery becomes more stable.

Many people move between levels of care as they progress.

Anorexia in Teens and Young Adults

Anorexia most often begins in adolescence or young adulthood. Because it can disrupt growth, bone development, and brain development, early treatment is especially important for young people. Specialized treatment programs for teens often involve families directly in care.

How to Support a Loved One With Anorexia

If you're worried about someone, approach them with compassion rather than criticism. Focus on your concern for their health and well-being, not their weight or appearance. Avoid comments about food, bodies, or dieting, and encourage them to see a doctor or eating disorder specialist.

People with anorexia may deny that anything is wrong. This is part of the illness, not a sign that help isn't needed. For children and teens, parents can and should seek an evaluation even if their child resists.

Finding Anorexia Treatment in California

Our California directory includes providers that specialize in treating anorexia and other eating disorders. Options range from outpatient therapists and dietitians to residential and partial hospitalization programs.

When comparing providers, look for eating disorder specialization, a multidisciplinary team, medical monitoring, and evidence-based approaches such as FBT or CBT-E. Recovery from anorexia takes time, but with the right support, lasting recovery is possible.

If you or someone you love is in crisis or experiencing thoughts of suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or text HOME to 741741 to reach the Crisis Text Line. If someone is fainting, has chest pain, or has an irregular heartbeat, call 911 or go to the nearest emergency room.