Anorexia Nervosa

DEFINITION: Self-induced malnutrition resulting in a body weight that is 15 percent or more below normal for age and height combined with a pathological fear of becoming fat.

ANATOMY OR SYSTEM AFFECTED: Brain, endocrine system, gastrointestinal system, hair, heart, immune system, kidneys, musculoskeletal system, nails, nervous system, psychic-emotional system, reproductive system, skin

CAUSES: Emotional and psychological disorders pertaining to body image

SYMPTOMS: Extreme weight loss, amenorrhea, malnutrition, forgetfulness, attention deficits, confusion, fatigue, apathy, irritability, brittle nails, hair loss, dry skin, cold hands and feet, osteopenia, osteoporosis

DURATION: Chronic

TREATMENTS: Individual counseling, nutritional counseling; antidepressants; nasogastric feeding

Causes and Symptoms

Anorexia nervosa is an eating disorder characterized by a body weight at or below 85 percent of normal, an intense fear of weight gain that leads to restrictive eating to the point of self-starvation, and a distorted perception of one's body weight and the seriousness of the effects of the disorders. Anorexia nervosa is typically a physical manifestation of underlying emotional conflicts such as guilt, anger, lack of control, and poor self-image, and is often characterized by obsessive-compulsive symptoms about weight and body image. Anorexia is the third most common eating disorder among adolescents and adults in the United States, after binge eating disorders and bulimia nervosa. Anorexia is more common in women and girls, although the incidence rate among boys and men has been rising; a 2023 study found that men make up about 10 to 15 percent of people with anorexia. Additionally, some studies have shown that transgender people have an increased risk of developing anorexia and other eating disorders compared to cisgender people.

Anorexia nervosa often occurs following a successful dieting experience, and frequent dieting may contribute to the development of the disorder. Dieters may experience positive feedback regarding weight loss and feel compelled to continue losing weight.

Although the term “anorexia” means “loss of appetite,” individuals with anorexia continue to experience hunger but ignore or resist the body’s normal craving for food. Individuals with anorexia frequently identify specific areas of the body that they believe are “fat,” despite their emaciated condition. Anorexia is characterized by extreme body-image distortions. Secrecy and ritual eating habits may be signs of anorexia nervosa. Those experiencing anorexia often lie to family and friends to avoid eating meals and may eat only a set diet at a specific time of day.

Common comorbid conditions in individuals with anorexia nervosa include obsessive-compulsive disorder, depression, anxiety disorders, social phobia, and simple phobias. Many people with anorexia are high achievers, exhibiting perfectionist or “people-pleasing” personalities. In addition, a strong correlation exists between anorexia nervosa and athletic activities that emphasize the physique, such as ballet, figure skating, gymnastics, cheerleading, and dance. People with anorexia may demonstrate additional obsessive-compulsive behaviors such as weighing themselves, examining themselves in the mirror several times per day, being overly concerned with calorie or fat content, exercising compulsively and excessively, and maintaining unusually consistent eating patterns.

Anorexia nervosa is frequently a symptom of depression, though studies have also shown that depression can emerge as a symptom of anorexia, possibly due, in part, to reduced nutrition and overall health. While the exact cause of anorexia is often unclear in specific cases, studies have demonstrated a 58 percent rate of heritability for the condition; other factors, such as upbringing and cultural values, can contribute to the development of anorexia as well. The condition may also be triggered as a result of a traumatic situation such as death, divorce, pregnancy, or sexual abuse.

Symptoms and resulting physical conditions include amenorrhea, the abnormal interruption or absence of menstrual discharge, which can occur when body fat drops below 23 percent. Anorexia nervosa may also be characterized by a distended abdomen as a result of a buildup of abdominal fluids and the slowing of the digestive system.

Resulting malnutrition can impair the immune system and cause anemia or decreased white blood cell counts. Brain and central nervous system functions may also be affected, resulting in forgetfulness, attention deficits, and confusion. Individuals with anorexia frequently experience fatigue, apathy, irritability, and extreme emotions.

Additional symptoms can include thyroid abnormalities, fainting spells, irregular heartbeat, brittle nails, hair loss, dry skin, cold hands and feet, hypotension (low blood pressure), infertility, broken blood vessels in the face, and the growth of downy body hair called lanugo as the body attempts to insulate itself because of the loss of natural fat.

The occurrence of eating disorders in adolescents is especially dangerous because the condition can retard growth and delay or interrupt puberty. Anorexia nervosa can also result in the erosion of heart muscle, which lowers the heart’s capacity and can lead to congestive heart failure. Individuals with anorexia may experience musculoskeletal problems such as muscle spasms, atrophy, and osteoporosis as a result of potassium and calcium deficiencies. In extreme cases, patients may also experience organ failure and cardiac complications that can result in sudden death. Anorexia is the deadliest psychiatric condition, with a mortality rate of 5 to 10 percent.

Treatment and Therapy

Treatment of anorexia nervosa generally consists of medical treatment, including electrolyte balance, and diagnosing and addressing any related health problems, such as heart problems, depression, and osteoporosis; individual psychotherapy; and nutrition counseling, as most people with anorexia need to focus away from weight loss and toward nutritional gain and health.

Research indicates that eating disorders are one of the psychological problems least likely to be treated, and anorexia nervosa has the highest mortality rate of all psychological problems. The National Institute of Mental Health estimates that as many as one in ten anorexia cases ends in death from starvation, suicide, or medical complications such as metabolic collapse, heart attacks, or kidney failure.

Psychologists play a vital role in the successful treatment of eating disorders and are integral members of the multidisciplinary team that may be required to provide patient care. As part of this treatment, a physician may be called on to rule out medical illnesses and determine that the patient is not in immediate physical danger. A nutritionist may be asked to help assess and improve nutritional intake.

It is frequently necessary first to treat the acute physical symptoms associated with anorexia nervosa. Patients with severe cases of anorexia—characterized by weight that is 75 to 80 percent of ideal body weight—benefit from treatment in a controlled environment that allows medically supervised feeding to achieve a target rate of weight gain. Hospitalization may be necessary. Less severe cases can be effectively treated on an outpatient basis.

During the initial phase of supervised feeding, the patient may receive a low-calorie diet to avoid overwhelming low-functioning organs. Patients who do not comply with the recommended diet may receive caloric supplements and, in serious cases, intravenous feeding or nasogastric intubation.

Successful treatment also involves resolution of underlying emotional issues through counseling, such as cognitive behavioral therapy, and family therapy. Treatment may also include use of antidepressants or antianxiety medication.

Anorexia nervosa is extremely difficult to treat, though roughly 50 to 75 percent of all of those who experience anorexia can fully recover from the condition. An additional one-third of patients with anorexia improve with treatment, and about 20 percent of patients develop a chronic course.

Perspective and Prospects

Anorexia is a multifaceted problem that has physical, genetic, emotional, and cultural components. The lifetime prevalence of anorexia nervosa among adults in the United States is 0.6 percent, with 0.9 percent of women and 0.3 percent of men affected. and the incidence of anorexia among adolescent girls rose every decade between 1940 and 2000. Transgender youth and adults are disproportionately affected by anorexia and other eating disorders; a 2015 study of a large sample of college students found that 15 percent of transgender youths polled had received an eating disorder diagnosis within the past year. The beginning of the global COVID-19 pandemic in late 2019 and early 2020 caused a negative impact on mental health worldwide, and also may have contributed to a spike in reported symptoms of eating disorders, including anorexia. The stress of the pandemic and its economic effects, combined with social isolation and other factors, may have helped trigger symptom relapses in recovered patients, as well as the onset of eating disorders in new patients.

Conditions such as anorexia nervosa gained the attention of medical professionals during the 1960s and beyond as a result of the media’s obsession with thinness. Television and magazines send confusing messages to young consumers, such as depicting painfully thin models promoting high-fat snacks and depicting overweight people in stereotyped roles in films and television series. The growing popularity of social media beginning in the late 2000s has led to new mental health challenges, including the development of body image and self-esteem issues in children and adolescents. In a 2024 study, researchers found a link between increased social media use and reduced satisfaction with one's own body and reported that both girls and boys felt that images on social media had caused them anxiety about their appearance.

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