U.S. Department of Health and Human Services, Office on Women’s Health FAQ on anorexia nervosa

1. Frequently Asked Questions
Anorexia
more in control of life and to ease ten-
sion, anger, and anxiety. Most people
with anorexia are female. An anorexic:
Nervosa
• Has a low body weight for her or his
height
• Resists keeping a normal body
weight
Q: What is anorexia nervosa? • Has an intense fear of gaining weight
A: A person with anorexia nervosa (an-uh- • Thinks she or he is fat even when
http://www.womenshealth.gov RECK-see-uh nur-VOH-suh), often very thin
1-800-994-9662 called anorexia, has an intense fear of
• Misses 3 menstrual periods in a row
gaining weight. Someone with anorexia
TDD: 1-888-220-5446 (for girls/women who have started
thinks about food a lot and limits the
having their periods)
food she or he eats, even though she or
he is too thin. Anorexia is more than
just a problem with food. It's a way of Q: Who becomes anorexic?
using food or starving oneself to feel A: While anorexia mostly affects girls and
women (85 - 95 percent of anorexics
are female), it can also affect boys and
It was 6 months ago
men. It was once thought that women
when I realized my
of color were shielded from eating disor-
daughter, Jen, had an
ders by their cultures, which tend to be
eating disorder. Jen has
more accepting of different body sizes.
always been a picky
It is not known for sure whether African
eater. But I started to
American, Latina, Asian/Pacific Islander,
see that she moved
and American Indian and Alaska Native
food around her plate.
people develop eating disorders because
And she never ate very much. She exer-
American culture values thin people.
cised all the time — even when she was
People with different cultural back-
sick. And she was sick a lot. She became
grounds may develop eating disorders
very skinny and pale. Her hair thinned.
because it’s hard to adapt to a new cul-
Jen became moody and seemed sad — I
ture (a theory called “culture clash”).
thought that's what teens act like. But
The stress of trying to live in two differ-
once I put the signs together, I talked to
ent cultures may cause some minorities
Jen about anorexia. She denied she had
to develop their eating disorders.
a problem. But I knew she needed help. I
took her to our doctor, and she asked me
to put Jen in the hospital. Jen’s treatment Q: What causes anorexia?
helped her return to a normal weight. It's A: There is no single known cause of
been a tough road since then for all of anorexia. Eating disorders are real,
us, but Jen is back home now. She is still treatable medical illnesses with causes in
seeing her doctors, and may need help for both the body and the mind. Some of
some time. But she’s doing much better. these things may play a part:
page
U.S. Department of Health and Human Services, Office on Women’s Health

2. Frequently Asked Questions
• Culture. Women in the U.S. are • Eating very small amounts of only
under constant pressure to fit a cer- certain foods
tain ideal of beauty. Seeing images • Moving food around the plate
of f lawless, thin females everywhere instead of eating it
makes it hard for women to feel
good about their bodies. More and Someone with anorexia may also have
more, men are also feeling pressure a distorted body image, shown by
to have a perfect body. thinking she or he is fat, wearing baggy
clothes, weighing her or himself many
• Families. If you have a mother or times a day, and fearing weight gain.
sister with anorexia, you are more
http://www.womenshealth.gov likely to develop the disorder. Anorexia can also cause someone to not
Parents who think looks are impor- act like her or himself. She or he may
1-800-994-9662
tant, diet themselves, or criticize talk about weight and food all the time,
TDD: 1-888-220-5446 not eat in front of others, be moody or
their children's bodies are more
likely to have a child with anorexia. sad, or not want to go out with friends.
People with anorexia may also have
• Life changes or stressful events. other psychiatric and physical illnesses,
Traumatic events (like rape) as well including:
as stressful things (like starting a new
• Depression
job), can lead to the onset of anorexia.
• Anxiety
• Personality traits. Someone with
anorexia may not like her or himself, • Obsessive behavior
hate the way she or he looks, or feel • Substance abuse
hopeless. She or he often sets hard-
to-reach goals for her or himself and • Issues with the heart and/or brain
tries to be perfect in every way. • Problems with physical development
• Biology. Genes, hormones, and
chemicals in the brain may be factors Q: What happens to your body
in developing anorexia. with anorexia?
A: With anorexia, your body doesn't get
Q: What are signs of anorexia? the energy from foods that it needs,
A: Someone with anorexia may look very so it slows down. Look at the picture
thin. She or he may use extreme mea- below to find out how anorexia affects
sures to lose weight by: your health.
• Making her or himself throw up
• Taking pills to urinate or have a
Q: Can someone with anorexia get
bowel movement better?
A: Yes. Someone with anorexia can get
• Taking diet pills better. A health care team of doctors,
• Not eating or eating very little nutritionists, and therapists will help
• Exercising a lot, even in bad weather the patient get better. They will:
or when hurt or tired • Help bring the person back to a nor-
page mal weight
• Weighing food and counting calories
U.S. Department of Health and Human Services, Office on Women’s Health

3. Frequently Asked Questions
• Treat any psychological issues related Other recent studies, however, suggest
to anorexia that antidepressants may not stop some
• Help the person get rid of any patients with anorexia from relaps-
actions or thoughts that cause the ing. Also, no medicine has shown to
eating disorder work 100 percent of the time during
the important first step of restoring a
These three steps will prevent “relapse” patient to healthy weight. So, it is not
(relapse means to get sick again, after clear if and how medications can help
feeling well for a while). anorexic patients get better, but research
Some research suggests that the use of is still happening.
http://www.womenshealth.gov medicines — such as antidepressants, Some forms of psychotherapy can help
antipsychotics, or mood stabilizers make the psychological reasons for
1-800-994-9662
— may sometimes work for anorexic anorexia better. Psychotherapy is some-
TDD: 1-888-220-5446 patients. It is thought that these medi- times known as “talk therapy.” It uses
cines help the mood and anxiety symp- different ways of communicating to
toms that often co-exist with anorexia. change a patient’s thoughts or behav-
Anorexia affects your whole body
Brain and Nerves
can't think right, fear of gaining weight, sad, moody, irritable,
bad memory, fainting, changes in brain chemistry
Dash line indicates
that organ is behind
other main organs.
Hair
hair thins and gets brittle
Heart
low blood pressure, slow heart rate, fluttering of the heart
(palpitations), heart failure
Blood
anemia and other blood problems
Muscles, Joints, and Bones
weak muscles, swollen joints, fractures, osteoporosis
Kidneys
kidney stones, kidney failure
Body Fluids
low potassium, magnesium, and sodium
Intestines
constipation, bloating
Hormones
periods stop, problems growing, trouble getting pregnant.
If pregnant, higher risk for miscarriage, having a C-section,
baby with low birthweight, and post partum depression.
Skin
bruise easily, dry skin, growth of fine hair all over body,
get cold easily, yellow skin, nails get brittle
page
U.S. Department of Health and Human Services, Office on Women’s Health

4. Frequently Asked Questions
ior. This kind of therapy can be useful Q: What is outpatient care for
for treating eating disorders in young anorexia treatment and how is it
patients who have not had anorexia for different from inpatient care?
a long time. A: With outpatient care, the patient
Individual counseling can help someone receives treatment through visits with
with anorexia. If the patient is young, members of their health care team.
counseling may involve the whole fam- Often this means going to a doctor’s
ily. Support groups may also be a part of office. Outpatients usually live at home.
treatment. In support groups, patients, Some patients may need “partial hospi-
and families meet and share what talization.” This means that the person
http://www.womenshealth.gov they’ve been through. goes to the hospital during the day for
1-800-994-9662 Some researchers point out that pre- treatment, but sleeps at home at night.
TDD: 1-888-220-5446 scribing medicines and using psy- Sometimes, the patient goes to a hos-
chotherapy designed just for anorexic pital and stays there for treatment. This
patients works better at treating is called inpatient care. After leaving
anorexia than just psychotherapy the hospital, the patient continues to
alone. Whether or not a treatment get help from her health care team and
works, though, depends on the per- becomes an outpatient.
son involved and his or her situation.
Unfortunately, no one kind of psycho-
therapy always works for treating adults Q: Can women who had anorexia in
with anorexia. the past still get pregnant?
A: It depends. When a woman has “active
Is it safe for young people anorexia,” meaning she currently has
to take antidepressants for anorexia, she does not get her period
anorexia? and usually does not ovulate. This
makes it hard to get pregnant. Women
It may be safe for young people to be who have recovered from anorexia and
treated with antidepressants. However, are at a healthy weight have a better
drug companies who make antidepres- chance of getting pregnant. If you’re
sants are required to post a “black having a hard time getting pregnant, see
box” warning label on the medication. your doctor.
A “black box” warning is the most
serious type of warning on prescrip-
tion drugs. Q: Can anorexia hurt a baby when
It may be possible that antidepressants the mother is pregnant?
make children, adolescents, and young A: Yes. Women who have anorexia while
adults more likely to think about sui- they are pregnant are more likely to
cide or commit suicide. lose the baby. If a woman with anorexia
doesn’t lose the baby, she is more likely
The latest information from the FDA
to have the baby early, deliver by C-sec-
— including what drugs are included
tion, deliver a baby with a lower birth-
in this warning and things to look for
weight, and have depression after the
— can be found on their Web site at
baby is born.
http://www.fda.gov.
page
U.S. Department of Health and Human Services, Office on Women’s Health

5. Frequently Asked Questions
Q: What should I do if I think 4. Avoid conf licts. If your friend won’t
someone I know has anorexia? admit that she or he has a problem,
A: If someone you know is showing signs don’t push. Be sure to tell your
of anorexia, you may be able to help. friend you are always there to listen
if she or he wants to talk.
1. Set a time to talk. Set aside a time to
talk privately with your friend. Make 5. Don’t place shame, blame, or guilt
sure you talk in a quiet place where on your friend. Don’t say, “You just
you won’t be distracted. need to eat.” Instead, say things like,
“I’m concerned about you because
2. Tell your friend about your con-
you won’t eat breakfast or lunch.”
cerns. Be honest. Tell your friend
http://www.womenshealth.gov Or, “It makes me afraid to hear you
about your worries about her or his
1-800-994-9662 throwing up.”
not eating or over exercising. Tell
TDD: 1-888-220-5446 your friend you are concerned and 6. Don’t give simple solutions. Don’t
that you think these things may be a say, If you'd just stop, then things
sign of a problem that needs profes- would be fine!
sional help. 7. Let your friend know that you will
3. Ask your friend to talk to a profes- always be there no matter what.
sional. Your friend can talk to a Adapted from “What Should I Say?
counselor or doctor who knows Tips for Talking to a Friend Who May
about eating issues. Offer to help Be Struggling with an Eating Disorder”
your friend find a counselor or doc- from the National Eating Disorders
tor and make an appointment, and Association. n
offer to go with her or him to the
appointment.
page
U.S. Department of Health and Human Services, Office on Women’s Health

6. Frequently Asked Questions
For more information
For more information on anorexia nervosa, please call womenshealth.gov at 1-800-994-
9662 or contact the following organizations:
National Institute of Mental Health Academy for Eating Disorders
(NIMH), NIH, HHS Phone: (847) 498-4274
Phone: (866) 615-NIMH (6464) Internet Address: http://www.aedweb.org
Internet Address: http://www.nimh.nih.gov
http://www.womenshealth.gov National Association of Anorexia
National Mental Health Information Nervosa and Associated Disorders
1-800-994-9662
Center, SAMHSA, HHS Phone: (847) 831-3438
TDD: 1-888-220-5446 Phone: (800) 789-2647 Internet Address: http://www.anad.org
Internet Address: http://mentalhealth.
samhsa.gov National Eating Disorders Association
Phone: (800) 931-2237
Internet Address: http://www.nationaleat-
ingdisorders.org
All material contained in this FAQ is free of copyright restrictions, and may be copied,
reproduced, or duplicated without permission of the Office on Women's Health in the
Department of Health and Human Services. Citation of the source is appreciated.
Content last updated June 15, 2009.
page
U.S. Department of Health and Human Services, Office on Women’s Health