Anorexia nervosa is an eating disorder characterized by restrictive eating habits and an intense fear of gaining weight. People with anorexia often diet excessively and exercise compulsively in an attempt to lose weight. Long-term effects of anorexia include potential medical complications due to malnutrition as well as psychological issues like depression, anxiety, and social withdrawal. Treatment aims to address the psychological factors driving the disorder and support healthy eating and weight restoration.

1. What is anorexia nervosa?
Anorexia is a condition that goes beyond concern about obesity or out-of-control dieting. A person with
anorexia often initially begins dieting to lose weight. Over time, the weight loss becomes a sign of
mastery and control. The drive to become thinner is actually secondary to concerns about control
and/or fears relating to one's body. The individual continues the ongoing cycle of restrictive eating,
often accompanied by other behaviors such as excessive exercising or the overuse of diet pills to induce
loss of appetite, and/or diuretics, laxatives, or enemas in order to reduce body weight, often to a point
close to starvation in order to feel a sense of control over his or her body. This cycle becomes an
obsession and, in this way, is similar to an addiction.
Who is at risk for anorexia nervosa?
Approximately 95% of those affected by anorexia are female, most often teenage girls, but males can
develop the disorder as well. While anorexia typically begins to manifest itself during early adolescence,
it is also seen in young children and adults.
Caucasians are more often affected than people of other racial backgrounds, and anorexia is more
common in middle and upper socioeconomic groups.
Many experts consider people for whom thinness is especially desirable, or a professional requirement
(such as athletes, models, dancers, and actors), to be at risk for eating disorders such as anorexia
nervosa. Health-care professionals are usually encouraged to present the facts about the dangers of
anorexia through education of their patients and of the general public as a means of preventing this and
other eating disorders.
What causes anorexia nervosa?
no definite cause of anorexia nervosa has been determined. However, research within the medical and
psychological fields continues to explore possible causes.
Studies suggest that a genetic (inherited) component may play a more significant role in
determining a person's susceptibility to anorexia than was previously thought. Researchers are
currently attempting to identify the particular gene or genes that might affect a person's tendency
to develop this disorder, and preliminary studies suggest that a gene located at chromosome 1p
seems to be involved in determining a person's susceptibility to anorexia nervosa.
Other evidence had pinpointed a dysfunction in the part of the brain, the hypothalamus (which
regulates certain metabolic processes), as contributing to the development of anorexia. Other
studies have suggested that imbalances in neurotransmitter (brain chemicals involved in

2. signaling and regulatory processes) levels in the brain may occur in people suffering from
anorexia.
Feeding problems as an infant, a general history of undereating, and maternal depressive
symptoms tend to be risk factors for developing anorexia. Other personal characteristics that can
predispose an individual to the development of anorexia include a high level of negative feelings
and perfectionism. For many individuals with anorexia, the destructive cycle begins with the
pressure to be thin and attractive. A poor self-image compounds the problem. People who suffer
from any eating disorder are more likely to have been the victim of childhood abuse.
While some professionals remain of the opinion that family discord and high demands from
parents can put a person at risk for developing this disorder, the increasing evidence against the
idea that families cause anorexia has mounted to such an extent that professional mental-health
organizations no longer ascribe to that theory. Possible factors that protect against the
development of anorexia include high maternal body mass index (BMI) as well as personal high
self-esteem.
How is anorexia nervosa diagnosed?
Anorexia nervosa can be a difficult disorder to diagnose, since individuals with anorexia often
attempt to hide the disorder. Denial and secrecy frequently accompany other symptoms. It is
unusual for an individual with anorexia to seek professional help because the individual typically
does not accept that she or he has a problem (denial). In many cases, the actual diagnosis is not
made until medical complications have developed. The individual is often brought to the
attention of a professional by family members only after marked weight loss has occurred. When
anorexics finally come to the attention of the health-care professional, they often lack insight into
their problem despite being severely malnourished and may be unreliable in terms of providing
accurate information. Therefore, it is often necessary to obtain information from parents, a
spouse, or other family members in order to evaluate the degree of weight loss and extent of the
disorder. Health professionals will sometimes administer questionnaires for anorexia as part of
screening for the disorder.
Warning signs of developing anorexia or one of the other eating disorders include excessive
interest in dieting or thinness. One example of such interest includes a movement called
"thinspiration," which promotes extreme thinness as a lifestyle choice rather than as a symptom
of illness. There are a variety of web sites that attempt to inspire others toward extreme thinness
by featuring information on achieving that goal, photos of famous, extremely thin celebrities, and
testimonials, as well as before and after pictures of individuals who ascribe to extreme thinness.
The actual criteria for anorexia nervosa are found in the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-
TR).
There are four basic criteria for the diagnosis of anorexia nervosa that are characteristic:

3. 1. The refusal to maintain body weight at or above a minimally normal weight for age and
height (maintaining a body weight less than 85% of the expected weight)
2. An intense fear of gaining weight or becoming fat, even though the person is underweight
3. Self-perception that is grossly distorted, excessive emphasis on body weight in self-
assessment, and weight loss that is either minimized or not acknowledged completely
4. In women who have already begun their menstrual cycle, at least three consecutive
periods are missed (amenorrhea), or menstrual periods occur only after a hormone is
administered.
The DSM-IV-TR further identifies two subtypes of anorexia nervosa. In the binge-eating/purging
type, the individual regularly engages in binge eating or purging behavior which involves self-
induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode of
anorexia. In the restricting type, the individual severely restricts food intake but does not
regularly engage in the behaviors seen in the binge-eating type.
What are anorexia symptoms and signs (psychological and behavioral)?
Anorexia can have dangerous psychological and behavioral effects on all aspects of an
individual's life and can affect other family members as well.
The individual can become seriously underweight, which can lead to depression and
social withdrawal.
The individual can become irritable and easily upset and have difficulty interacting with
others.
Sleep can become disrupted and lead to fatigue during the day.
Attention and concentration can decrease.

4. Most individuals with anorexia become obsessed with food and thoughts of food. They
think about it constantly and become compulsive about eating rituals. They may collect
recipes, cut their food into tiny pieces, prepare elaborate calorie-laden meals for other
people, or hoard food. Additionally, they may exhibit other obsessions and/or
compulsions related to food, weight, or body shape that meet the diagnostic criteria for an
obsessive compulsive disorder.
Other psychiatric problems are also common in people with anorexia nervosa, including
affective (mood) disorders, anxiety disorders, and personality disorders.
Generally, individuals with anorexia are compliant in every other aspect of their life
except for their relationship with food. Sometimes, they are overly compliant, to the
extent that they lack adequate self-perception. They are eager to please and strive for
perfection. They usually do well in school and may often overextend themselves in a
variety of activities. The families of anorexics often appear to be "perfect." Physical
appearances are important to the anorexia sufferer. Performance in other areas is stressed
as well, and they are often high achievers in many areas.
While control and perfection are critical issues for individuals with anorexia, aspects of
their life other than their eating habits are often found to be out of control as well. Many
have, or have had at some point in their lives, addictions to alcohol, drugs, or gambling.
Compulsions involving sex, exercising, housework, and shopping are not uncommon. In
particular, people with anorexia often exercise compulsively to speed the weight-loss
process.
Symptoms of anorexia in men tend to co-occur with other psychological problems and
more commonly follow a period of being overweight than in women. Men with anorexia
also tend to be more likely to have a distorted body image.
Compared to symptoms in men, symptoms of anorexia in women tend to more frequently
include a general displeasure with their body and a possibly stronger desire to be thin.
Women with anorexia also tend to experience more perfectionism and cooperativeness.

5. Due to the growth and development inherent during childhood and adolescence, symptoms and
signs of anorexia in children and teenagers can include a slowing of the natural increase in height
or a slowed increase in development of other body functions.
All of these features can negatively affect one's daily activities. Diminished interest in previously
preferred activities can result. Some individuals also have symptoms that meet the diagnostic
criteria for a major depressive disorder.
What are anorexia symptoms and signs (physical)?
Most of the medical complications of anorexia nervosa result from starvation. Few organs are
spared the progressive deterioration brought about by anorexia.
Heart and circulatory system: Although not life-threatening, an abnormally slow heart
rate (bradycardia) and unusually low blood pressure (hypotension) are frequent
manifestations of starvation and are commonly associated with anorexia. Of greater
significance are disturbances in the heart rhythm (arrhythmia). A reduction in the work
capacity of the heart is associated with severe weight loss and starvation.
Gastrointestinal complications are also associated with anorexia. Constipation and
abdominal pain are the most common symptoms. The rate at which food is absorbed into
the body is slowed down. Starvation and overuse of laxatives can seriously disrupt the
body's normal functions involved in the elimination process. While liver function is
generally found to be normal, there is evidence that some individuals with anorexia
develop changes in enzyme levels and overall damage to the liver.
The glandular (endocrine) system in the body is profoundly affected by anorexia. The
complex physical and chemical processes involved in the maintenance of life can be
disrupted, with serious consequences. Disturbances in the menstrual cycle are frequent,
and secondary amenorrhea (absence of menstrual periods) affects about 90% of
adolescent girls with anorexia. Menstrual periods typically return with weight gain and
successful treatment. Hormonal imbalances are found in men with anorexia as well.
Continual restrictive eating can trick the thyroid into thinking that the body is starving,
causing it to slow down in an attempt to preserve calories. When anorexia occurs in a
person who also has diabetes mellitus (a tendency toward very high blood sugar levels),
the risk of death is higher than in people who have either anorexia or diabetes mellitus
alone.
Kidney (renal) function may appear normal. However, there are significant changes in
kidney function in many people with anorexia, resulting in increased or decreased

6. urination or potentially fatal potassium deficiency. Diabetes insipidus, characterized by
excessive urination and extreme thirst, has also been seen in anorexia.
Bone density loss (osteopenia or thinning of the bones) is a significant complication of
anorexia, since women acquire 40%-60% of their bone mass during adolescence. Studies
have shown that bone loss can occur fairly rapidly in girls with anorexia. While some
studies have shown that bone density may be restored if overall health improves and
anorexia is successfully treated, other studies suggest that an increased risk for fracture
may persist later in life.
Anorexics who use a large quantity of laxatives or who frequently vomit are in danger of
electrolyte imbalance, which can have life-threatening consequences.
Anemia is frequently found in anorexic patients. In addition to having fewer red blood
cells, people with anorexia tend to have lower numbers of white blood cells, which play a
major role in protecting the body from developing infections. Suppressed immunity and a
high risk for infection are suspected but not clinically proven.
Contrary to what might be expected, anorexia nervosa is associated with a high total
cholesterol levels.
Physical symptoms, other than the obvious loss of weight, can be seen. Anorexia can
cause dry, flaky skin that takes on a yellow tinge. Fine, downy hair grows on the face,
back, arms, and legs. Despite this new hair growth, loss of hair on the head is not
uncommon. Nails can become brittle. Frequent vomiting can erode dental enamel and
eventually lead to tooth loss. People with anorexia might also develop trouble
maintaining a consistent body temperature.
What is the prognosis (outcome) of anorexia nervosa?
Anorexia is among the psychiatric conditions that have the highest mortality rate, with an
estimated 6% of anorexia victims dying from complications of the disease. The most common
causes of death in people with anorexia are medical complications of the condition, including
cardiac arrest and electrolyte imbalances. Suicide is also a cause of death in people with
anorexia. In the absence of any coexisting personality disorder, younger individuals with
anorexia tend to do better over time than their older counterparts.

7. Early diagnosis and treatment can improve the overall prognosis in an individual with anorexia.
Despite most psychiatric medications having little effect on the symptoms that are specific to
anorexia, the improvement in associated symptoms (for example, anxiety and depression) can
have a powerful, positive effect on the improvement that individuals with anorexia show over
time. With appropriate treatment, about half of those affected will make a full recovery. Some
people experience a fluctuating pattern of weight gain followed by a relapse, while others
experience a progressively deteriorating course of the illness over many years, and still others
never fully recover. It is estimated that about 20% of people with anorexia remain chronically ill
from the condition.
As with many other addictions, it takes a day-to-day effort to control the urge to relapse. Many
individuals will require ongoing treatment for anorexia over several years, and some may require
treatment over their entire lifetime. Factors that seem to predict more difficult recovery from
anorexia include vomiting and other purging behaviors, bulimia nervosa, and symptoms of
obsessive personality disorder. The longer the disease goes on, the more difficult it is to treat as
well.
The future of anorexia
Given the complexity of anorexia and how many people with this illness continue to suffer from
it despite receiving treatment, researchers are seeking to better understand how this illness
develops and how it is most effectively treated. For example, as individuals with anorexia tend to
have low levels of cortisol in their blood, and behaviors like dieting and exercise tend to increase
cortisol levels, giving anorexia sufferers cortisol supplements is being explored with some
success. The best approaches for psychotherapy in adults with anorexia, the possible benefit of
12-step programs in treatment, the role of genetics in the development of this disorder, and the
effectiveness of various medications in treating anorexia are other areas of continued need for
research.
Anorexia Nervosa At A Glance
Anorexia nervosa is an eating disorder and, more importantly, a psychological disorder.
The cause of anorexia has not been definitively established, but self-esteem and self-image
issues, societal pressures, and genetic factors likely each play a role.
Anorexia affects females far more often than males and is most common in adolescent females.
Anorexia tends to affect the middle and upper socioeconomic classes and Caucasians more than
less advantaged classes and ethnic minorities in the United States.
The disorder affects about 1% of adolescent girls and about 0.3% of males in the U.S.
People with anorexia tend to show compulsive behaviors, may become obsessed with food, and
often show behaviors consistent with other addictions in their efforts to overly control their
food intake and weight.
Men with anorexia are more likely to also have other psychological problems; affected women
tend to be more perfectionistic and be more displeased with their bodies.
Children and adolescents with anorexia are at risk for a slowing of their growth and
development.
The extreme dieting and weight loss of anorexia can lead to a potentially fatal degree of
malnutrition.

8. Other possible consequences of anorexia include heart-rhythm disturbances, digestive
abnormalities, bone density loss, anemia, and hormonal and electrolyte imbalances.
Given the prevalence of denial of symptoms by individuals with anorexia, gathering information
from loved ones of the anorexia sufferer is important in the diagnosis and treatment of the
disorder.
Most medications treat symptoms that are associated with anorexia much better than they
address the specific symptoms of anorexia themselves.
The treatment of anorexia must focus on more than just weight gain and often involves a
combination of individual, group, and family psychotherapies in addition to nutritional
counseling.
The Maudsley model of family therapy, in which the family actively participates in helping their
loved one achieve a more healthy weight, is considered the most effective method of family
therapy for treating anorexia in adolescents.
The prognosis of anorexia is variable, with some people making a full recovery. Others
experience a fluctuating pattern of weight gain followed by a relapse, or a progressively
deteriorating course over many years.
As with many other addictions, it takes a day-to-day effort to control the urge to relapse, and
treatment may be needed on a long-term basis.
Increased understanding of the causes and treatments for anorexia remain the focus of ongoing
research in the effort to improve the outcomes of individuals with this disorder.