Anorexia Nervosa
Anorexia nervosa is a serious eating disorder. It is characterized by restriction of energy intake leading to significantly low weight for age, developmental course and physical health, together with a strong fear of weight gain or persistent behaviours that prevent weight gain.
It is not a 'choice', vanity or simple dieting. It can affect people of all genders, ages, ethnicities and social backgrounds. The consequences of malnutrition can be life-threatening even when the person does not recognize their severity. Early specialised and coordinated care improves the chances of recovery.
What Is Anorexia Nervosa?
The disorder involves more than body weight. A person may experience body weight or shape in a distorted way, allow weight or shape to have an undue influence on self-evaluation, or persistently fail to recognize the seriousness of low body weight. Fear of weight gain may be stated directly or expressed through persistent behaviours that interfere with weight gain, such as severe restriction, fasting, excessive exercise, or purging. In children and adolescents, significantly low weight may appear as failure to make expected weight gains or deviation from the individual's growth trajectory rather than obvious weight loss.
Key Features and Signs
No one sign is sufficient on its own, but assessment is important when combined:
- Gradual or rapid weight loss, failure to grow as expected, or weight significantly low in the context of age, sex, developmental trajectory and physical health.
- Skipping meals, very small portions, rituals around food or eliminating an increasing range of foods.
- Intense fear of weight gain or persistent behaviour that prevents weight regain, even if the fear is not expressed.
- Frequent weighing, body checking, comparing or exaggerating the effect of weight and shape on self-esteem.
- Excessive or compulsive exercise, inducing vomiting or abuse of laxatives/diuretics in some cases.
- In the binge/purge subtype, frequent vomiting may cause dental wear or painless swelling of the parotid/salivary glands—not necessarily infectious parotitis.
- Feeling cold, tiredness, dizziness, fainting, constipation, menstrual disorders, decreased libido, difficulty concentrating or sleep disturbance.
- Social withdrawal, irritability and avoidance of meals with others or activities involving food.
How It Is Diagnosed
The assessment combines a psychiatric/psychological history, an examination of intake and behaviours, a complete medical examination and a developmental assessment.
- Restriction of energy intake leads to significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- There is either a strong fear of weight gain/fatness or persistent behaviour that prevents weight gain, even at a significantly low weight.
- There is a disturbance in how body weight or shape is experienced, an undue influence of body weight or shape on self-evaluation, or a persistent lack of recognition of the seriousness of the low body weight.
- The restricting and binge-eating/purging types are specified according to the absence or presence of recurrent binge eating or purging during the last 3 months.
How It Can Affect Daily Life
Thoughts about food, the body, and exercise can occupy much of the day. Malnutrition affects mood, memory, concentration, cognitive flexibility, and decision-making. Education, work, relationships, and interests may become restricted, while family members feel frightened or uncertain. A person does not have to 'look' ill to be at serious risk. The condition may be difficult to recognize because dietary restriction is initially praised as discipline or 'healthy living.'
Causes and Risk Factors
The aetiology is multifactorial. Genetic and neurobiological factors, temperament, anxiety, perfectionism, stressful experiences, diet, and social pressures around the body may interact. No single factor alone predicts who will get sick. Anorexia is not universally explained away as a "need for control," silent protest, or specific family dynamics. Families should not be blamed; when they are involved in treatment, they can be an important part of recovery.
Similar or Co-occurring Conditions
The assessment looks at both other causes of low weight and co-occurring difficulties:
- Avoidant/restrictive food intake disorder (ARFID) causes restriction without fear of weight gain and without disturbance in the experience of weight or shape.
- In bulimia there are binge eating and compensatory behaviours, but the episodes do not occur exclusively during anorexia and a significantly low weight is not required.
- Atypical anorexia nervosa can have all the basic features except for being significantly underweight and can also be medically serious.
- Endocrine, gastrointestinal, infectious, malignant, or other medical conditions may cause weight loss and require investigation.
- Depression, anxiety, obsessive-compulsive disorder (OCD), autism, substance use, and other eating disorders may co-occur.
Treatment and Support
Treatment is usually multidisciplinary and combines nutritional rehabilitation, medical monitoring and specific psychological intervention.
- Restoring and maintaining a healthy weight for the individual is a central goal because it supports physical and mental recovery.
- For adults, evidence-based options include eating disorder-focused cognitive-behavioural therapy (CBT-ED), MANTRA therapy—a structured approach that links eating, thinking, emotion, and relationships—and specific supportive clinical management.
- For children and adolescents, family-based treatment focused on anorexia is often a primary option and explicitly does not blame the family.
- The clinician monitors cardiac function, blood pressure, electrolytes, bone health, growth, and the effects of purging or excessive exercise.
- Nutritional guidance is given as part of coordinated treatment and not as a sole intervention.
- There is no drug that is a stand-alone treatment for anorexia; medication may be used for specific co-occurring conditions with attention to malnutrition.
When to Seek Help
Seek prompt evaluation for persistent restriction, rapid weight loss or faltering growth, fear of weight gain, purging, compulsive exercise, fainting, or social withdrawal. A person does not need to fully recognize or request help before a safe conversation begins. Raise the concern calmly, using specific observations and avoiding comments about appearance or diagnostic labels.
Frequently Asked Questions
Can anorexia exist without a stated fear of weight gain?
Yes. The relevant diagnostic element may be either intense fear or persistent behaviour that prevents weight gain. The assessment is based on the overall pattern and not just one statement.
Does anorexia only affect teenage girls?
No. It can affect people of all genders and ages. Stereotypes delay diagnosis in boys, men, older adults and people from different social or cultural backgrounds.
What do the two subtypes of anorexia mean?
They describe current behaviour in the past 3 months: restrictive or binge/purging subtype. They may change over time and do not determine a person's worth or prognosis.