Frequently Asked Questions About Anorexia Nervosa

Anorexia nervosa is probably the first thing most people think of when they hear the term “eating disorder.” Even though it has significant name recognition, this disorder still carries several myths and misunderstandings with it. To help dispel some of these myths and provide information, we’ll take on some of the most frequently asked questions about anorexia nervosa, its treatment, and the people who are impacted by this disorder.

What Is Anorexia Nervosa?

The clinical definition, provided by the DSM-V, reads partially as follows (there are other, less pertinent descriptions as well):

1. Restriction of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health (less than minimally normal/expected).
2. Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain.
3. Disturbed by one’s body weight or shape, self-worth influenced by body weight or shape, or persistent lack of recognition of seriousness of low body weight.

Put more simply, anorexia nervosa is a mental health condition that causes people to restrict the amount of food they eat to the point that it begins to negatively impact their health. The restricting behaviors are driven by a fear of gaining weight and/or a body image disturbance that causes them to see themselves as overweight or otherwise flawed.

Anorexia nervosa is typically characterized by two main types.

1. Anorexia nervosa restricting type

The individual restricts the amount of food taken in, making an effort to lose weight or prevent weight gain. They often exercise excessively as well.

2. Anorexia nervosa purging type

The individual binge eats (eats a large amount of food in a small period) and then purges the food, usually by vomiting, to avoid gaining weight. The binge eating episodes are often prompted by an extended period of restriction which causes extreme hunger. This type is distinguished from bulimia nervosa, which also includes binging and purging, in that the latter case the individual does not routinely restrict food or lose large amounts of weight.

There is also a condition known as atypical anorexia nervosa, in which the individual restricts food intake and loses significant amounts of weight, but does not become medically deemed underweight. These individuals are often overweight when atypical anorexia nervosa sets in. Although they may not become underweight, the health risks of atypical anorexia nervosa are every bit as serious as those of “typical” anorexia nervosa.

What Causes Anorexia Nervosa?

Like all mental health and behavioral disorders, anorexia nervosa doesn’t have a single cause but is instead a combination of several factors. Risk factors include

1. Genetics and heredity – People with anorexia nervosa often come from families that have an eating disorder themselves. This is also true for people with other mental health disorders or type 1 diabetes. There is no specific gene for anorexia nervosa, but some studies indicate genetics play a role in the disorder.
2. Home environment – People who experience pressure to lose weight from their family, especially at a young age, are at a greater risk for eating disorders. Likewise, parents who suffer from an eating disorder or body image distortion may inadvertently pass those attitudes on to their children.
3. Sociocultural factors – This might include bullying at school or online for a person’s weight, the prevailing attitudes in their culture about weight and attractiveness, or the kinds of images and videos that are shown in the media and social media. These factors can create unrealistic perceptions of what a person’s weight or body size should be, and the perfectionist tendencies that most people with anorexia nervosa show leads them to take drastic measures to achieve them.

Another potent factor that contributes to disordered eating behavior is the presence of past trauma. Physical or emotional abuse, including bullying or forced dieting as a child, can prompt PTSD in later years. PTSD is a potent trigger for disordered eating behaviors since they can bring a temporary sense of relief from the negative emotions it brings.

Who Gets Anorexia Nervosa?

The prevailing stereotype of a person with anorexia nervosa is that of a wealthy white adolescent girl. While there is some indication that females present anorexia more often than males, the demographics are more varied than the stereotypes would suggest.

Anorexia nervosa affects girls and women at a rate from 2 to 10 times as much as boys and men. The most prevalent view is that 0.9% of women and 0.3% of men develop anorexia nervosa at some point in their lifetimes. That seems like a small number, but it comes out to millions of individuals who struggle with this dangerous disorder.

As for the number of men who develop anorexia nervosa, many experts think the true number is higher than 0.3%. In general, men are less likely to seek treatment for eating disorders and other mental health conditions, due to societal stigmas about admitting “weakness” or admitting to what is traditionally seen as a “female” disorder.

Demographically, white women are seen stereotypically as the main sufferers of anorexia nervosa, but several studies indicate that the disorder occurs as frequently in other ethnicities, but is underreported or undiagnosed due to imbalances in income and availability of care. These studies show that African-American women tend to go undiagnosed for longer before receiving eating disorder treatment than their white peers. There is also some indication that Hispanic / Latinx women have higher rates of anorexia nervosa than other ethnicities, in contradiction to the prevailing stereotype.

Although anorexia nervosa has been observed in children as young as 7 and the first onset is known to occur in adulthood, the stereotype of adolescents being affected is broadly true. The first signs of anorexia nervosa typically appear during and directly after puberty, with the ages of 13 – 18 being the most common times for onset. Even with what seems like a relatively low rate of 0.9% of women presenting the symptoms of anorexia nervosa, it remains the third most common chronic disease among teenagers.

What Are the Warning Signs of Anorexia Nervosa?

Identifying anorexia nervosa in someone else can be difficult; it’s just as hard to identify it in yourself. Mental health disorders have a way of promoting denial in the individual who has them, and the temporary relief they bring to emotional pain makes the behaviors feel necessary and justified. It’s also impossible to make a diagnosis of anorexia nervosa just by looking at someone – being thin isn’t necessarily a sign of a disorder, and some people with anorexia nervosa are not underweight.

However, there are certain physical and behavioral signs that the disorder might be present. 

Physical signs for anorexia nervosa include:

• Stoppage of menstruation in women
• Constant feeling of being cold
• Insomnia
• Constant fatigue and lethargy
• Strokes and seizures
• Decreased cognition
• Confusion and lightheadedness
• Lanugo (growth of small, fine hairs all over the body, thought to be the body’s reaction to the constant feeling of coldness)
• Organ failure, especially kidneys, liver, and heart
• Thinning hair or hair falling out
• Malnutrition
• Drying skin and brittle nails

Behavioral signs for anorexia nervosa include:

• Social withdrawal and self-isolation
• Avoiding meals or social situations where eating is a focus
• Distorted body image (dysmorphia), specifically seeing themselves as overweight
• Chewing and spitting
• Obsessive or excessive exercising
• Continued weight loss even after becoming emaciated
• Food rituals that help to avoid eating
• Counting calories obsessively
• Trying various extreme diets and fasting regimens

If you notice these signs in yourself or another, there is an indication you should consider looking into eating disorder treatment or at least consult with a doctor or psychiatrist.

How Do I Get Help?

Typically, family doctors and general practitioners aren’t highly specialized in mental health disorders like anorexia nervosa. However, they can almost always provide referrals to specialists in those fields. A doctor is a good first step to getting specialized treatment. They’ll normally refer to a licensed psychologist or psychiatrist, who can then make a full diagnosis. After that, the proper level of care can be determined and placement in an anorexia nervosa treatment center can be made.

For more severe cases and those that require medical stabilization and weight restoration, residential programs are considered the norm. These programs typically last 30 or more days, depending on the progress the client makes during that time. Residential programs provide 24/7 coverage and support for people trying to overcome their disordered selves.

Outpatient or day treatment is also an option. These programs can act as a step-down treatment for people who have finished residential treatment, or they can act as standalone programs. Virtual day treatment has become a popular and viable option.

What Should I Expect in Treatment?

Broadly speaking, eating disorder treatment breaks down into three main categories: medical, psychological, and nutritional. Each aspect of treatment is essential; a full recovery depends on continued emotional growth, proper nutrition, and medical stability.

• Medical – Clients with advanced anorexia nervosa often suffer the complications of malnutrition and can need extensive medical help to stabilize their health. Most treatment facilities will have doctors and nurses available for clients to manage anemia, heart and organ disease, and bone density issues that can arise from malnutrition.
• Nutritional – Eating disorder treatment, especially for anorexia nervosa, often centers around intuitive eating and eating for pleasure. Nutritionists and dietitians help clients plan meals that they enjoy without worrying about calories or “fattening” ingredients. Learning to eat for sustenance and satiety rather than eating to lose weight is a key factor in long=term recovery.
• Psychological/Therapy – A wide variety of therapeutic techniques from traditional talk therapy and group therapy sessions to cognitive retraining methods are used. Some treatments are based on removing disordered thoughts and behaviors; these are often based on Cognitive Behavioral Therapy, a technique used in a wide variety of mental health treatments. CBT and its offshoots help people identify disordered thoughts and replace them with healthier ones, easing the transition to healthier eating patterns.

Is It Possible to Beat Anorexia Nervosa?

Absolutely. Although untreated anorexia nervosa is a serious ailment, which can lead to myriad health problems or even death, millions of people have recovered from the disorder with the help of eating disorder treatment professionals. It’s important to educate yourself and get started early in recovery. You can check out the Alliance for Eating Disorder Awareness, a non-profit organization with a wealth of resources, or even take a look at our blog for info on a wide variety of eating disorder-related topics. It won’t always be easy, but your life or the life of a loved one is worth it.

Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.