What Is Anorexia Nervosa?

Anorexia Nervosa is a type of eating disorder characterised by extreme food restriction, significant weight loss and an intense fear of gaining weight (American Psychiatric Association, 2022). As the illness progresses, people with Anorexia Nervosa develop increasingly obsessive or rigid ways of thinking and behaving. They often become committed to extreme dieting, which may involve meticulous calorie counting, refusing food or fluids, and abiding by strict food rules.

It is also common for people with Anorexia Nervosa to exercise excessively and engage in other dangerous behaviours intended to lose weight (such as self-induced vomiting or misuse of laxatives). People with Anorexia Nervosa experience a disturbance in the way they perceive their body, weight and shape. Food restriction and weight loss result in malnutrition and starvation, which lead to a range of physical and psychological health complications and can even result in death. Anorexia Nervosa has one of the highest death rates of any mental illness.

Types of Anorexia Nervosa:

Restricting type: People who mostly engage in dieting, fasting and/or excessive exercise. They do not regularly engage in binge eating or purging behaviours.

Binge eating/purging type: People who regularly engage in binge eating or purging behaviours (i.e. self-induced vomiting, misuse of laxatives, diuretics or diet pills).

The Function of Anorexia Nervosa:

Anorexia Nervosa is often used as a way of dealing with underlying personal, emotional, and psychological difficulties. It can be experienced by the individual as helping them to function by numbing their emotions, providing a sense of accomplishment, helping them to feel in control, and can form a part of the individual’s sense of identity.

“It didn’t just take over my eating habits, it took over my whole life. Anorexia dominated my every thought and action. Food was all I could think about.” - Jenny, 22

The Causes of Anorexia Nervosa:

A range of factors are believed to contribute to the development of Anorexia Nervosa, including genetics, biology, environmental and societal influences, as well as pre-existing anxiety or depression. Like all eating disorders, Anorexia Nervosa can develop in males and females at any age. However, it often starts during adolescence. There is growing evidence to indicate that eating disorders are often preceded by anxiety and/or depression.

On average, 8 people are expected to die from Anorexia Nervosa every year, 1 in 5 of those deaths is expected to be by suicide.

Signs & Symptoms of Anorexia Nervosa:

Physical signs:

• Rapid weight loss, persistent low weight, failure to gain expected growth, or frequent weight changes

• Loss or disturbance of menstruation in girls and women and decreased libido in men

• Fainting or dizziness

• Feeling cold most of the time, even in warm weather

• Feeling bloated and constipated

• Feeling tired and not sleeping very well

• Lethargy or low energy

• Fine hair appearing on face and body

Psychological signs:

• Denial of any issues

• Preoccupation with eating, food, body shape and weight

• Feeling anxious and/or irritable around mealtimes

• Intense fear of gaining weight

• Low self-esteem and feelings of shame, self-loathing, or guilt, particularly after eating

• Depression and anxiety

• Reduced capacity for thinking and increased difficulty concentrating

• 'Black and white’ or rigid thinking

• Distorted body image and body image dissatisfaction

• Perfectionism

Behavioural signs:

• Dieting behaviour

• Self-induced vomiting or deliberate misuse of laxatives, appetite suppressants, enemas and diuretics

• Compulsive or excessive exercising

• Repetitive or obsessive behaviours relating to body shape and weight

• Evidence of binge eating

• Eating in private and avoiding meals with other people

• Anti-social behaviour

• Secrecy around eating

• Radical changes in food preferences

• Obsessive rituals around food preparation and eating

• Preoccupation with nutrition, preparing food for others, looking at recipes, food programs or food posts on social media

• Elimination of entire food group

Remember! These are just some of the signs of Anorexia Nervosa. Not all of these symptoms are indicative of Anorexia Nervosa alone.

Treatment Options

The good news is that recovery from Anorexia Nervosa is not only possible, but also to be expected, providing the person receives timely and appropriate treatment. Different treatments are likely to be beneficial at different stages of the illness. For children and adolescents, the first line treatment recommendation is Family Based Treatment, commonly referred to as FBT or Maudsley Family Therapy.

For adults, the best evidence for treatment is a combination of nutritional rehabilitation and psychological therapies. Hospital-based treatment may be required when a person needs medical stabilisation, nutritional rehabilitation and intensive support to manage disordered eating behaviours.

For any person with Anorexia Nervosa, it is important to seek care from an empathetic and skilled GP who can remain involved in your care throughout treatment and can monitor your physical health. A trained and skilled community clinician will almost always be needed to deliver evidence-based treatment.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed. Text Revision). Washington, DC: American Psychiatric Press.