Understanding Anorexia Nervosa

Anorexia nervosa, or anorexia, is an eating disorder that involves restricting the amount of calories or the types of foods that a person eats. While this disorder is often characterized by extreme weight loss, those battling anorexia do not always appear underweight.

What is Anorexia Nervosa?

Anorexia nervosa, or anorexia, is an eating disorder characterized by extreme calorie restriction. Those struggling with anorexia typically restrict the amount of calories or the types of food they consume.

The disorder is most common in adolescents. However, more children and adults are receiving diagnoses.

It is common for people with anorexia to experience significant weight loss. Those with anorexia may also have difficulty maintaining an appropriate weight for their age and size. Another common characteristic of this disorder is distorted body image. People struggling with anorexia will often see their body as much larger than it is in reality.

People often think that those battling anorexia will appear severely underweight or even emaciated. This is not always the case. Anorexia can happen to people of all races, ages, genders, ethnicities and sexual orientations.

Unfortunately, people with anorexia who do not appear underweight may not seek treatment because they believe they are not “sick enough” to get help. In turn, many cases of anorexia go undiagnosed.

In some cases, anorexia is accompanied by over-exercising, laxative abuse, purging and/or binge eating.

Anorexia and the DSM-5

Anorexia nervosa is recognized as an eating disorder by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 includes criteria that must be met to reach an anorexia diagnosis.

These diagnostic criteria include:

  • Significant calorie restriction that leads to a low body weight for the person’s age and height
  • Extreme fear surrounding weight gain
  • Distorted self-evaluation of the person’s body shape or weight

The DSM-5 provides helpful guidelines for diagnosing anorexia. However, an eating disorder may still be present even if the criteria are not met.

If you believe you or someone you love is battling anorexia, share your concerns and begin your path to recovery.

Anorexia Signs & Symptoms

Those struggling with anorexia will display various emotional, behavioral and physical symptoms. Educate yourself on the symptoms of anorexia so you can determine if you or someone you love is facing this disorder.

Emotional Signs

  • Feelings of loss of control or a strong need for control
  • Inflexible thinking
  • Restrained expression of emotions
  • Feelings of inadequacy
  • Fear of eating in public
  • Fear of gaining weight or becoming “fat”
  • Distorted view of the person’s own body weight or shape

Behavioral Signs

  • Person wears multiple layers of clothing to keep warm or hide their weight loss
  • Preoccupation with dieting, weight, food, calories, etc.
  • Refusing to eat certain types of foods
  • Commenting about feeling “fat”
  • Denial of hunger
  • Developing rituals surrounding food, including eating at certain times, excessive chewing, etc.
  • Cooking meals or baked goods for other people without eating
  • Making excuses to avoid mealtimes
  • Avoiding social situations involving food, including going out to eat or to parties
  • Commenting about needing to “burn off” the calories they ate
  • Keeping an intense and rigid exercise routine
  • Withdrawing from activities the person once enjoyed
  • Secretive behaviors surrounding food and eating
  • Inability or unwillingness to maintain a healthy body weight

Physical Signs

  • Significant weight loss
  • Gastrointestinal (GI) issues
  • Trouble concentrating
  • Abnormal laboratory findings, including low hormone levels, slow heart rate, etc.
  • Dizziness
  • Fainting
  • Constantly feeling cold
  • Trouble sleeping or insomnia
  • Loss of menstrual cycle or menstrual irregularities
  • Dry skin, hair and nails
  • Layer of fine hair on the body
  • Muscle weakness
  • Weakened immune system
  • Slow wound healing

Timeline of the Disorder

Because anorexia can happen to anyone, the progression of the disorder will look different in each person it affects. Anorexia is commonly associated with the later, more severe stages of the disorder. However, there are many early signs that reveal the intensity of the disorder and how quickly it can progress.

Beginning Stages of Anorexia

In the beginning stages of anorexia, the person affected becomes immersed in their new diet plans and exercise routines. Their initial desire to lose weight turns into extreme weight loss.

At first, someone at risk of developing anorexia may attribute their behaviors to a desire to be healthier and look more toned. Depending on how quickly the weight loss occurs, the person may experience negative health effects even in the early stages of the disorder.

Losing weight too quickly can lead to lean muscle loss, liver problems, poor skin elasticity and even gallstones.

Soon, the person’s weight loss goals morph into an obsession. Those struggling with anorexia have rigid behaviors and rules surrounding food and exercise. They may count calories consumed versus those burned off through exercise. Other obsessive behaviors include only eating at certain times, using a scale to portion out food and continuously reducing the amount of calories they eat.

Anorexia and Malnutrition

Obsessive weight loss leads to malnutrition. This poses various health risks, including dehydration, vitamin/mineral deficiencies, osteoporosis and deterioration of organs, muscles and cartilage.

Despite malnutrition, those battling anorexia typically find it difficult to stop their weight loss. In today’s diet-fueled society, losing weight is often celebrated. Those struggling with anorexia view their weight loss as a good thing. As negative health consequences arise, those with anorexia may hide their symptoms to protect their eating disorder.

Consequences of Anorexia

If left unaddressed, anorexia can cause serious health risks and even death. The disorder has the highest rate of fatalities among all mental health disorders.

If you believe that you or a loved one is battling anorexia, it is never too late to seek help. Telling just one person about your disorder can lead you closer to food freedom and full recovery.

Health Risks of Anorexia

Anorexia is treatable. However, if left unaddressed, the disorder can lead to a variety of negative health effects.

Examples of serious health risks caused by anorexia include:

  • Loss of menstrual cycle
  • Substance abuse
  • Low hormone levels
  • Anemia
  • Irregular heartbeat
  • Heart failure
  • Gastrointestinal (GI) problems
  • Electrolyte imbalances
  • Anxiety, depression or other mood disorders
  • Obsessive-compulsive disorder (OCD)
  • Suicidal thoughts
  • Death

Despite these terrible health risks, anorexia is treatable. You have the power to beat your eating disorder. Many of anorexia’s health risks can also be reversed with proper treatment and care.

Anorexia in Society

Anorexia is a prevalent issue in today’s society. The disorder can happen to anyone, regardless of their job or socioeconomic status. Even celebrities and other prominent figures have battled anorexia.

Below are examples of public figures who have struggled with anorexia. Let their stories serve as sources of hope and inspiration as you work toward your own recovery.

Demi Lovato, Musician & Actress

Following her childhood in the limelight, Demi Lovato developed anorexia and bulimia. After years of physical, mental and emotional turmoil, she sought treatment for her disorders in 2010. Now, she is an avid mental health advocate and unofficial spokesperson for adolescents battling eating disorders. She has inspired millions of fans throughout her recovery journey.

Kesha, Musician

Kesha has not been one to shy away from her battle with anorexia. After seeking treatment for her eating disorder, Kesha now works to encourage and inspire those with similar struggles. She recently partnered with the National Eating Disorders Association (NEDA) during their NEDAwareness Week to share her story and raise awareness.

Author:Eating Disorder Guide Team
Eating Disorder Guide Team

Eating Disorder Guide is a trusted resource devoted to educating people about eating disorders, their many forms and how to get well.

The site is founded by a team of health-centric content producers who experienced firsthand the terror and pain of an eating disorder, but who took steps to seek recovery.

Last modified: October 9, 2021