What is anorexia nervosa?

Anorexia nervosa is an eating disorder and a serious mental illness. A person with anorexia nervosa restricts their energy intake, has a distorted body image and an intense fear of gaining weight. The restriction in energy intake can cause a significant amount of weight loss in a short period of time and may result in a person having a very low weight.

Anorexia nervosa is most common in women and usually starts in adolescence. It is the third most common chronic illness in girls and young women and affects up to 1 in 200 girls. One in 11 people who develop anorexia after puberty are male.

People with anorexia nervosa may see themselves as being heavy or large when they are actually severely underweight. Their perceived body weight or shape can have a significant influence on how they evaluate or feel about themselves. Out of a fear of gaining weight, they follow restrictive diets and may undertake harsh, excessive exercise routines.

Anorexia falls into 3 general types:

Restricting type

People with this type of anorexia nervosa place severe restrictions on the quantity and type of food they consume.

This could include counting calories, skipping meals, restricting certain foods (such as carbohydrates) and following obsessive rules, such as only eating foods of a certain colour.

These behaviours may be accompanied by excessive exercise.

Binge eating/purging type

People with this type of anorexia also place severe restrictions on the food they eat. But this is accompanied by binge eating and then purging.

When binge eating, someone eats a large amount of food and has feelings of being out of control. The person then 'compensates' for this eating by purging the food through vomiting or misusing laxatives, diuretics or enemas.

Atypical anorexia nervosa

Atypical anorexia nervosa is a subtype of other specified feeding or eating disorders (OSFED) in which a person’s body weight is still in the normal weight range despite having significant weight loss from their restricted energy intake. They also have a distorted body image and an intense fear of gaining weight. Apart from the normal weight range, they have all the other characteristics, and similar complications, of anorexia nervosa.

What are the symptoms of anorexia nervosa?

The most obvious sign that someone has anorexia nervosa may be that they are underweight, they have lost weight very quickly, or their weight fluctuates dramatically.

A BMI of less than 18.5 is considered underweight. But being very thin is not the only sign of anorexia. There are also other signs that a person may have anorexia nervosa.

Physical signs

• loss of menstruation in women, decreased libido (sex drive) in men
• fainting or dizziness
• always feeling cold
• bloating, constipation or developing food intolerances
• poor sleep
• lethargy and tiredness
• looking pale
• dry, yellow skin
• sunken eyes
• fine hair on the face and body

Psychological signs

• being preoccupied with eating, food, body shape and weight
• being extremely dissatisfied with their body, or having a distorted body image
• being anxious and/or irritable at meal times
• depression and anxiety
• difficulty concentrating
• having rigid thoughts about food
• low self-esteem and perfectionism

Behavioural signs

• intense dieting (counting calories, avoiding foods)
• deliberately misusing laxatives, appetite suppressants, enemas and diuretics
• obsessive behaviour around body weight or shape (weighing themselves obsessively, pinching waist or wrists)
• binge eating
• avoiding eating with other people and secrecy around food
• wanting to be alone
• excessive exercising
• obsessive rituals around food
• preoccupation with cooking, recipes and nutrition
• self-harm, substance abuse or suicide attempts

What causes anorexia nervosa?

The causes of anorexia nervosa are not fully understood.

There may be genetic risk factors and a combination of environmental, social and cultural factors. It's likely that some people are more vulnerable to anorexia because of particular personality traits.

The causes that may contribute to a person developing anorexia nervosa include:

Psychological factors, such as a high level of perfectionism or obsessive-compulsive personality traits, feeling limited control in life and low self-esteem, a tendency towards depression and anxiety and a poor reaction to stress.

Environmental factors, including the onset of puberty, stressful life events and relationship problems.

Cultural pressures to be thin stemming from media and pop culture such as magazines, TV shows and movies.

Occupations that demand a thin physique may increase the risk of anorexia nervosa, such as certain sports, ballet, or the television and fashion industries.

Brain chemistry, because extreme dieting can affect the balance of hormones in the body, affecting how the brain functions.

Genetic predisposition, which arises from the genes inherited from parents. Anorexia nervosa often runs in families, suggesting there may be a genetic cause.

When should I see my doctor?

Many people with anorexia nervosa think they’re not sick enough or thin enough to need treatment. But seriously restricting calorie intake is dangerous and can have a serious impact on health. If you have anorexia nervosa, the earlier you seek help, the better your chances of recovery.

If you are worried about your eating, it’s important to speak someone. Your doctor is a good place to start, or you could talk to someone you trust like a friend, family member or teacher. They will help you take the first steps towards treatment and recovery.

How is anorexia nervosa diagnosed?

After ruling out that weight loss is caused by another condition, your doctor or another medical or mental health professional may diagnose anorexia nervosa based on your thoughts, feelings and eating behaviours. They will also check for any other mental or physical complications.

How is anorexia nervosa treated?

The first step to recovery is restoring good nutrition and a healthy weight. This allows treatments to work effectively. If the person has life threatening medical complications or is extremely low weight, they may need to spend time in hospital.

A psychologist can help a person with anorexia nervosa learn behaviours that will help them to return to and maintain a healthy weight. Someone with anorexia nervosa may also see a dietitian, family therapist, psychiatrist or other members of a healthcare team.

Antidepressants and other medicines are sometimes used to treat anorexia nervosa along with psychological therapy.

On average, people have anorexia nervosa for 5 to 7 years. It's common for people with the condition to relapse, so follow-up and treatment for anorexia nervosa is important.

Complications of anorexia nervosa

When people with anorexia nervosa enter a state of starvation, their brain stops functioning properly. They are at risk of self-harm, substance abuse, suicide attempts, depression and anxiety.

Anorexia nervosa can also cause physical complications including:

• malnutrition
• an irregular heartbeat or other heart problems
• osteoporosis and bone problems that can increase the risk of broken bones
• pneumonia
• kidney failure

Unfortunately, around 1 in 5 people eventually die of the consequences of anorexia nervosa, and one in 5 will attempt suicide.

Resources and support

• Butterfly Foundation — call 1800 33 4673
• National Eating Disorders Collaboration
• Eating Disorders Victoria (for people in Victoria with eating disorders) — call 1300 550 236