Anorexia Nervosa

Tape measure wrapped around hand

Anorexia nervosa (anorexia) is an eating disorder. Anorexia is characterised by an intense fear of weight gain which causes the individual to severely restrict the amount of food they eat and engage in behaviours to prevent weight gain. People with anorexia struggle with negative body image and often have a distorted perception of how their body looks; they may believe they are overweight even if they are underweight. 

Anorexia is caused by a combination of biological, psychological, and societal factors. Those with certain personality traits, such as being highly anxious, having low self-esteem, and/or a drive for perfectionism, are at a higher risk of developing the condition. It is also recognised that wider societal factors, such as the high value placed on thinness within certain cultures, are involved in the development of anorexia. Traumatic or stressful life events or big life changes can also act as triggers for the condition.

Anorexia is a serious condition. The physical harm caused by starvation and malnutrition can lead to death. If you think you have anorexia then please seek help. If you think someone you know may have anorexia, please encourage them to seek help. Many with anorexia do not seek treatment as they may not be aware they have a problem or the fear of weight gain stops them from getting help. There are effective treatments for anorexia and the earlier treatment starts the better the outcomes.

Common symptoms
  • Severe restriction of food intake leading to weight loss or preventing weight gain.
  • Intense fear of weight gain, even if severely underweight.
  • Distorted perception of body weight and shape.
  • Efforts to control weight and shape significantly interfere with daily life.
  • A significantly low body weight, compared to what is normal for that person.
  • Compensating for eating through behaviours such as vomiting, excessive exercise, use of dieting aids, laxatives, diuretics, etc.
  • Unhappy with weight and body shape.
  • Bingeing and purging - eating a large amount of food and then engaging in behaviour to avoid weight gain, e.g. self induced vomiting.
  • Constantly thinking about food.
  • Refusing to eat, skipping meals, making excuses to not eat, and/or lying about eating.
  • Routines and rituals around meals and eating. E.g. using a particular plate, measuring or weighing food, eating small bites.
  • Repeatedly weighing self, measuring body, and/or checking body in the mirror.
  • Feeling emotionally numb.
  • Low mood
  • Irritability
  • Fatigue and low energy
  • Difficulty sleeping
  • Feeling dizzy or faint.
  • Difficulty concentrating
  • Mood swings and changes in personality.
  • Loss of menstruation/ periods.
  • Feeling cold all the time - cold fingers and toes.
  • Reduced sex drive
  • Abdominal pain, constipation, bloating
How common is in the general population
An estimated 0.1-1% of the general population will suffer from anorexia nervosa at some point in their life. The prevalence varies a lot by gender and age. Anorexia is most common in adolescent females.
Gender differences
Anorexia nervosa is much more common in women than men.
Anorexia most commonly begins in adolescence but can develop at any stage of life.
Typical Course
The typical course of anorexia nervosa varies. Some may recover after a single episode, others will have multiple episodes which may be triggered by stress. For some, anorexia is chronic and can result in death due to physical health complications.
Common Comorbid (concurrent) Conditions
Depression, anxiety disorders, obsessive-compulsive disorder (OCD), personality disorders, substance abuse disorders, self-harm, suicidal thoughts or attempts.
Common treatments

There are effective treatments for anorexia nervosa and with early treatment there is a high chance of recovery. Treatment for anorexia typically takes a multidisciplinary team approach with input from a medical professional (e.g. GP), mental health professional (e.g. psychologist), and dietitian. 

Malnutrition can cause serious physical health complications and organ damage. In severe cases, anorexia can lead to death due to electrolyte imbalance or abnormal heart rhythms. Therefore, it is important to have regular appointments with medical professionals, such as a GP or nurse, to monitor your physical health. 

The first goal in treatment is to reach a healthy body weight. Working with a dietitian can be helpful in achieving this goal. A dietitian can create a meal plan and provide advice on the types of food and amount of food that should be eaten during recovery.

Psychological Therapy:

Family based treatment (FBT) is the recommended treatment for children and adolescents with anorexia. Through FBT parents and caregivers learn how to help their child/ teen reach a healthy weight and reduce their eating disorder behaviours. There is a focus on normalising eating, establishing good eating habits, and teaching families how they can support their child/ teen through recovery. 

For adults with anorexia, cognitive behavioural therapy (CBT) is the recommended treatment. CBT is a structured form of talk therapy which aims to change the thoughts, beliefs, and behaviours that are maintaining the eating disorder, normalise eating, and address the causes of food restriction. 

There is currently no medication that specifically treats anorexia. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may be prescribed to treat associated mood and anxiety symptoms. 

Residential Treatment or Hospitalisation:

In some cases a more intensive treatment may be needed, such as a residential treatment program or hospitalisation. Hospitalisation may be required if the individual is at an extremely low body weight, is refusing to eat, or there are other serious physical or mental health concerns. The aim of hospitalisation is to help the individual reach a healthy weight so they are medically stable and able to engage in psychological therapy.