What it is
Anorexia nervosa is an eating disorder characterized by:
- Significant restriction of energy intake leading to low body weight (relative to age, sex, development, and health)
- Intense fear of weight gain or persistent behavior that interferes with weight gain
- Distorted body image or undue influence of shape/weight on self-worth
Atypical anorexia includes the same psychological/behavioral features without low body weight—medical risk can still be serious. Recovery is possible.
Common signs and symptoms
- Eating/weight: restrictive eating, rituals, cutting out food groups, calorie counting; dramatic weight loss or failure to gain expected weight
- Body image: feeling “fat” despite being underweight; body checking; overvaluation of weight/shape
- Exercise: compulsive or secret exercise; distress if unable to exercise
- Physical: dizziness, feeling cold, hair loss, missed periods or low testosterone, constipation, sleep issues
- Emotional/cognitive: perfectionism, rigidity, anxiety, irritability, social withdrawal
- Medical risks: low heart rate and blood pressure, electrolyte imbalances, bone loss, organ stress—can be life-threatening even without very low weight
Warning: Sudden refeeding without medical oversight can cause dangerous shifts in electrolytes (refeeding syndrome).
Why it happens
- Biological: genetic predisposition; differences in reward, anxiety, and interoception systems
- Psychological: perfectionism, harm avoidance, need for control, body dissatisfaction
- Social/cultural: weight stigma, diet culture, comments about body/food
- Stressors: transitions, trauma, bullying, sports pressures
What helps
- Medical safety first
- Medical evaluation for vitals, labs (including electrolytes), ECG; monitor for bradycardia, hypotension
- Level of care matched to risk: outpatient, intensive outpatient/partial hospitalization, residential, or inpatient
- Evidence-based therapies
- Adolescents: Family-Based Treatment (FBT/Maudsley) is first-line—parents support nutritional rehabilitation
- Adults: CBT-E (enhanced CBT) and other therapies (MANTRA, SSCM) targeting eating patterns and body image
- Nutrition rehabilitation
- Structured meal plans and regular eating; supervised meals when indicated
- Gradual increases to avoid refeeding complications; registered dietitian involvement
- Medications
- No specific “cure” medication; SSRIs may help co-occurring anxiety/depression after weight restoration
- Address bone health (vitamin D/calcium) per clinician guidance
- Supports
- Involve family/supports when possible; limit body-checking cues; challenge diet culture
- Treat co-occurring conditions (OCD, anxiety, trauma)
Recovery targets: medical stability, normalized eating, flexible thoughts about food/body, and return to valued activities.
When to seek help now
- Dizziness/fainting, chest pain, extremely low energy, or inability to maintain nutrition/hydration
- Very low heart rate/blood pressure or rapid weight loss
- Self-harm thoughts or severe depression
- If you’re a parent/caregiver noticing signs—seek evaluation promptly
How to talk to a clinician
- “I’m restricting food and losing weight with intense fear of weight gain. I’d like an urgent medical evaluation and referral to eating-disorder–informed therapy and nutrition care.”
Outlook
Early, aggressive support improves outcomes. Many people recover fully; setbacks can be part of the process. Compassionate, team-based care makes a difference.
Resources for readers in the USA
- Immediate help: 988 Suicide & Crisis Lifeline (call/text 988); Crisis Text Line (text HOME to 741741)
- Eating disorder care:
- National Alliance for Eating Disorders: allianceforeatingdisorders.com (support groups, referrals)
- NEDA (National Eating Disorders Association): nationaleatingdisorders.org (screening tool, info)
- F.E.A.S.T. (family support): feast-ed.org
- Find care: Psychology Today (filter for eating disorders/FBT/CBT-E); FindTreatment.gov; NAMI HelpLine (nami.org/help)
- Low-cost/community: Community Health Centers (findahealthcenter.hrsa.gov); 211
- Insurance tips: Confirm in-network eating-disorder programs, nutrition visits, higher levels of care (IOP/PHP/residential/inpatient), prior authorization, appeal rights under parity laws; copay/coinsurance, deductible, out-of-pocket max
- Work/school supports: Medical leave (FMLA), ADA accommodations (reduced load, meal breaks), EAP; campus counseling and disability services
- Urgent options besides ER: If medically unstable, ER is appropriate; otherwise, Mobile Crisis via 988 (where available), behavioral urgent care
Disclaimer: Educational information, not a diagnosis. If in crisis, use the resources above.