What is Anorexia Nervosa?
Anorexia is one of the deadliest mental illnesses. Due to its complexity, this condition requires comprehensive anorexia treatment from experienced eating disorder experts. Here at Eating Recovery Center (ERC), we offer a multidisciplinary treatment approach including medical and psychiatric stabilization, nutritional intervention and psychological support.
What Causes Anorexia?
Genetic Causes of Anorexia Nervosa
Although there is no one cause of anorexia, we have known for years that there is a genetic link to anorexia nervosa. However, this does not mean that there is a particular anorexia gene. Some researchers believe there may be hundreds of genes related to the disorder.
Twin and family studies have yielded strong evidence that anorexia nervosa, as well as other eating disorders, runs in families. The heritability of anorexia has been reported between 40% and 60%. Relatives of individuals with anorexia nervosa are 11 times more likely to develop the illness than relatives of individuals without anorexia. Although we do not inherit anorexia per se, we can inherit a vulnerability to anorexia.
Co-existing Illnesses and Personality Traits
Researchers have identified correlations, and possible genetic overlap, between anorexia nervosa and other psychiatric disorders such as major depression, anxiety, and obsessive compulsive disorder as well as certain personality traits. The heritable nature of these traits, including harm avoidance, perfectionism, and inflexibility, suggests the relationships may be genetic.
Genetic linkage studies and genome-wide association studies of anorexia are being conducted to increase our understanding of the role of genetics in anorexia risk.
Psychological Causes of Anorexia Nervosa
Psychological factors can also play an important role in the development of anorexia nervosa. We have learned that there are certain characteristics and experiences that are common to individuals with anorexia (including perfectionism, low impulsivity, harm avoidance, low self-esteem, anxiety, low self-directedness, and overvaluation of body image) that may place a person at greater risk for the illness. These factors are often considered to be maintaining features that contribute to the perpetuation of the illness and can be directly targeted during treatment.
Perfectionism refers to a personality style where an individual strives for flawlessness, is highly concerned with approval, and may be extremely self-critical regarding performance. Mistakes are often viewed as personal failures – and something to be avoided at all costs. For individuals with anorexia nervosa, high levels of perfectionism can be seen within the illness (e.g., strict rules around eating and food) as well as outside of the illness (e.g., extremely high standards and expectations for themselves in academics, work, etc.).
Anxiety disorders and anxious personality traits are very common among people with anorexia and are often present prior to the development of the eating disorder. Mealtime anxiety can be extreme, even phobic-like. The use of avoidance behaviors to manage anxiety (e.g., restrictive eating) may contribute to the persistence of the illness.
Self-directedness refers to the ability to adapt behaviors in a way that is consistent with desired and value-driven goals. It involves the careful evaluation of a situation and development of a thoughtful plan of action. Individuals with anorexia often possess reduced levels of self-directedness. Because of this, there is a tendency to react in a way that may alleviate an immediate concern but is not necessarily in line with long-term goals and values. Someone in treatment for anorexia may decide to skip a meal as a way of solving the immediate problem with their body image. Although this may help in the moment, it also serves to perpetuate the illness – which is not the desired outcome.
Sociocultural Causes of Anorexia Nervosa
The sociocultural context (social networks, media influence, and cultural norms relating to eating and appearance) during the development of anorexia nervosa requires important consideration. In fact, there are certain aspects of Western society values that have been linked to anorexia, including the pursuit of the “ideal body” and the overvaluation of appearance as a measure of success and worth.
Messages promoting unrealistic beauty standards that place high value on achieving a certain look (thinness, muscularity) can create pressure to engage in behaviors, like dieting, that place certain persons at greater risk. Other social influences include involvement in specific activities, groups, or occupations that emphasize weight and appearance.
The Thin Beauty Ideal
Studies have demonstrated that cultural pressures to achieve the thin beauty ideal can lead to increased body dissatisfaction and weight concerns, which may then contribute to the development of anorexia nervosa. Being bombarded with media images of extremely thin models, for example, promotes the internalization of anti-fat attitudes and the need to control weight. With modern developments like social media, Western ideals and values have been disseminated globally. Recent studies have demonstrated increases in eating disorders in non-Western cultures as well as minority groups.
High-Risk Social Environments
Certain environments have been shown to create an increased risk for the development of anorexia nervosa. Participating in sports that focus heavily on weight (e.g., running, dancing, wrestling, gymnastics), belonging to a sorority, or working in a field highly reliant on appearance and image (e.g., modeling or acting) can create additional pressure to achieve a certain weight and/or appearance in order to achieve “success.”
Symptoms & Warning Signs of Anorexia Nervosa
Anorexia nervosa is a serious eating disorder that can cause many health and behavioral issues. If you are concerned that you or someone you know might be experiencing anorexia, there are a number of signs and symptoms to look for.
One of the most common misconceptions about anorexia nervosa is that sufferers are underweight, which is not always the case. In many instances, a patient with anorexia may appear to be healthy when they are actually malnourished. That’s why it’s important to understand all the warning signs and symptoms of anorexia. There are two types of symptoms for anorexia nervosa: medical symptoms and behavioral warning signs.
Medical Symptoms of Anorexia
When learning more about the signs and symptoms of anorexia, it’s important to understand the medical symptoms one may be experiencing. Although these symptoms will vary from person to person, these are the most common symptoms of anorexia.
For someone who is experiencing anorexia nervosa, a common symptom may be low weight. Low weight may not always be obvious and will depend on a person’s age, sex, developmental stage, and physical health. Low weight can be defined as weight less than minimally normal or expected (for growing children and adolescents).
Dramatic Weight Loss
Besides having a low body weight, someone who is experiencing anorexia may have a significant or dramatic decrease in their weight. It is important to be aware of marked weight loss occurring over a short period of time.
Another sign that someone may have anorexia is when they are demonstrating excessive or compulsive exercising. Exercise routines can become extreme and interfere with daily life activities.
Many people who exhibit compulsive exercising may feel the need to work out several times a day, even canceling plans or staying away from social situations to do so.
A serious symptom of anorexia is bradycardia, which is when someone’s heart beats at a lower rate than normal, which is 60 beats per minute. This occurs in about 95% of patients with anorexia and is due to the conservation of energy in the nervous system.1
Lack of Menses
Someone who is suffering from anorexia may also experience an absence of or delayed onset of their menstrual cycle or experience a lighter than normal menstrual cycle.
Hypotension and Orthostasis
When someone with an eating disorder isn’t getting the right amount of nutrition, they may experience low blood pressure (below 90/60 mm Hg) and orthostasis, which occurs when your blood pressure drops due to a positional change (i.e., standing or sitting up).
Finally, another physical symptom one may experience is hair thinning or hair loss due to nutritional deficiencies.
Behavioral Warning Signs of Anorexia
Besides physical symptoms of anorexia, there are also behavioral warning signs that one may be exhibiting while suffering from this eating disorder. Family members or friends can often identify these warning signs below.
Extreme Weight Loss
One of the most common warning signs when observing someone with anorexia nervosa is that they recently lost an extreme amount of weight over time, such as seeing someone for the holidays or back at school after a break.
If you observe someone restricting their calories or food intake, this could be a sign of anorexia.
Another warning sign is witnessing someone who appears to be preoccupied with food, their weight or calorie intake. They may keep track excessively and may also have an obsession with dieting behaviors. Sometimes an interest in preparing food for others may develop.
Sudden Interest in Diet
Having a sudden interest in a diet could be another sign of an eating disorder. This person might be researching diets, have a diet app or might be sharing their interest in a new diet or fad.
Fear of Weight Gain
Someone who has an extreme fear of weight gain may be suffering from an eating disorder. They may weight themselves excessively, make comments about “feeling fat,” keep track of their weight daily and get upset if they’ve gained or haven’t lost weight.
Refusal of Food
Another warning sign of anorexia is the refusal of food. This may start out as just a small change but can expand to include more and more foods – ultimately whole food groups.
This can occur in many different age groups, but it’s common in those who have a fear of gaining weight due to their eating disorder
Strange Eating Habits or Food Rituals
There may be other eating habits or rituals involving food that someone with anorexia can experience. This could be counting foods, such as crackers or pieces of fruit or cutting up food into small pieces, excessive chewing, etc.
Denial of Hunger or Weight Loss
Someone exhibiting eating disorder behaviors may be in denial when it comes to their weight loss or even deny that they are ever hungry.
Although this is a physical symptom, compulsive exercising is also a behavioral habit that one with anorexia nervosa may take part in.
Finally, someone who is withdrawing from their favorite social gatherings or who loses interest in their friends or family may be showing signs of an eating disorder.
What are the Health Risks of Anorexia?
Anorexia nervosa is a serious medical condition that can affect every organ system of the body. The most serious health risk of anorexia is increased mortality. Other health risks associated with anorexia are also very serious and may require treatment to achieve lasting recovery.
Short-Term Health Risks of Anorexia Nervosa
Anorexia can lead to several short-term and long-term effects. Short-term health risks include weight loss, gastrointestinal complaints, fatigue, dehydration, and hair loss, among others.
Weight loss is the most common health risk associated with anorexia nervosa. Severe weight loss can set off a series of other serious health risks that can become life threatening.
Someone suffering from anorexia may experience nausea, stomach pain, bloating, vomiting, constipation, and dizziness.
Fatigue is often seen in people with anorexia as a result of decreased intake of food and nutritional deficiencies. After a while this can lead to extreme exhaustion.
Hair loss is another health risk associated with anorexia. When people with anorexia don’t get proper nutrition, their hair becomes thinner.
Individuals with anorexia may experience dehydration associated with restrictive eating– even if they are drinking water. This occurs because a large percentage of dietary water comes from food. Dehydration can become a serious health risk if not treated.
Long-Term Health Risks of Anorexia Nervosa
Anorexia nervosa is a very serious medical condition. If untreated, those who are suffering from this eating disorder may experience long-term health risks. Starting treatment right away for anorexia is essential in finding recovery and decreasing the odds of these associated health risks.
Anorexia is associated with bone health issues. This can include osteopenia, fractures, osteoporosis, and more. The longer a person lives with anorexia, the more severe these problems will be. Additionally, some bone loss stemming from anorexia can be irreversible.1
Another serious long-term health risk associated with anorexia is seizures. These can occur in people with bulimia as well as those with anorexia. Loss of consciousness, incontinence, and muscle spasms can also occur. 2
People with anorexia often have a low level of red blood cells, which can cause fatigue, shortness of breath, dizziness, and rapid heart rate−all signs of anemia.
Because of the toll an eating disorder can take on the body, infertility can occur in girls and women who have experienced severe anorexia.3
Hoffman, E. R., Zerwas, S. C., and Bulik, C. M. (2011). Reproductive Issues in anorexia nervosa. Expert Reviews of Obstetrics and Gynecology, 6(4), 403-414.
Complications from anorexia nervosa can be serious and can cause death. In fact, anorexia nervosa has one of the highest death rates compared to other mental health conditions, second only to opioid overdose.
Anorexia Can be a Deadly Illness
Anorexia nervosa is an illness with very serious psychological and medical complications. With a mortality rate of about 10%, anorexia deaths are due to starvation, cardiovascular complications, and suicide.
According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), "eating disorders are among the deadliest mental illnesses, second only to opioid overdose."4 ANAD also reports that there are more than 10,000 deaths each year associated with eating disorders.
Anorexia Treatment Methods
At Eating Recovery Center (ERC), treatment for anorexia nervosa begins with medical and psychiatric stabilization, including nutrition, rest, and medication management of co-occurring conditions as needed to restore stability and sufficient awareness to engage in therapeutic treatment.
How to Treat Anorexia
For patients with severe anorexia nervosa, treatment initially focuses on weight restoration and medical and/or psychiatric stabilization, including around-the-clock nursing supervision, direct psychiatric care, and medication management. Nourishing meals and psychosocial support prepare patients to step down to lower levels of care.
It is important to note that while our Inpatient and Residential programs offer 24/7 medical support to address the physical and psychiatric complications of anorexia, our patients are not confined to a hospital bed or room. To the extent that they are physically able, patients participate in therapeutic programming and interact with the supportive treatment community of patients and staff.
We firmly believe that a beautiful, serene environment is essential to healing. All our eating disorder treatment centers are carefully designed with that in mind. They are restful, spacious facilities that support the therapeutic process.
Anorexia Treatment Stages
Patients who are entering into ERC's anorexia treatment program begin their journey with our clinical assessment team, staffed with compassionate, master’s-level clinicians. We assess each patient’s treatment history, current status, and personal needs to determine one’s appropriateness for care. From there, a customized anorexia program begins, consisting of three stages to prepare each patient for lasting recovery: medical stabilization, psychiatric stabilization, and weight restoration (if indicated).
Goals of Anorexia Treatment
At ERC, we believe lasting recovery from anorexia nervosa is possible, and we are here to light every patient’s path forward. Lasting recovery from anorexia is the goal, but we acknowledge that many patients need to first achieve medical stability and a healthy weight.
Specialized Treatment for Anorexia
Our medically stable patients may step down to a lower level of care where the focus shifts to helping them understand the factors that maintain anorexia symptoms and to learning recovery skills. Individual, family, and group therapies, including art, psychodrama, relaxation, movement, and yoga, are important parts of our treatment approach.
As treatment progresses, our patients have opportunities to test recovery in real-world situations, including meal and activity outings as well as day and weekend passes. Together with their treatment teams, these exercises help to identify recovery challenges and determine readiness for entry into a lower level of care with more autonomy.
Eating Recovery Center is the nation's only healthcare system dedicated to the treatment of anorexia nervosa at all levels of care, including inpatient treatment, residential treatment, partial hospitalization treatment, and intensive outpatient treatment.
Anorexia Facts & Statistics
Anorexia nervosa is an illness that impacts women, men, adolescents, and children. It does not discriminate. It affects all ethnicities, cultures, and socioeconomic groups. It is also the deadliest mental illness, with a higher mortality rate than any other mental illness. That’s why it’s important to understand the symptoms and complications of anorexia as well as the facts and statistics about anorexia.
What are the Facts About Anorexia Nervosa?
When it comes to fully understanding anorexia nervosa, there are many facts as well as misconceptions about this eating disorder. If you or a loved one is suffering from anorexia, learning more about this condition may help you understand the severity and importance of seeking anorexia treatment.
- 1 in 5 deaths in patients with anorexia is by suicide.1
- Standardized Mortality Ratio (SMR) for anorexia nervosa is 5.86 (SMR is a ratio between the observed number of deaths in a study population and the number of deaths that would be expected).2
- There are over 2,600 additional deaths per year from anorexia nervosa in the US.3
- 50 - 80% of the risk for anorexia is genetic.4
- 33 - 50% of anorexia patients have a comorbid mood disorder, such as depression. Mood disorders are more common in the binge/purge subtype than in the restrictive subtype.5
- About half of anorexia patients have comorbid anxiety disorders, including obsessive compulsive disorder and social phobia.5
- Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61(3), 348–358.
- Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724-731.
- Trace, S. E., Baker, J. H., Peñas-Lledó, E., & Bulik, C. M. (2013). The genetics of eating disorders. Annual Review of Clinical Psychology, 9, 589-620.
- Ulfvebrand, S., Birgegard, A., Norring, C., Hogdahl, L., & von Hausswolff-Juhlin, Y. (2015). Psychiatric comorbidity in women and men with eating disorders results from a large clinical database. Psychiatry Research, 230(2), 294-299.
- Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020.
Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/
Gaps in Anorexia Research
As one of the deadliest mental health illnesses, the research around anorexia nervosa is ongoing. While there are some gaps in the research on this eating disorder, our team is constantly doing their part to study and understand anorexia in order to improve our specialized treatment approach.
Family Eating Disorders Manual by Laura Hill, PhD
Frequently Asked Questions About Anorexia Nervosa
What is anorexia nervosa?
Anorexia Nervosa refers to the restriction of energy intake (calories) relative to what a person needs. This reduction in calories leads to a significantly low body weight in the context of the individual’s age, sex, developmental trajectory and health status.
People with anorexia experience negative body image and an intense fear of gaining weight — even when others don't view them as underweight.
Some early signs of anorexia include the following:
- Body dissatisfaction
- Weight fluctuations
- Sudden changes in eating disorder behaviors (i.e. veganism/vegetarianism, gluten free, etc.)
- Sudden changes in exercise
- Persistent body image disturbance
What causes anorexia?
Anorexia is a bio-psycho-social illness. This means that biological, psychological and cultural aspects contribute to the development of the illness over time.
There are many contributing factors of Anorexia Nervosa:
- Diet culture
- Temperament (i.e. perfectionism, harm avoidance)
- Athletic culture
- Body shaming and/or the attempt to fit body shape ideals
Anorexia, like all eating disorders, is often secretive. In fact, anorexia is perpetuated by this secrecy; the secrecy performs some sort of function for the individual, even if it’s a maladaptive coping mechanism.
For example, restricting food intake may start off as a picky behavior, but then unintentionally become a means of control or predictability when life seems unmanageable. Or, not eating can create a numbing of emotions similar to the way drugs or alcohol can numb emotions and create an alternate state of being.
What are the symptoms of anorexia?
Anorexia is one of the deadliest mental illnesses. It is crucial to understand the warning signs and symptoms of this complex condition.
What are the health risks associated with anorexia?
Anorexia nervosa is a serious and sometimes fatal condition that can affect nearly every system of the body. There are many short-term and long-term health risks associated with anorexia nervosa.
How is anorexia treated?
Anorexia treatment is personalized, depending on each patient’s needs. Medical stabilization, psychiatric stabilization, nutritional rehabilitation, and weight restoration (when appropriate) are all considered when determining a patient’s treatment plan.
What are the facts about anorexia?
A devastating illness that often requires intensive treatment, anorexia takes the lives of far too many people each year.
Do I have anorexia?
If you or a loved one struggle with some of the symptoms described here, we can help you explore anorexia treatment options.
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