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Anorexia nervosa (say
"an-uh-RECK-see-uh nur-VOH-suh") is a type of
eating disorder. People who have anorexia have an
intense fear of gaining weight. They severely limit the amount of food they eat
and can become dangerously thin.
Anorexia affects both the body
and the mind. It may start as dieting, but it gets out of control. You think
about food, dieting, and weight all the time. You have a distorted body image.
Other people say you are too thin, but when you look in the mirror, you see your body as overweight.
Anorexia usually starts in the teen years. It's much more common in females than males. Early
treatment can be effective. The earlier it is treated, the better the chances someone can recover from anorexia. Untreated anorexia can lead to starvation and serious
health problems, such as bone thinning (osteoporosis),
kidney damage, and heart problems. Some people die from these problems.
If you or someone you know has anorexia, get help right away. The longer
this problem goes on, the harder it is to overcome. Over time and with treatment, a person
with anorexia can feel better and stay at a healthy weight.
Eating disorders are
complex, and experts don't really know what causes them. But they may be due to
a mix of genetics, family behaviors, social factors, and personality traits. You may be
more likely to have anorexia if:
People who have anorexia
often strongly deny that they have a problem. They don't see or believe that
they do. It's usually up to their loved ones to get help for them. If you are
worried about someone, you can look for certain signs.
Their lives become focused on controlling their weight.
If your doctor thinks
that you may have an eating disorder, he or she will compare your weight with
the expected weight for someone of your height and age. He or she will also
check your heart, lungs, blood pressure, skin, and hair to look for problems
caused by not eating enough. You may also have blood tests or X-rays.
Your doctor may ask questions about how you feel. It is common for a
treatable mental health problem such as depression or anxiety to play a part in
an eating disorder.
All people who have anorexia
need treatment. Even if you, your child, or someone else you care about has only a couple of the
signs of an eating disorder, get help now. Early treatment gives the best
chance of overcoming anorexia.
Treatment can help you get back to
and stay at a healthy weight. It can also help you learn good eating habits and learn to feel
better about yourself. Because anorexia is both a physical and emotional
problem, you may work with a doctor, a
dietitian, and a counselor.
If your weight
has dropped too low, you will need to be treated in a hospital.
take a long time to overcome, and it is common to fall back into unhealthy
habits. If you are having problems, don't try to handle them on your own. Get
It can be very scary to realize that someone you care about has an eating
disorder. But you can help.
If you think your child has anorexia:
If you're worried about someone you know:
Learning about anorexia:
Living with anorexia:
The cause of
anorexia nervosa is not fully understood. It is
thought to develop from a mix of physical, emotional, and social
Common feelings and actions that
are linked to
anorexia nervosa include:footnote 1
Some people who have anorexia may also have times where they binge eat and make themselves vomit or
use laxatives or diuretics to lose weight.
Breakdown of the enamel on the teeth is a common symptom of long-term
Common physical signs of malnutrition from anorexia include:footnote 2
People who have anorexia often form rituals associated with eating. These may include:
In some cases, people who have eating disorders can feel
If someone you know shows warning signs of suicide, make
sure that the person is not left alone. Seek help from a mental health
If you are
having suicidal thoughts, talk to someone about it. Call a local suicide
hotline, your local health department, or the national suicide hotline
(1-800-273-TALK or 1-800-273-8255), or seek help at a
local hospital emergency room.
Anorexia almost always begins with a plan to follow a strict weight-loss
diet. Over time, severely limiting foods leads to malnutrition and unhealthy weight loss.
malnutrition sets in, the brain and
metabolism change. This limits the appetite, how your
body uses food, and your ability to think clearly and make good
decisions. As the illness gets worse, irrational behaviors begin, such as making rules about food or making yourself vomit out of fear of gaining weight.
Starvation and malnourishment from anorexia can cause
complications, such as
osteoporosis or an
irregular heartbeat. Often
other mental health conditions occur along with anorexia, such as
After anorexia starts, returning to normal eating is very hard without help. When left untreated, anorexia
can last for a lifetime.
Early treatment of anorexia offers the best chance of recovery.
People who have anorexia tend
to strongly deny that they have a problem and are secretive about their eating. So their
family members or loved ones usually have to get help for them.
The risk for
anorexia nervosa increases if you:
people, limiting what they eat can meet a need for personal control and
self-esteem. Some teens may fall into this pattern as a way to cope with big
changes and challenges.
A parent may have cause for concern
Call your doctor immediately if you (or someone you care about) have been
anorexia nervosa and:
Call your doctor if you (or someone you care
Watchful waiting is a wait-and-see
approach. Watchful waiting is not a safe way to handle a possible eating
Getting early treatment improves your chances of
The following health professionals can help diagnose
or treat an eating disorder:
For severe anorexia, starvation, or life-threatening
mental health problems, getting treatment in a hospital or an eating disorder
treatment center is needed.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
There is no single test that can diagnose
anorexia. But this illness has a visible effect on
your health and eating habits.
If your doctor thinks
that you may have an eating disorder, he or she will check you for signs of
malnutrition or starvation. Your doctor may also ask questions
about your mental well-being. It is common for a treatable mental health
problem (such as
obsessive-compulsive disorder) to happen with an
Common exams and tests for a possible eating
If your doctor thinks that you may have organ
damage, doing heart or kidney tests can be helpful.
All people with
anorexia need treatment. In most cases, this
involves seeing a doctor and having regular counseling
sessions. A hospital stay is needed for those who are seriously underweight or
who have severe medical problems. The goals of treatment are to restore a
healthy weight and healthy eating habits.
If you have an eating disorder, try not to resist treatment. Although
you may be very afraid of gaining weight, try to think of weight gain
as a life-saving measure. With help, you can learn to eat well and keep your
weight at a healthy level.
Ideally, you can take charge of
anorexia with the help of a team that includes a
mental health professional (such as a psychologist or licensed counselor), a
medical health professional (such as a doctor or nurse), and a
If your medical
condition is not life-threatening, your treatment likely will
An important part of your recovery will include:
For the teen with anorexia,
family involvement is a key part of treatment. Family therapy helps parents support their child, both emotionally and physically.
One type of family therapy, The Maudsley method, has been shown to help children and teens who have anorexia. The Maudsley method helps parents feed their child and create a healthy eating pattern for their child. Although this is a difficult task that involves the whole family, a Maudsley therapist can help the family reach this goal. After your child or teen has gained enough weight, treatment will begin to address more general family issues.
Any brothers or
sisters also need support during treatment. Family, group, and individual
counseling are all effective and are often combined.
Ongoing (chronic) forms of
anorexia may require treatment for many years,
including hospitalizations when needed. Ongoing treatment usually
includes psychological counseling. A counselor will help you make your own plan to use new
coping and stress management skills and prevent
relapse. Your counselor can help you at those times
when it is hard to follow healthy ways of thinking about food and your body.
Some people fully recover from anorexia. Many people with
anorexia have ups and downs over the years. Try thinking of treatment as an
severely underweight can cause
dehydration, starvation, and
electrolyte imbalance, any of which can be
anorexia causes life-threatening medical problems, you
need urgent medical treatment. A hospital stay is needed for those who are seriously underweight or
who have severe medical problems. This can include several weeks in the hospital followed by outpatient treatment to monitor your progress. Treatment includes:
Insurance coverage varies for inpatient treatment of
eating disorders. Check with your insurance carrier to learn about your
Anorexia can be a lifelong illness.
Many people who have anorexia recover, some improve, and some have problems
with anorexia throughout their lives.
Many people don't get treatment for mental health problems. You may not seek treatment because you think your symptoms are not bad enough or that you can work things out on your own. But
getting treatment is important.
If you need help deciding whether
to see your doctor, read about
some reasons why people don't get help and how to overcome them.
There is no known way to prevent
anorexia nervosa. Early treatment may be the best way
to prevent the disorder from progressing. Knowing the early signs and seeking
treatment right away can help prevent
complications of anorexia.
many ways adults can help children and teens form a healthy view of themselves
and learn to approach food and exercise with a positive attitude. Doing this
may prevent some children and teens from having this disorder.
Continuing good care at home will help
you recover from
anorexia nervosa. Set goals with your doctor, mental health professional, and registered dietitian. Include
goals in the areas of:
Ask your family members to also support your emotional and
physical goals for healing. If someone close to you has trouble understanding
eating disorders, share what you have learned in treatment.
You may have used anorexia to deal with the stresses of life. Learning how to cope with stress without anorexia is an important part of recovery. Relieving stress in a healthy way can help you
recover, improve your quality of life, and stay healthy.
All families have patterns
that can get in the way of change. To make healthy change easier, have everyone
in the family take a look at how they handle their loved one's eating disorder.
Keep in mind that severe weight loss makes a person unable to think clearly or function
well in daily life. This is a sign that a loved one needs medical care.
There are no medicines to treat
anorexia nervosa. But if you are depressed or anxious,
your doctor may prescribe an antidepressant medicine.
An antidepressant may help if you also have
anxiety disorder, or
If you have anorexia and are taking medicine, you must have
regular checkups. Being malnourished or severely underweight can change the
amount of medicine in your body. Too much or too little can be dangerous.
During a checkup, your doctor will note your heart
rate, temperature, and blood pressure. You may also have blood tests to check
the amount of medicine in your blood.
Agras WS (2008). The eating disorders. In DC Dale, DD Federman, eds., ACP Medicine, section 13, chap. 9. Hamilton, ON: BC Decker.
Guarda AS, Joffe A (2011). Anorexia nervosa and bulimia nervosa. In M Augustyn et al., eds., The Zuckerman Parker Handbook of Developmental and Behavioral Pediatrics for Primary Care, 3rd ed., pp. 107–114. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
Agras WS (2008). The eating disorders. In DC Dale, DD Federman, eds., ACP Medicine, section 13, chap. 9. Hamilton, ON: BC Decker.
American Academy of Pediatrics (2010). Clinical report: Identification and management of eating disorders in children and adolescents. Pediatrics, 126(6): 1240–1253.
Anderson AE, Yager J (2009). Eating disorders. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 2128–2149. Philadelphia: Lippincott Williams and Wilkins.
Coughlin JW, et al. (2014). Behavioral disorders affecting food intake: Eating disorders and other psychiatric conditions. In AC Ross et al., eds., Modern Nutrition in Health and Disease, 11th ed., pp. 1319–1329. Philadelphia: Lippincott Williams and Wilkins.
Fitzpatrick KK, Lock J (2011). Anorexia nervosa, search date April 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Sadock BJ, et al. (2007). Eating disorders. In Kaplan and Sadock's Synopsis of Psychiatry, Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 727–735. Philadelphia: Lippincott Williams and Wilkins.
Sadock BJ, Sadock VA (2010). Eating disorders. In Kaplan and Sadock's Pocket Handbook of Clinical Psychiatry, 5th ed., pp. 259–268. Philadelphia: Lippincott Williams and Wilkins.
Steering Committee on Practice Guidelines, American Psychiatric Association (2006). Treating Eating Disorders: A Quick Reference Guide. Arlington, VA: American Psychiatric Publishing.
Yager J, et al. (August 2012). Guideline Watch: Practice Guideline for the Treatment of Patients With Eating Disorders, 3rd ed. Arlington, VA: American Psychiatric Association. Also available online: http://psychiatryonline.org/content.aspx?bookid=28§ionid=39113853.
ByHealthwise StaffPrimary Medical ReviewerKathleen Romito, MD - Family MedicineJohn Pope, MD - PediatricsSpecialist Medical ReviewerW. Stewart Agras, MD, FRCPC - Psychiatry
Current as ofApril 10, 2015
Current as of:
April 10, 2015
Kathleen Romito, MD - Family Medicine & John Pope, MD - Pediatrics & W. Stewart Agras, MD, FRCPC - Psychiatry
To learn more about Healthwise, visit Healthwise.org.
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