What is Anorexia Nervosa?

Anorexia nervosa is characterized by an irrational dread of becoming fat coupled with a relentless pursuit of thinness. People with anorexia go to extremes­ to reach and maintain a dangerously low body weight. But no matter how much weight is lost, no matter how emaciated they become, it’s never enough. The more the scale dips, the more obsessed they become with food, dieting, and weight loss.

The key features of anorexia nervosa are:

• Refusal to sustain a minimally normal body weight
• Intense fear of gaining weight, despite being underweight
• Distorted view of one’s body or weight, or denial of the dangers of one’s low weight

There are two types of anorexia. In the restricting type, weight loss is achieved by restricting calories. Restricting anorexics follow drastic diets, go on fasts, and exercise to excess. In the purging type, people get rid of calories they’ve consumed by vomiting or using laxatives and diuretics.

Anorexia is most common in adolescent girls and young women, with a typical age of onset between the ages of 13 and 20. But people of all ages­—including men and children—can suffer from anorexia.

Signs and symptoms of anorexia

People with anorexia often hide their condition, so the warning signs are not always easy to spot. Furthermore, anorexics will typically try to explain away their disordered eating behaviors when confronted. But as anorexia progresses, the signs and symptoms become increasingly obvious and difficult to deny.

Eating and food behavior signs and symptoms

• Dieting despite being thin – Follows a severely restricted diet. Eats only certain low-calorie foods. Bans “bad” foods such as carbohydrates and fats.
• Obsession with calories, fat grams, and nutrition – Reads food labels, measures and weighs portions, keeps a food diary, reads diet books.
• Pretending to eat or lying about eating – Hides, plays with, or throws away food to avoid eating. Makes excuses to get out of meals (“I had a huge lunch” or “My stomach isn’t feeling good.”).
• Preoccupation with food – Eats very little, but constantly thinks about food. May cook for others, collect recipes, read food magazines, or make meal plans.
• Strange or secretive food rituals – Often refuses to eat around others or in public places. May eat in rigid, ritualistic ways (e.g. cutting food “just so”, chewing food and spitting it out, using a specific plate).

Appearance and body image signs and symptoms

• Dramatic weight loss – Rapid, drastic weight loss with no medical cause.
• Feeling fat, despite being underweight – May complain about being overweight in general or just “too fat” in certain places such as the stomach, hips, or thighs.
• Fixation on body image – Obsessed with weight, body shape, or clothing size. Frequent weigh-ins and concern over tiny fluctuations in weight.
• Harshly critical of appearance – Spends a lot of time in front of the mirror checking for flaws. There’s always something to criticize. They’re never thin enough.
• Denies being too thin – Refuses to believe that his or her low body weight is a problem, but may try to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized clothes).

Purging signs and symptoms

• Using diet pills, laxatives, or diuretics – Abuses water pills, herbal appetite suppressants, prescription stimulants, ipecac syrup, and other drugs for weight loss.
• Throwing up after eating – Frequently disappears after meals or goes to the bathroom. May run the water to disguise sounds of vomiting or reappear smelling like mouthwash or mints.
• Compulsive exercising – Follows a punishing exercise regimen aimed at burning calories. Will exercise through injuries, illness, and bad weather. Works out extra hard after bingeing or eating something “bad.”

Facts about anorexia nervosa:

• Anorexia nervosa occurs in 1% to 5% of the population.
• About 90% to 95% are females between ages 13 and 30. However, anorexia nervosa can also occur in males and people of all ages.
• Although anorexia nervosa is most common in the white upper and middle class, it occurs in people of all racial, ethnic, and socioeconomic backgrounds.
• People in certain occupations that emphasize leanness to improve performance and appearance are at increased risk for developing anorexia nervosa. These include dancers, gymnasts, figure skaters, runners, wrestlers, and models.

Effects of anorexia

The severe calorie restriction of anorexia has dire physical effects. When the body doesn’t get the fuel it needs to function normally, it goes into starvation mode. It slows down to conserve energy and turns in on itself for essential nutrients. In essence, the body begins to consume itself. As the self-starvation continues and more body fat is lost, the medical complications pile up.

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