Understanding Anorexia Nervosa

Anorexia, the common name of the disorder anorexia nervosa, is a complex brain-based disorder that severely disrupts the relationship with food and your body. Anorexia can make eating seem threatening and create an intense fear of gaining weight. 

Myths about anorexia being a “lifestyle” or a “phase” are incredibly dangerous. Anorexia is not a choice. It’s a serious, life-threatening illness. Because it can cause severe physical damage and is often accompanied by high suicide risk, anorexia nervosa is the second most deadly mental illness, after opioid addiction. 

If you or someone you know is exhibiting any signs of anorexia, text “START” to 741-741 or call 1-800-273-TALK (8255)

Who gets anorexia?

While many people may have a stereotypical image in mind, anorexia does not have “a look.” Anorexia affects people of all genders, all ethnicities, all socioeconomic groups, all body sizes. The onset is most common during adolescence, but younger children and older adults can also develop anorexia. Anorexia is more common among athletes than in the general population, and it’s not only in sports and activities that focus on body shape and size, like dance, gymnastics, and wrestling. Sports requiring a high energy output or that put an emphasis on speed–such as swimming, soccer, tennis, and cross-country–also see high rates of anorexia. 

What causes anorexia?

Anorexia is a complex neurobiological illness that is strongly tied to genetics. Social and environmental factors can also play a role in the development of anorexia. 

If you happen to have a genetic vulnerability to anorexia, it is usually triggered by something called energy deficit, when you don’t take in enough calories to meet your body’s needs. Restricting food (whether by following a specific diet or trying to “eat healthier”) is the most common cause of energy deficit. Other causes include weight loss from surgery, illness, or medication. High energy output, such as during intense athletic training, can also cause caloric deficit when there isn’t enough refueling after workouts.

While we don’t know the exact mechanism behind this process, the main theory is that the body perceives this energy imbalance as a danger signal–which makes sense because not having enough food was one of our ancestors’ biggest threats to survival. Signs of scarcity then shift the brain’s perception of food and physical activity. This “Famine and Migration Theory” suggests that some human beings evolved with the capacity to go without eating very much and to have an intense drive to move, allowing them to walk for miles and miles with little nutrition. This genetic difference–even if held by only a few members of early human communities–allowed for more people to survive. Today, our brains don’t know the difference between a famine and a fad diet. 

There are two subtypes of anorexia:

  • Restricting Type: Severely limiting food intake
  • Binge-Purge Type: Restricting food followed by bingeing and purging (through vomiting, exercising, and/or use of laxatives). 

Signs to watch out for

In a society that idealizes thinness and “restraint” around food, it can be hard to know if someone is struggling with anorexia. And you can’t tell if someone has anorexia just by the way they look. Appearing  “underweight” isn’t always a red flag. And someone can be in any size body but be malnourished and suffering from anorexia. That’s why it’s important to understand the range of  warning signs and symptoms. The most common include:

  • Anxiety around food
  • Weight loss
  • Altered body image or extreme fear of gaining weight
  • Denial of hunger, skipping meals, or taking only small portions of food 
  • Rejection of foods previously enjoyed
  • Rigidity and/or rituals around eating 
  • Cooking/baking for others without eating the food
  • Eating alone rather than with family or friends
  • Extreme fatigue
  • Always feeling cold
  • Wearing baggy clothes or many layers of clothing Withdrawal and other negative mood changes
  • Excessive workouts or a rigidity around exercise

What anorexia does to the body

In addition to causing severe mental anguish, anorexia takes a toll on the body. Some common physical symptoms include:

  • Difficulty concentrating
  • Feeling dizzy 
  • Stomach cramps, nausea, and other gastrointestinal complaints (constipation, acid reflux, etc.)
  • Trouble sleeping
  • For those who can menstruate, irregular periods or no period (including only having a period while on birth control, as it is a “false” period)
  • Dental problems, such as discoloration, enamel erosion, cavities, and tooth sensitivity
  • Dry skin, brittle nails, and thinning hair
  • Broken bones, including stress fractures
  • The growth of fine, downy body hair (called lanugo)

How to get help

Anorexia is treatable. Eating disorder professionals can assess your symptoms and develop a treatment plan to heal both the physical and mental aspects of the illness.

As with any mental health condition, it’s never too early or late to seek help. You can contact the National Eating Disorder hotline by phone or chat at 800-931-2237 or access their website for more information.

Helping someone with anorexia

Avoid talking about food and weight–theirs or yours . Telling someone with anorexia that they look thin can reinforce their illness because the eating disorder wants them to be thin. Commenting positively about them gaining weight or “looking healthier” during recovery may also be counterproductive  (even if your intention is to encourage them).

Your friend likely wants you to see them as exactly that: a friend, not as someone who is sick or who is defined by their eating disorder. You can’t go wrong with asking how you can support their recovery. 

Supporting a friend who might have anorexia and needs help

Even if it seems obvious to you that your friend is really struggling, you might find it hard to support them to get the help they need. If you encounter resistance, don’t give up. Focus on communicating that you care and that you are there for them.

Remember that your friend may be suffering deeply and yet may not realize they are sick. It’s common for someone with anorexia to experience anosognosia, the inability to recognize their illness. 

Even someone who is aware of the severity of their eating disorder can feel defensive, ashamed, and afraid. It’s best to approach with compassion and curiosity–and to show that you love and accept them. Some examples of ways to start a conversation might be:

  • “I’m worried about you, and I want you to know I’m here to listen.”
  • “I care so much about you. Would you like some support?”
  • “When you’re ready to talk about what’s going on, I’ll be here for you.”

If you’re noticing that things are not improving, talk to someone who can help. Caring friends often decide to share their concerns with a school counselor, administrator, or someone at a campus mental health center. Reaching out for support from a professional on your campus–even if your friend is currently refusing treatment–can be tough, but it can also be life-saving. 

You can contact the National Eating Disorders Association hotline by phone or chat at 800-931-2237 for more information and resources.

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If you or someone you know needs to talk to someone right now, text HOME to 741-741 or call 1-800-273-TALK (8255) for a free confidential conversation with a trained counselor 24/7. 

If you are experiencing a mental health crisis, text or call 988.

If this is a medical emergency or if there is immediate danger of harm, call 911 and explain that you need support for a mental health crisis.