Anorexia nervosa

Anorexia is a mental health condition, not a lifestyle choice or a diet that went too far. It involves persistent restriction of energy intake, an intense fear of weight gain or behaviors that prevent it, and a disturbance in how body shape or weight is experienced. Self-worth often becomes closely tied to food, weight and control.

There are two main patterns. In the restricting type, weight loss happens mainly through dieting, fasting or excessive exercise. In the binge-eating/purging type, a person may also binge or purge, for example by vomiting or misusing laxatives.

People with anorexia are not always underweight. Atypical anorexia describes the same thoughts and behaviors in someone whose weight is within or above the typical range, often after significant weight loss. It can be just as serious medically and psychologically. Because anorexia nervosa can affect the heart, bones, hormones and brain, it needs both psychological and medical care.

Signs of anorexia can be emotional, behavioral and physical. Common anorexia symptoms include:

• Strict dieting, skipping meals or cutting out whole food groups
• Preoccupation with calories, food, weight or body shape
• Intense fear of gaining weight, even when underweight
• Exercising excessively or compulsively, even when unwell or injured
• Avoiding eating with others or hiding food
• Rituals around eating, such as cutting food into tiny pieces
• Frequent body checking or weighing
• Wearing baggy clothes or layers to hide weight loss
• Feeling cold, tired, dizzy or faint
• Loss of periods, hair thinning, dry skin or fine body hair
• Irritability, anxiety, low mood and social withdrawal

Someone who is anorexic may deny there is a problem, which is part of the illness rather than stubbornness. If you notice several of these warning signs in yourself or someone else, it is important to seek help early.

Anorexia develops from a complex combination of factors. No single cause explains it, and it is not anyone's fault. Contributing factors may include:

• Genetics and family history of eating disorders, anxiety, depression or OCD
• Personality traits such as perfectionism, high self-criticism or a strong need for control
• Anxiety disorders or obsessive-compulsive traits
• Dieting, especially in adolescence
• Puberty and other major life transitions
• Stressful or traumatic experiences, including bullying about weight
• Cultural and social pressures that value thinness
• Sports or activities that emphasize weight or appearance

Once restriction begins, the effects of starvation on the brain can intensify rigid thinking, anxiety and preoccupation with food. This is one reason anorexia can become entrenched and why early treatment matters so much.

Treatment usually involves a team, which may include a psychologist or therapist, a psychiatrist, a medical doctor and a dietitian specializing in eating disorders. Care is tailored to the person's age, physical health and needs.

Evidence-based approaches include:

• Family-based treatment (FBT), the leading approach for children and teenagers, in which parents play an active role in restoring nutrition
• Cognitive behavioral therapy for eating disorders (CBT-E), which targets the thoughts and behaviors that maintain the illness
• Specialist supportive clinical management and other structured therapies for adults
• Nutritional rehabilitation and medical monitoring to restore health safely

Treatment may take place in outpatient settings, intensive day programs or, when medical risk is high, in a hospital or residential setting. A psychiatrist may treat co-occurring anxiety, depression or OCD. Medication is not a primary treatment for anorexia itself.

Anorexia recovery takes time and often involves setbacks, but many people make a full or substantial recovery, especially with early treatment and ongoing support.

Anorexia can become a medical emergency. Seek urgent medical help, by calling 911 in the US or your local emergency number, or by going to an emergency department, if someone:

• Faints, has chest pain, a very slow or irregular heartbeat, or severe dizziness
• Is confused, extremely weak or unable to stand
• Is vomiting blood or has severe dehydration
• Has stopped eating or drinking almost entirely

Anorexia is also associated with an increased risk of suicide. If you or someone you know is thinking about suicide or self-harm, reach out now. In the US, call or text 988 to reach the 988 Suicide & Crisis Lifeline. In the UK and Ireland, call Samaritans on 116 123.

If there is no immediate danger but you are worried, contact a doctor soon. Early assessment, including physical checks, can make treatment safer and more effective.

A clinical psychologist or psychologist specializing in eating disorders, a psychiatrist and a doctor are usually involved. At a first appointment, expect questions about eating, weight changes, exercise and thoughts about your body, as well as a physical assessment. You may feel ambivalent about change; that is common and something professionals are used to working with.

If you're supporting someone with anorexia:

• Express concern calmly, focusing on behaviors and feelings rather than weight or appearance
• Avoid blame, ultimatums or comments about their body
• Encourage professional help and offer to go with them
• Learn about eating disorders so you understand what they're facing
• Look after your own wellbeing; support for families is an important part of recovery