Anorexia Defined: Diagnosing, Treating, and Preventing Anorexia

​​Anorexia nervosa is a common eating disorder that affects your weight and body image. It’s associated with a wide variety of mental and physical health problems. It can affect all ages, genders, ethnicities, and body sizes. 

If you have anorexia, it’s important to know that you’re not alone. There are many resources available to treat anorexia, and recovery is possible. 

Here’s a guide to anorexia, including common symptoms, how it’s diagnosed and treated, and steps to help you get through recovery. 

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Quiz: Do I have an eating disorder?

What is anorexia nervosa?

Anorexia is an illness that causes you to avoid or restrict food. It often leads to a significant change in body weight. 

People with anorexia have a strong fear of gaining weight. They also have a negative or distorted view of their body’s shape and size. As part of their illness, people with anorexia sometimes also binge eat. Or they may “purge” by vomiting, exercising, or misusing laxatives. 

Anorexia usually occurs in girls between the ages of 15 to 19 years old. But it can affect any age and gender. Anorexia affects about 1% to 2% of women, and they’re about 10 times more likely to be affected than men. College athletes are also at increased risk for developing anorexia. 

Anorexia is also associated with higher risks of mental health disorders like depression and anxiety. Of all the mental health conditions, anorexia has the highest rate of death, which can happen in up to 5% of people who have it. About 20% of those deaths are from suicide. 

Some studies show that only about half of people with anorexia get diagnosed. And only about one-third of those get specialized treatment. Some reasons for this are that people with anorexia may deny having the condition, hide their symptoms, or avoid getting treatment. Black people are also less likely to be diagnosed with anorexia, even though they may experience it for a longer period of time. 

Anorexia can result in serious medical problems, so getting treatment is important. Early treatment (especially for young people) can improve your chances of recovery. 

Do you have anorexia nervosa?

If you have symptoms of anorexia, it’s important to get help. It can be hard to talk to your provider about your weight and eating behaviors. But remember: They’re there to help.

When you meet with your provider, they may ask you questions about your eating behavior and body image. They may also measure your height, weight, and blood pressure. In some cases, they might also do a physical exam and suggest additional tests like a:

• Blood test 

• Urine test

• Electrocardiogram (heart function test)

• Bone scan (called a DEXA, or dual-energy X-ray absorptiometry)

• CT scan

• X-ray

• MRI 

How is anorexia diagnosed?

Your healthcare provider will use the information from your interview, physical exam, and tests to decide whether or not you have anorexia — or another health condition. 

People with anorexia have the following three characteristics:

1) Food restriction: People with anorexia eat less food than their body needs. This can cause unsafe weight loss. And it can sometimes lead to a very low body weight (compared to people of the same gender, age, and physical health).

2) Intense fear of gaining weight: People with anorexia have a strong fear of gaining weight or becoming “fat” — even if they have a very low body weight.

3) Distorted body image: People with anorexia see their weight and body shape in a distorted way. They may think they have overweight or obesity, even if they do not. They may also not be able to understand how their low body weight could cause serious health problems.

People with lower body weight are considered to have more severe anorexia. But it’s important to know that anorexia can affect all body sizes (more on atypical anorexia below).

Can bulimia also cause physical symptoms?

Yes. People with anorexia can also have physical symptoms. These include:

• Missing periods (amenorrhea)

• Brittle hair and nails

• Fine hair growing on the body (lanugo)

• Weakness

• Fatigue

• Constipation

What is atypical anorexia?

People with atypical anorexia have all the criteria of regular anorexia but have a normal (or high) weight — despite having lost weight. They may have similar health problems as typical anorexia and experience even more distress related to eating and body image. You can read more about this condition in our GoodRx guide to atypical anorexia. 

What are the causes of anorexia nervosa?

We don’t know exactly what causes anorexia, but it can run in families. Having a first-degree relative (like a sibling) with anorexia can make you 10 times as likely to get it yourself. 

There are also many psychological, environmental, and social risk factors for anorexia. Keep in mind that everyone is different, and these factors may affect each person differently.  

Physical and genetic risk factors

• Having a family member with a mental health condition (like depression)

• Having a history of attempting to control your weight through diets or other methods

• Having certain genes that may be linked to a higher chance of developing anorexia

• Having Type 1 diabetes, which can lead to skipping insulin injections to stay thin (called diabulimia)

Psychological risk factors

• Being a perfectionist, especially toward yourself (called self-oriented perfectionism)

• Having psychological illnesses, like depression, anxiety, and substance abuse

• Being unhappy with your body image

• Being inflexible or having a hard time changing your behaviors 

Social risk factors

• Feeling lonely or isolated

• Being exposed to weight stigma (discrimination or stereotyping based on weight)

• Being teased or bullied in the past, especially about weight

• Having a traumatic life event or stress

What happens if you don't treat anorexia?

If anorexia isn’t treated, it can cause many serious medical problems — and sometimes even lead to death. Treatment and weight gain (if weight was low) can improve some of these conditions. But others may lead to permanent damage. Serious damage may include:

• Heart problems: including irregular heart rhythms, problems with your heart valves, and low blood pressure

• Digestive problems: like constipation or diarrhea, fullness or pain after eating, and liver disease

• Lung problems: like a collapsed lung or lung inflammation (pneumonia)

• Hormone problems: can affect your period and other body systems

• Skin changes: like brittle hair and nails, dry skin, growth of fine hairs on the body (called lanugo)

• Bone loss: including osteoporosis and osteopenia

• Muscle loss: can lead to weakness 

• Death: from sudden loss of heart function, suicide, and other causes 

How do you treat anorexia?

Treatment for anorexia focuses on addressing any medical problems, working toward a healthy weight, and changing your eating disorder behaviors. It’s also important to treat any other mental health conditions, like depression or anxiety. 

Treatment looks different for each person. And it depends on many factors, like your age, physical and mental health, and insurance coverage. It’s important to remember that recovery can take months or years, and that slips and backslides are normal. 

First we’ll review some common treatments, and then we’ll discuss where people usually get treatment. 

Psychotherapy

Psychotherapy (talk therapy) is one of the main treatments for anorexia. Here are some different types of therapy that can be helpful for people with anorexia:

• Cognitive behavioral therapy (CBT): helps identify and change negative thoughts and beliefs in order to change your feelings and behaviors.

• Maudsley anorexia nervosa treatment for adults (MANTRA): is a specialized integrative therapy that treats anorexia. 

• Specialist supportive clinical management (SSCM): is a combination of supportive psychotherapy and hands-on support for changing your eating habits and behaviors.

• Family therapy: helps family members understand and support each other. It’s especially recommended for people under 18 years of age, or for anyone whose family relationships affect their eating disorder.  

Nutrition therapy

Reaching and maintaining a healthy weight and getting the proper nutrition is an important part of recovery. For some people, this may mean spending time in a medical facility to help with treatment. 

Medications 

In general, studies haven’t shown that medications are very helpful in treating anorexia. But they  are still sometimes used — especially when other treatments haven’t worked. 

• Selective serotonin reuptake inhibitors (SSRIs): These may be used to treat depression, anxiety, and obsessive-compulsive disorder (OCD) in people with anorexia.

• Olanzapine (Zyprexa): This is a medication that can help some people with anorexia regain weight. It’s usually only used when psychotherapy and nutrition education haven’t worked. 

Self-care 

Getting treatment for any disorder can be hard, so it’s important to care for yourself as much as possible during and after treatment. Here are some self-care tips:

• Surround yourself with supportive people, like friends and family, and keep talking to them even as you recover. 

• Follow your treatment plan and the advice of your team, even as you’re getting better.

• Join an eating disorder support group. 

• Get regular and adequate nutrition. 

• Identify your triggers, and get a plan to cope with them. 

• Work with your team to create a relapse prevention plan.

• Try to avoid people who make you feel bad about yourself or drain your energy.  

• Find activities that make you happy.

• Be kind to yourself and believe in your recovery and yourself.

Where do you treat anorexia?

There are different levels of care available to treat anorexia. The type of care you get depends on your physical, mental, and nutritional needs. As you recover, it’s common to move between some of these different levels of care: 

• Outpatient: This includes regular office or clinic appointments with different healthcare providers. This is if you have stable health and can continue with your regular routines. So you eat and sleep at home.

• Intensive outpatient program: This is for when you need a little more support. You still sleep at home, but you’ll go to a treatment center or clinic a few times a week for several hours at a time. This includes group meetings with other people and some supervised meals and snacks at the program.

• Partial hospitalization/day program: This is when you could benefit from daily and more structured support. This can include individual and group meetings at a treatment center for 6 to 8 hours a day and some supervised meals and snacks. You would spend the night at home.

• Residential program: This is for when you would benefit from living at a program full time with continued support and supervision. This includes individual and group meetings, supervised meals and snacks, and staying at the program overnight. Family and friends are able to visit during visiting hours.

• Inpatient: This treatment is done at a hospital and provides 24-hour care. It’s for serious medical problems and those that don’t respond to other treatments. After you’re physically and mentally well enough, you may transition into other levels of care. You may need Inpatient care if you have these conditions:

  • Very low heart rate, blood pressure, or body temperature

  • Changes in your blood pressure or heart rate when you stand from a sitting or lying position

  • Irregular heart rate

  • Very low body weight or body fat

  • Refusal to eat

  • Not responding to other treatments

• Family-based treatment (FBT): This is for young people with anorexia whose family is interested and able to treat their child’s eating disorder at home. This includes regular family meetings with a therapist who specializes in FBT and consultations with other providers. Parents supervise meals and snacks.

Stages of recovery

There are different stages of recovery. Knowing about stages can help people with anorexia and their loved ones on the road to recovery. These stages may happen in a cycle, and you may revisit different stages before moving on to the next one. It’s also common to have a relapse during recovery. Stages of recovery include:

• Precontemplation stage: This happens when you don’t believe you have a problem. Part of this stage is to learn about the negative effects of anorexia and how recovery can bring positive change.

• Contemplation stage: You’re willing to admit there’s a problem and are open to getting help. A therapist is helpful to identify the role and purpose of the anorexia, and why it no longer helps you.

• Preparation stage: You’re ready to change, but you aren’t sure how to do it. Along with the treatment team and family members, you identify barriers to change and develop a plan of action.

• Action stage: You start the treatment plan, and you’re willing to face fears in order for change to occur.

• Maintenance stage: This occurs when you maintain the action stage for 6 months or longer. You may revisit possible triggers in order to prevent relapse.

• Termination stage and relapse prevention: Termination depends on many factors, like progress, the existence of a relapse plan, and willingness to get treatment again if needed.

How do you tell if a friend or family member has anorexia?

It can be hard to know if someone has anorexia. Here are some warning signs:

• Dramatic weight loss

• Excessive concern with weight, food, and dieting, and making excuses to avoid mealtimes

• Dressing in layers to stay warm or hide weight loss

• Withdrawing from normal friends or activities and becoming more isolated

• Making comments about being overweight or “fat” despite losing weight

• Food rituals (like cutting food into tiny pieces)

Resources for anorexia

Here are a handful of resources for anorexia:

• National Association of Anorexia Nervosa and Associated Disorders: This is a nonprofit organization that provides free, peer support services to people struggling with eating disorders. 

• National Eating Disorders Association: This is a nonprofit organization dedicated to supporting people and families affected by eating disorders through different programs and services. Their eating disorder screening tool for people 13 years and older can help determine if it’s a good idea to get professional help. 

• The Eating Disorder Foundation: This is a nonprofit organization devoted to helping people with eating disorders and their families through support, education, and advocacy. 

• Eating Disorders Coalition: This organization advances the awareness of eating disorders as a public health priority by working with policymakers and organizing others to advocate on behalf of people with eating disorders. 

• Pride Counseling: This is an organization that provides online therapy to the LGBTQ community. The therapists are all licensed and specialize in the LGBTQ community, and they offer a range of counseling services. 

• National Suicide Prevention Lifeline: This service is available at 1-800-273-8255 any time or day.

• National Alliance on Mental Illness: This is a mental health organization that works to improve the lives of those affected by mental illness through education and advocacy. 

• Project HEAL: This is a nonprofit organization focused on ensuring all people have equal access to eating disorder treatments. People with an eating disorder and no or low access to treatment can apply for support on their website. 

What can parents do?

We don’t know how to prevent anorexia. But identifying and treating it early in your child can lower the symptoms and improve the chance of recovery. Here are some tips if your child has anorexia:

• Talk to your child’s provider to understand and participate in the treatment plan.

• Talk to your child in a compassionate and supportive way, and be prepared to listen.

• Participate in family therapy if it’s recommended.

• Get advice from the treatment team on how to handle mealtimes.

• Talk to your child’s school about their treatment plan and if specialized education is needed.

• Get counseling for yourself.

• Have a strong support system, including support groups that can help you be in touch with other parents in a similar situation.

• Connect with family-centered resources like F.E.A.S.T. and Maudsley Parents.

Why trust our experts?

Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

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