Anorexia Nervosa
Anorexia nervosa is more than not eating enough. It's a serious mental health condition involving an intense fear of weight gain, a distorted relationship with one's body, and self-starvation that can have life-threatening consequences.
What is anorexia nervosa?
Anorexia nervosa has three defining features that must all be present for a diagnosis. First, a person restricts how much they eat, to the point of reaching a significantly low body weight for their age, sex, and stage of development. Second, they have an intense fear of gaining weight or becoming fat—or they engage in ongoing behaviors that prevent weight gain—even when already dangerously underweight. Third, there is a disturbance in how they experience their own body: they may see themselves as larger than they are, place excessive importance on weight or shape in how they judge themselves, or fail to recognize just how serious their low weight has become.
This combination—severe restriction, fear of weight gain, and a distorted sense of the body—is what sets anorexia apart from other eating difficulties.
The two subtypes
Restricting type (F50.01)
In this subtype, weight loss is achieved primarily through dieting, fasting, and/or excessive exercise. Over the past three months, there have been no recurrent episodes of binge eating or purging behaviors such as self-induced vomiting or misuse of laxatives.
Binge-eating/purging type (F50.02)
In this subtype, the person also engages in recurrent episodes of binge eating or purging behavior (such as self-induced vomiting or misuse of laxatives, diuretics, or enemas) during the past three months. It is important to note that subtypes can shift over time—which subtype applies reflects the current picture, not the person's entire history.
How severity is measured
In adults, severity is based on body mass index (BMI). In children and adolescents, BMI-for-age percentiles are used instead.
Severity may be increased beyond BMI alone if symptoms, degree of functional disability, or the need for supervision are particularly high.
Signs and symptoms
Beyond the core features of restriction and fear of weight gain, anorexia nervosa is associated with a wide range of physical and psychological effects:
- Loss of menstrual periods and other hormonal disruptions
- Bone loss, increasing the risk of fractures
- Low blood pressure and an unusually slow heart rate
- Fine downy hair on the body (lanugo), dry or yellowish skin
- Feeling cold all the time
- Constipation and abdominal discomfort
- Preoccupation with food, ritualized eating habits, or perfectionism around meals
- Social withdrawal and emotional restraint
- Excessive exercise, often pursued despite injury or illness
In those who also purge, additional physical effects can include electrolyte imbalances that affect heart function, which can be medically dangerous.
How common is it?
Anorexia nervosa occurs across all ethnic groups in the United States, though prevalence varies globally. It is more common in high-income countries but is increasingly recognized in other settings as well.
When does it start and how does it progress?
Anorexia nervosa most commonly begins in adolescence or young adulthood, and onset is often linked to a stressful life event. The course is variable—some people recover fully after a single episode, while for others the illness becomes chronic, with periods of improvement and relapse.
Without treatment, the condition can persist for many years. The mortality rate is approximately 5% per decade, from both medical complications and suicide, making early intervention especially important.
Risk factors
Temperament and personality
People who experience anxiety disorders or have obsessive-compulsive traits—such as perfectionism, a need for control, and rigid thinking—may be at higher risk of developing anorexia nervosa.
Environment
Cultural pressure around thinness and appearance, as well as involvement in certain occupations or activities—such as modeling, gymnastics, dance, or competitive sport—can increase risk.
Genetics and biology
Anorexia nervosa runs in families, and the genetic risk overlaps with that for anxiety disorders and mood disorders. Having a close relative with an eating disorder increases a person's own risk.
Anorexia nervosa and suicidal thoughts
Suicide is the second leading cause of death in anorexia nervosa. Approximately one in four people with the condition report suicidal thoughts, and around 9% have attempted suicide. If you or someone you know is struggling, please reach out for help.
988 Suicide & Crisis Lifeline: Call or text 988 (available 24/7 in the U.S.)
Conditions that often occur alongside anorexia nervosa
Anorexia nervosa rarely occurs in isolation. It commonly appears alongside:
- Anxiety disorders
- Depressive disorders
- Bipolar disorder
- Obsessive-compulsive disorder
- Substance use disorders
What to do next
If you recognize yourself or someone you care about in these descriptions, know that anorexia nervosa is treatable—and the earlier treatment begins, the better the chances of full recovery. Effective approaches include family-based treatment (particularly for adolescents), individual therapy such as cognitive behavioral therapy, nutritional rehabilitation, and medical monitoring. For severe cases, inpatient or intensive outpatient care may be needed to ensure physical safety.
A GP or mental health professional is a good first point of contact. You do not need to be at your lowest weight to deserve help.