From Matthew Tiemeyer,
Your Guide to Eating Disorders.
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About.com Health's Disease and Condition content is reviewed by Steven Gans, MD

When a person struggles with anorexia nervosa, information she receives from others about her body will often be rejected. She (or he) will generally have a profoundly distorted body image, believing that she is overweight regardless of how much weight she loses. A person with anorexia nervosa may not even feel good about weight she has lost: She will often believe that she needs to lose more, or she may have a profound fear of gaining weight (or both).

Diagnostic Criteria for Anorexia Nervosa

Not everyone who skips a meal here and there qualifies for a diagnosis of anorexia nervosa. There are gray areas in which people may meet some of the criteria for anorexia and not all (see Eating Disorders Not Otherwise Specified). Knowing the difference may lead professionals to suggest different treatment options.

• Diagnosis of Anorexia Nervosa

Physical Symptoms of Anorexia Nervosa

The most visible symptom of anorexia nervosa is a sometimes dramatic loss of body weight that is clear to the casual observer. But the symptoms range far beyond appearance. A person's body changes in many ways--some subtle, some not (University of Maryland, 2006):

• Weight loss (which can be achieved via restricting food or purging it)
• Menstrual problems (amenorrhea)
• Bone loss (osteoporosis or osteopenia)
• Extra sensitivity to cold
• Bloated stomach after eating (when the stomach has lost its ability to deal with a normal quantity of food at one sitting)
• Lanugo--a fine hair that grows on the skin in response to the body's need for warmth
• Yellowed skin (often from getting too much vitamin A as a result of eating only certain foods, like carrots)
• Thinning hair
• Confused thinking (since the brain needs fuel to function properly)

Mental and Behavioral Changes in Anorexia

In addition to physical changes, friends and family may notice changes to the person's thoughts and behaviors:

• Distortion of body image
• Ritualistic eating (including cutting food into a planned number of bites)
• Spitting out food before swallowing
• Much more attention paid to nutrition labels
• Major increase in exercise output, even when exhausted
• Hatred for foods that used to be favorites
• Refusal to eat with others

(compiled in part with information from ANRED [2005])

Statistics

Some studies suggest that 1 in every 25 women suffers from anorexia at some point in her lifetime. This and other statistics highlight the importance of understanding more about the disorder.

• Prevalence, Onset and Mortality Statistics for Anorexia Nervosa

Risk Factors

Every person is unique, and anorexia arises for lots of different reasons. We do know, however, that there are factors that make anorexia and other eating disorders more likely to occur. The following have been linked to eating disorder development:

• Abuse and Trauma
• Family Issues
• Social Isolation
• Genetic Factors
• Cultural Factors
• Triggering Events

• More on Risk Factors for Anorexia Nervosa

Related Mental Disorders

Frequently, those who struggle with anorexia show signs of other mental disorders.

• Mood disorders are very common. Depression, the mood disorder most likely present, often deepens symptoms of anorexia.
• Anxiety disorders may also be prominent. Anxiety may arrive in a generalized form. It may also manifest in the form of obsessive-compulsive disorder, or OCD. As mentioned above, obsessions can take the form of ritualistic eating, but OCD can be present in other ways as well.
• Personality disorders less commonly occur alongside anorexia. They are very severe and are usually more resistant to treatment. A personality disorder may be present when it seems that a person's character traits have been damaged. Several kinds of personality disorders are possible, but those with anorexia are most likely to deal with [em]avoidant personality disorder[/em]. In these cases, avoiding relationships becomes extremely important--to the point that it impairs the person's ability to function.

• Further Information on Related Mental Disorders

Treatment Strategies

Treatment of anorexia, as with other eating disorders, usually involves a number of different treatment strategies. Physical problems take precedence over psychological symptoms in many cases. For example, one might wish to treat depression in a person with severe anorexia with an SSRI or other antidepressant. But her body will not be able to metabolize the drug, so it will not provide any benefit. Treating the physical parts of the disorder first can give the person strength to deal with psychological, social, and spiritual issues. It is important to treat the entire person.

• What to Expect When You Begin Treatment
• A Four-Part Treatment Approach
• The Maudsley Method (A Family Approach)

• Further Information on Anorexia Nervosa Treatment Strategies

Seeking Professional Help

Knowing how you want treatment to look is one thing. Finding the professionals to help is another. There are several options to consider as you choose your caregivers, and your decision may be based on geography or finances. If you can afford it and live near one, an appropriate and qualified treatment center is a solid choice. In other circumstances, you may need to build your treatment team piece by piece.

• Things to Know About Inpatient and Outpatient Treatment
• How to Build Your Own Treatment Team
• What to Expect When Beginning Treatment

• More on Finding Help for Anorexia Nervosa

Sources:

Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED), 2005. "Eating Disorders Warning Signs." <http://www.anred.com/warn.html>. Accessed 11 December 2006.

University of Maryland Medical Center, 2004a. "Anorexia Nervosa." A.D.A.M. <http://www.umm.edu/altmed/ConsConditions/AnorexiaNervosacc.html>. Accessed 2 December 2006.

University of Maryland Medical Center, 2004. "What Causes Eating Disorders?" <http://www.umm.edu/patiented/articles/what_causes_eating_disorders_000049_3.htm>. Accessed 2 December 2006.