Anorexia Nervosa

Anorexia nervosa is a very serious and complex condition, which is widely known but perhaps not always fully understood. Anorexia is a phobia of being a normal weight. It is not, as is often described, a fear of ‘being fat’; for a person with anorexia, body image disturbance is such that there is an overwhelming fear of being within a normal weight range.

  • What is anorexia?
  • What are the symptoms of anorexia?
  • What are the causes of anorexia?

The diagnosis of anorexia nervosa is based on a number of indicators. The signs of anorexia are:

  • Intentional weight loss leading to BMI of less than 17.5 (or for young people aged 18 and under, a significantly lower percentile BMI than would be expected for their age)
  • Loss of periods for three cycles or more (in adolescents, if menstruation has been established). In boys and men, there is a loss of libido (sexual drive)
  • Severe body image disturbance: the individual believes they are overweight when they are extremely underweight
  • There is an intense fear of gaining weight and behaviour (restricting food intake, sometimes over-exercising and purging) to maintain a low weight

It can be difficult to identify the symptoms of anorexia because people do experience changes in how they feel about their body image and dieting and some weight loss commonly occurs. Equally, the typical time of onset for anorexia nervosa is adolescence, which is a time when young people are eating more independently, and mealtime habits often go through changes.

There may be other signs which may alert parents or concerned friends to symptoms of anorexia: for example, an individual may start to wear very baggy clothes and many layers, they may consistently find reasons to miss meals (going to clubs instead of joining friends for school dinners, avoiding social occasions that involve food) and what they say about their appearance may be a sign of body image disturbance.

Because anorexia is such a serious condition, if you have any concerns about a child, relative or friends, it is best to find a way to raise your concerns with them, as anorexia treatment is known to be more effective if started at an early stage. Left untreated for a longer period, a full anorexia recovery is harder to achieve.

There is never a single cause of anorexia nervosa. There will always be a number of causes and the exact interaction of different factors will vary for each individual. For some, there is a trauma or family distress which they are struggling to deal with and this may be combined with other related issues, such as social isolation and difficulties at school. Others will have stable, well-functioning families, but may struggle with academic pressures, perfectionism, and self-esteem.

There is ongoing research to assess to what extent genetic factors may be anorexia causes, together with other difficulties. What is clear is that effective anorexia treatment must address the multiple causes in a deep and lasting way in order to achieve a full recovery.