What is anorexia nervosa?

Anorexia nervosa is a mental illness that has serious physical, emotional and social impacts.

Anorexia nervosa is characterised by body image distortion with an obsessive fear of gaining weight, which manifests itself through depriving the body of food. It often coincides with increased levels of exercise. When identifying anorexia nervosa, it’s important to remember that:

  • Anorexia nervosa occurs in people of all genders. Men and boys are more likely to go undiagnosed because of stigma and misinformation.
  • Anorexia nervosa can present differently for different people
  • Anorexia nervosa impacts people in all body shapes and sizes
  • Anorexia nervosa is serious and requires medical and psychological interventio

Eating disorders are not a lifestyle choice, a diet gone wrong or a cry for attention. They are mental illnesses recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and can take many different forms. Importantly, you cannot tell if someone has an eating disorder by the way they look.  

Restrictive anorexia nervosa

This is the most commonly known type of anorexia nervosa, whereby a person severely restricts their food intake. Restriction may take many forms (e.g. maintaining very low-calorie count, restricting types of food eaten, eating only one meal a day) and may follow obsessive and rigid rules (e.g. only eating food of one colour).

Binge-eating or purging anorexia nervosa

This type of anorexia nervosa forms when a person restricts their intake as above, but also has regularly engaged in binge-eating or purging behaviour (e.g. self-induced vomiting, over-exercise, misuse of laxatives, diuretics or enemas). 

Atypical anorexia nervosa

This diagnosis falls under the category of eating disorders known as OSFED (Other Specified Feeding or Eating Disorders) on the basis that individuals may still experience weight loss, however their weight will not fall into a low category.  

Many professionals and advocates believe that the term ‘atypical’ is unhelpful and stigmatising. Atypical anorexia nervosa is actually found to be more prevalent than ‘typical’ anorexia nervosa. People with atypical anorexia nervosa are just as likely to have worrying symptoms, such as psychological distress, low heart rate and nutritional deficiencies. It is important that those with atypical anorexia nervosa seek help, and that health professionals validate these experiences and provide appropriate treatment.  

Risk factors for anorexia nervosa

There is no single cause of anorexia nervosa, but there are risk factors that increase the likelihood of it developing. These can be biological, psychological and social.

Biological risk factors

Evidence tells us that anorexia nervosa has a moderate-high genetic heritability. Ongoing research into this field is analysing hundreds of genes that may influence the chance of developing an eating disorder with the hope of improving treatment and even preventing illness. You can learn more about the Eating Disorders Genetic Initiative (EDGI), the world’s largest ever genetic investigation of eating disorders, here.   

Anorexia nervosa usually develops during adolescence and generally has an earlier age of onset compared to bulimia nervosa and binge eating disorder (the latter are often developed during late adolescence or early adulthood). However, like all eating disorders, anorexia nervosa can develop at any age or stage of life, and for people of any gender, including males. It is a myth that only adolescent girls experience anorexia. 

Other research also shows that women with autism may have a higher chance of developing anorexia nervosa. It appears that up to 20-35% of women with anorexia meet the diagnostic criteria for autism. Symptoms and treatment for people with autism and anorexia nervosa may differ from other populations, with research into this field still ongoing. 

Psychological risk factors

Some psychological risks for anorexia nervosa encompass feelings of inadequacy, personality traits of perfectionism and anxiety, a fear or avoidance of conflict, low self-esteem, competitiveness, and impulsive or obsessive behaviours. 

It is important to note that psychological symptoms can also be present as the result of an eating disorder and the impact of starvation syndrome. Psychological symptoms may resolve with adequate re-nourishing and subsequent recovery.

Social risk factors

The cultural emphasis on ‘thinness’ or smaller bodies as a moral and health imperative, along with the normalisation of intentional dieting, contributes to the valuation of individuals based on outward appearance. Not conforming to these narrow standards can lead to shame and subsequently, the development of eating disorders. 

Media and popular culture play a significant role in shaping perceptions of ‘ideal’ or ‘acceptable’ body shapes, further influencing societal norms and the pressure to conform. 

Professions such as dancers, models, and athletes, which prioritise certain body shapes and sizes, can also be at increased risk of anorexia nervosa and other eating disorders.  

Signs and symptoms of anorexia nervosa

 

Some of the more common signs and symptoms of anorexia nervosa are listed below. Remember, anorexia nervosa is a mental illness. You can’t tell if someone has an eating disorder based on physical appearance alone.

Mental health symptoms

  • Preoccupation with body shape, weight and/or appearance 
  • Intense fear of gaining weight 
  • Preoccupation with food or food related activities 
  • Negative or distorted body image, perceiving self to be fat when at a healthy weight or underweight 
  • Low self-esteem (e.g. guilt, self-criticism, worthlessness) 
  • Rigid thinking (‘black and white’, ‘good and bad’ foods) 
  • Feeling out of control 
  • Mood swings 
  • Anxiety or depression 
  • Heightened anxiety around mealtimes 
  • Heightened sensitivity to comments or criticism about body shape, weight, appearance, eating or exercise habits 
  • Suicidal or self-harm thoughts or behaviours 

Behavioural symptoms

  • Constant or repetitive dieting, restrictive or rigid eating patterns 
  • Excessive or compulsive exercise
  • Obsessive rituals around food
  • Changes in food preferences
  • Repetitive or obsessive body-checking behaviours
  • Deceptive or secretive behaviour around food 

Social symptoms

  • Frequent avoidance of eating meals, making excuses not to eat 
  • Social withdrawal or avoidance of social situations involving food 
  • Changes in clothing style 
  • Impaired school or work performance