Anorexia Nervosa: Signs, Symptoms and Causes

It’s only human to wish you looked different or could fix something about yourself. But when a preoccupation with being thin takes over your eating habits, thoughts, and life, it’s a sign of an eating disorder. When you have anorexia, the desire to lose weight becomes more important than anything else. You may even lose the ability to see yourself as you truly are.

Anorexia is a serious eating disorder. It can damage your health and even threaten your life. But you’re not alone. There’s help available when you’re ready to make a change. You deserve to be happy. Treatment will help you feel better and learn to value yourself.


What is anorexia nervosa?

Maria’s Story

Seventeen-year-old Maria has been on one diet or another since she was in junior high. She recently lost 10 pounds from an already slender frame after becoming a strict vegetarian. Her parents are concerned about the weight loss, but Maria insists that she’s just under stress at school. Meanwhile, her vegetarian diet is becoming stricter by the day.

Maria obsessively counts calories, measures food portions, and weighs herself at least twice a day. She refuses to eat at restaurants, in the school cafeteria, or anywhere else in public, and she lives on salad dressed with vinegar, rice cakes, and sugar-free Jello. Maria also has a large stash of fat-free candy in her room. She allows herself to indulge as long as she goes for a run right afterwards.

Anorexia nervosa is a complex eating disorder with three key features:

• refusal to maintain a healthy body weight
• an intense fear of gaining weight
• a distorted body image

Because of your dread of becoming fat or disgust with how your body looks, eating and mealtimes may be very stressful. And yet, what you can and can’t eat is practically all you can think about.

Thoughts about dieting, food, and your body may take up most of your day—leaving little time for friends, family, and other activities you used to enjoy. Life becomes a relentless pursuit of thinness and going to extremes to lose weight. But no matter how skinny you become, it’s never enough.

While people with anorexia often deny having a problem, the truth is that anorexia is a serious and potentially deadly eating disorder. Fortunately, recovery is possible. With proper treatment and support, you or someone you care about can break anorexia’s self-destructive pattern and regain health and self-confidence.

Types of anorexia nervosa

There are two types of anorexia. In the restricting type of anorexia, weight loss is achieved by restricting calories (following drastic diets, fasting, and exercising to excess). In the purging type of anorexia, weight loss is achieved by vomiting or using laxatives and diuretics.

Are you anorexic?

• Do you feel fat even though people tell you you’re not?
• Are you terrified of gaining weight?
• Do you lie about how much you eat or hide your eating habits from others?
• Are your friends or family concerned about your weight loss, eating habits, or appearance?
• Do you diet, compulsively exercise, or purge when you’re feeling overwhelmed or bad about yourself?
• Do you feel powerful or in control when you go without food, over-exercise, or purge?
• Do you base your self-worth on your weight or body size?

Anorexia is not about weight or food

Believe it or not, anorexia isn’t really about food and weight—at least not at its core. Eating disorders are much more complicated than that. The food and weight-related issues are symptoms of something deeper: things like depression, loneliness, insecurity, pressure to be perfect, or feeling out of control. Things that no amount of dieting or weight loss can cure.

What need does anorexia meet in your life?

It’s important to understand that anorexia meets a need in your life. For example, you may feel powerless in many parts of your life, but you can control what you eat. Saying “no” to food, getting the best of hunger, and controlling the number on the scale may make you feel strong and successful—at least for a short while. You may even come to enjoy your hunger pangs as reminders of a “special talent” that most people can’t achieve.

Anorexia may also be a way of distracting yourself from difficult emotions. When you spend most of your time thinking about food, dieting, and weight loss, you don’t have to face other problems in your life or deal with complicated emotions.

Unfortunately, any boost you get from starving yourself or shedding pounds is extremely short-lived. Dieting and weight loss can’t repair the negative self-image at the heart of anorexia. The only way to do that is to identify the emotional need that self-starvation fulfills and find other ways to meet it.

Signs and symptoms of anorexia

Living with anorexia means you’re constantly hiding your habits. This makes it hard at first for friends and family to spot the warning signs. When confronted, you might try to explain away your disordered eating and wave away concerns. But as anorexia progresses, people close to you wont be able to deny their instincts that something is wrong—and neither should you.

As anorexia develops, you become increasingly preoccupied with the number on the scale, how you look in the mirror, and what you can and can’t eat.

Anorexic food behavior signs and symptoms

• Dieting despite being thin – Following a severely restricted diet. Eating only certain low-calorie foods. Banning “bad” foods such as carbohydrates and fats.
• Obsession with calories, fat grams, and nutrition – Reading food labels, measuring and weighing portions, keeping a food diary, reading diet books.
• Pretending to eat or lying about eating – Hiding, playing with, or throwing away food to avoid eating. Making excuses to get out of meals (“I had a huge lunch” or “My stomach isn’t feeling good.”).
• Preoccupation with food – Constantly thinking about food. Cooking for others, collecting recipes, reading food magazines, or making meal plans while eating very little.
• Strange or secretive food rituals – Refusing to eat around others or in public places. Eating in rigid, ritualistic ways (e.g. cutting food “just so”, chewing food and spitting it out, using a specific plate).

Anorexic appearance and body image signs and symptoms

• Dramatic weight loss – Rapid, drastic weight loss with no medical cause.
• Feeling fat, despite being underweight – You may feel overweight in general or just “too fat” in certain places such as the stomach, hips, or thighs.
• Fixation on body image – Obsessed with weight, body shape, or clothing size. Frequent weigh-ins and concern over tiny fluctuations in weight.
• Harshly critical of appearance – Spending a lot of time in front of the mirror checking for flaws. There’s always something to criticize. You’re never thin enough.
• Denial that you’re too thin – You may deny that your low body weight is a problem, while trying to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized clothes).

Purging signs and symptoms

• Using diet pills, laxatives, or diuretics – Abusing water pills, herbal appetite suppressants, prescription stimulants, ipecac syrup, and other drugs for weight loss.
• Throwing up after eating – Frequently disappearing after meals or going to the bathroom. May run the water to disguise sounds of vomiting or reappear smelling like mouthwash or mints.
• Compulsive exercising – Following a punishing exercise regimen aimed at burning calories. Exercising through injuries, illness, and bad weather. Working out extra hard after bingeing or eating something “bad.”

Anorexia nervosa causes and risk factors

There are no simple answers to the causes of anorexia and other eating disorders. Anorexia is a complex condition that arises from a combination of many social, emotional, and biological factors.  Although our culture’s idealization of thinness plays a powerful role, there are many other contributing factors, including your family environment, emotional difficulties, low self-esteem, and traumatic experiences you may have gone through in the past.

Psychological causes and risk factors for anorexia

People with anorexia are often perfectionists and overachievers. They’re the “good” daughters and sons who do what they’re told, excel in everything they do, and focus on pleasing others. But while they may appear to have it all together, inside they feel helpless, inadequate, and worthless. Through their harshly critical lens, if they’re not perfect, they’re a total failure.

Family and social pressures

In addition to the cultural pressure to be thin, there are other family and social pressures that can contribute to anorexia. This includes participation in an activity that demands slenderness, such as ballet, gymnastics, or modeling. It also includes having parents who are overly controlling, put a lot of emphasis on looks, diet themselves, or criticize their children’s bodies and appearance. Stressful life events—such as the onset of puberty, a breakup, or going away to school—can also trigger anorexia.