Anorexia Nervosa: Anorexia Symptoms, Risk Factors, & Treatment Options

Anorexia nervosa is one of the most well-known eating disorders and can significantly affect both the body and the mind. In fact, anorexia has the highest mortality rate of any psychiatric disorder.¹

Roughly 4% of young women and 0.3% of young men in the United States are affected by it.²However, most people with anorexia also experience other psychiatric conditions. This overlap can make the condition harder to treat and increase the risk of serious outcomes, including suicide.

If you’re concerned about the signs of anorexia in yourself or someone you care about, professional support is strongly advised. Eating disorders can be challenging to overcome, typically making specialist support necessary. This page can also help you better understand anorexia nervosa and all its dimensions, as it covers:

What anorexia nervosa is
Types of anorexia nervosa
The symptoms of anorexia
Anorexia risk factors and causes
Complications that can arise from anorexia
Mental health impacts of anorexia nervosa
How the anorexia diagnostic process works
Treatment options for anorexia nervosa

What Is Anorexia Nervosa?

Anorexia nervosa is a psychiatric disorder with specific diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It is a restrictive eating disorder that combines three core features:

Restriction of energy intake: This means consistently eating much less food than the body requires. This sustained restriction typically leads to significantly low body weight for age and developmental stage.
Intense fear of gaining weight: This fear exists even if someone is already underweight. It’s not eased by losing weight. In fact, the fear continues to grow.
A distorted perception of body size or shape: Someone seeing themself as overweight even when medically underweight. Or, their self-worth becomes completely tied to body size and shape.

According to the DSM-5, all three of these features must be present for an anorexia nervosa diagnosis.³

Types of Anorexia Nervosa

There are two main types of anorexia nervosa, based on eating behaviors:

Restricting type: This is the more “classic” presentation, where people lose weight through drastically cutting down food intake. They follow rigid food rules, skip meals, or exercise excessively. There’s no regular pattern of binge eating or purging (like vomiting or laxative misuse) in this subtype.
Binge-eating/purging type: In this type, food restriction is present, but the person also engages in binge eating or purging behaviors. Purging means self-induced vomiting, or misuse of laxatives, diuretics, or enemas.⁴

As anorexia has a high rate of mortality, seeking intervention and support is essential for recovery. The following symptoms of anorexia may highlight whether you or a loved one needs to find specialist treatment.

The Symptoms of Anorexia

Anorexia nervosa can affect nearly every organ system and has profound physical and psychological symptoms. To raise awareness of these symptoms, we’ve broken them down into their physical, emotional, and behavioral components.

Physical Symptoms of Anorexia

When the body remains undernourished for long periods, it often responds through aggressive physical symptoms. These can include:⁵

Rapid and extreme weight loss
Extreme thinness (emaciation) that is obvious around the face, arms, and abdomen
Fatigue and weakness
Dizziness
Thinning scalp hair and the development of fine body hair (lanugo) as the body tries to keep itself warm
Dry skin
Brittle nails
Feeling cold even in warm environments
Loss of menstrual periods
Constipation, bloating, or stomach pain due to slowed digestion
Slow heart rate and low blood pressure
Swelling of hands and feet
Frequent illness because of weakened immunity

Emotional and Behavioral Symptoms of Anorexia

The emotional and behavioral symptoms of anorexia can be equally as destructive as physical ones. They include:

Intense fear of weight gain, even when underweight
Spending significant time planning meals, reading calorie counts, or criticizing one’s body in the mirror
Rigid eating rituals, for example, cutting food into tiny pieces, eating very slowly, or refusing to eat in front of others
Making excuses to skip eating
Working out compulsively, sometimes secretly, to lose weight
Ignoring the body’s natural hunger cues
Irritability, mood swings, or depression
Social withdrawal
Perfectionism and need for control
Secretive behaviors like lying about food intake, hiding food, or pretending to have eaten

Anorexia Risk Factors and Causes

Anorexia is the product of a complicated mix of biological, psychological, and social factors, and no two people arrive at the disorder in exactly the same way. But there are several common explanations for the condition.

One explanation is that having a first-degree relative with an eating disorder or mood disorder can significantly increase your risk of developing anorexia.⁶

Also, alterations in serotonin and dopamine pathways, both of which are central to appetite regulation and reward processing, can increase the risk of restrictive eating behaviors.

Perfectionism, an obsessive need for control, and high levels of anxiety are also frequently documented in people with anorexia. These traits can make food restriction feel like a coping mechanism rather than a problem.

There are also many cultural and social pressures that can increase the risk of developing anorexia if thinness is equated with success and beauty. Teenagers in particular are in the process of identity formation. Therefore, they are often at increased risk of developing anorexia when a lean body figure is known as a beauty standard.⁷

Complications of Anorexia Nervosa

Anorexia can wreak havoc across the entire body. Plus, the longer it persists, the greater the toll it can take on physical health and mental stability.

Medically, starvation impairs nearly every system. When the heart doesn’t get enough nutrition, blood pressure drops, the heart rate slows down, and the rhythm of the heartbeat can become irregular.⁸

Further, women may stop having periods, and men might notice a drop in their testosterone levels. Due to low hormone levels and poor nutrition, the bones can start to become brittle, leading to a higher chance of fractures.

The digestive system slows down as well. Therefore, people with anorexia often experience excessive bloating and constipation because the digestive system can’t keep up. At the same time, the immune system weakens, so even a simple infection can become serious.

Finally, a lack of proper nutrients can shrink brain tissue, which could affect critical thinking abilities and exacerbate mental health issues.

These symptoms warrant hospitalization to stabilize your body before you can continue with therapy. Inpatient treatment provides 24/7 monitoring, medical support, structured nutrition, and intensive psychological therapy to bring you out of immediate danger.

Mental Health Impact of Anorexia Nervosa

Research consistently shows that people with anorexia are far more likely to struggle with additional psychiatric disorders than the general population. In fact, one large national study in the United States found that more than 80% of people with anorexia nervosa will experience another mental health condition at some point in their lives.⁹

Some of anorexia’s most common co-occurring conditions include:

Major depressive disorder (49.5%)
Persistent depressive disorder (22.4%)
Generalized anxiety disorder (21.9%)
Panic disorder (21.0%)
Post-traumatic stress disorder (PTSD) (22.7%)
Substance use disorders (60.3%)
Borderline personality disorder (30.3%)

Unfortunately, research also shows that people with anorexia are about 18 times more likely to die by suicide than the general population.¹⁰

How Is the Diagnosis of Anorexia and Concurrent Mental Health Conditions Made?

An anorexia diagnosis needs a comprehensive clinical interview where you talk about your eating habits, weight history, exercise routines, and attitudes toward food and body image with your healthcare provider.

A physical examination and medical workup are also required to assess the physical toll of malnutrition. This process typically includes:

Blood tests
Vital signs
Bone density scans
Heart evaluations

Clinicians also conduct structured assessments for comorbidities. For instance, the MINI International Neuropsychiatric Interview or Structured Clinical Interview for DSM Disorders are used to screen for depression, anxiety disorders, PTSD, personality disorders, and substance use disorders.¹¹

In many cases, family members are also interviewed to provide collateral information, since patients may minimize the severity of their symptoms.

Treatment Options for Anorexia Nervosa

Anorexia treatment works best when it combines psychotherapy with medical management. This is because physical symptoms need to be addressed medically, while the cause of these symptoms requires psychological intervention.

The following are some of the most recommended approaches for treating anorexia nervosa.

Psychotherapy

Psychotherapy remains the gold standard treatment for anorexia nervosa. However, there are various options to fit people’s unique needs and circumstances.

For instance, family-based therapy (FBT) is considered the first-line approach for adolescents and younger patients. It places parents at the center of care and empowers them to supervise meals, interrupt restrictive behaviors, and support healthy weight restoration.

FBT leads to higher rates of full remission compared to individual therapy in teens. In fact, a study found that nearly 40% of adolescents treated with FBT achieved full remission at one year, compared to just 18% receiving individual therapy.¹²

Cognitive behavioral therapy (CBT), particularly enhanced CBT (CBT-E), has the strongest evidence base for treating anorexia in adults. It helps break the cycle of restrictive eating, challenges distorted beliefs about weight and shape, and builds healthier coping strategies.

Research shows that patients receiving CBT-E can not only achieve a healthy weight but also experience significant reductions in eating disorder related thoughts and behaviors.¹³

Nutritional Counseling

This form of counseling is a structured, medically informed approach that addresses both the physical dangers of malnutrition and the psychological resistance to food. Registered dietitians with expertise in eating disorders lead the nutritional counselling component of care.

Counseling begins with carefully designed meal plans that ensure gradual increases in caloric intake. The dietician makes sure to avoid refeeding syndrome, a dangerous shift in electrolytes that can occur when nutrition is reintroduced too quickly.

Over time, the aim is to help you rebuild a healthy relationship with food. Plus, research shows that when nutritional counseling is combined with psychotherapy, outcomes are significantly better.¹⁴

Medications

Anorexia nervosa does not have a go-to, FDA-approved medication that treats it. Even though many different drug trials have been done, no medication alone has been shown to restore weight or resolve the core features of anorexia.

However, medications can play a supportive role when integrated into a broader treatment plan.

Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are prescribed to manage co-occurring depression and anxiety.

Atypical antipsychotics are another class of drugs that may reduce obsessive thoughts about weight and food. However, they have strong side effects and are therefore reserved for critical patients only.¹⁵

Other medications, such as mood stabilizers or hormone-related therapies, have been studied, but the evidence for their effectiveness is weak.

Hospitalization and Intensive Care

Many people with anorexia can be treated in outpatient settings, but there are times when the illness can become life-threatening and requires hospitalization.

Hospitalization is considered when:

Weight drops to dangerously low levels
Vital signs like blood pressure and heart rate become unstable
Complications such as electrolyte imbalances, dehydration, or heart rhythm problems put the patient at immediate risk

In hospitalized care, refeeding is done gradually and under strict supervision so that malnourished people do not begin eating again too quickly. Intravenous fluids and electrolyte replacement may also be needed.¹⁶

Once the immediate medical crisis is under control, the patient will likely require structured nutritional support and intensive therapy. For instance, they might receive meals on a strict schedule and at supervised eating sessions. They may also be counselled to reduce food-related distress.

For patients who are medically stable but still unable to make progress in outpatient care, there are also residential and partial hospitalization programs. These settings provide daily therapeutic support and structured meals in a less acute environment.

Get Evidence-Based Therapy for Anorexia at Mission Connection

At Mission Connection Healthcare, our licensed mental health professionals offer compassionate, evidence-based support for the underlying issues that contribute to anorexia nervosa.

Your treatment plan is designed around your individual needs. Depending on your situation, it may include outpatient therapy, partial hospitalization, inpatient care, or flexible online sessions.

We conduct a thorough assessment to better understand your experience and then match you with a therapist who fits your needs.

If an eating disorder is affecting your well-being or that of a loved one, you shouldn’t – and don’t have to – cope alone. Reach out to the team at Mission Connection Healthcare today.

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