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Equip: What is Anorexia?

Anorexia nervosa, usually referred to as just anorexia, is an eating disorder characterized by extreme food restriction and an intense fear of gaining weight. Many people with anorexia are at a low weight and appear extremely thin, but anorexia also affects people who appear to be at a “normal” weight, as well as those in large bodies.

Despite the focus on weight, anorexia isn’t a vanity issue or a choice. Like all eating disorders, anorexia is caused by a complex interplay of neurological, biological, and psychological factors, which is why we refer to it as a brain disorder. Social and environmental influences—like social media, family dynamics, and diet culture—can play a role, but they’re never the one “cause” of anorexia (nor is anything else). Rather, anorexia emerges out of a perfect storm of different causes.

Anorexia is serious and can be life-threatening if left untreated, but lasting recovery is possible with the right treatment.

Signs and symptoms of anorexia

Anorexia nervosa is perhaps the most commonly known eating disorder, but that doesn’t necessarily make it easy to spot. 

Like all eating disorders, anorexia thrives in secrecy, and most people struggling will go to great lengths to hide their disordered behaviors. This can make anorexia particularly tricky to detect—but understanding the many different red flags and subtle signs can go a long way toward helping you recognize a problem in yourself or someone you love.

Physical symptoms
  • Significant or rapid weight loss
  • Lack of expected weight gain (or falling off the growth chart for kids and teens)
  • Irregular or absent menstrual cycle
  • Growth of soft, downy hair all over the body (known as lanugo)
  • Constipation, abdominal pain, or other gastrointestinal issues
  • Lightheadedness
  • Low blood pressure
  • Fatigue
  • Feeling cold often
Psychological and mood-related symptoms
  • Irritability
  • Increased anxiety
  • Increased depressive symptoms
  • Obsessive or repetitive thought patterns 
  • Social withdrawal
  • Flat affect
  • Perfectionism
  • Trouble expressing emotions
  • Restricting the quantity or types of food eaten
  • Avoiding eating in front of others
  • Lying about food intake
  • Hiding when and what food is eaten
  • Counting calories and other nutrients, often weighing and measuring food
  • Obsessively checking nutrition labels
  • Only ever drinking water
  • Eating rituals, like cutting food up into very small pieces or eating in particular order
  • Exercising excessively or more than recommended by a coach or trainer
  • Compulsive exercise (i.e., an inflexible and uncontrollable need to exercise)
  • Exercising through injury, sickness, or poor weather
  • Using exercise to "make up for" or "earn" food
  • Checking or recording physical activity excessively
  • Skipping social plans, school, or work to exercise
Body image symptoms
  • A preoccupation with body shape and size
  • Distorted body image (i.e., viewing one's body as much bigger than it actually is)
  • Body checking (frequently looking in the mirror, checking to see how clothes fit, checking the size of different body parts)
  • Frequent weighing
  • A belief that one's self-worth is tied to body size or shape
  • Fear of gaining weight
  

Common questions about anorexia

What does anorexia treatment look like?

The initial focus of anorexia treatment is normalizing eating habits, stopping restriction, and restoring weight as necessary. As the patient's body and brain become more adequately nourished, they may be better equipped to then address other important areas. At this point, treatment might then shift to other areas like body image, social life, learning to handle triggers, and addressing co-occurring conditions.

To accomplish all this, our clinicians use a variety of different evidence-based treatment modalities, including CBT-E (a form of cognitive behavioral therapy designed specifically for eating disorders), DBT (dialectical behavioral therapy), and ERP (exposure and response prevention). For younger patients who live with their family, we generally use FBT (family-based treatment).

How common is male anorexia?

Male anorexia is far more common than most people think, with men and boys accounting for up to 25% of all patients with anorexia. Men and boys with anorexia often go undiagnosed for a long time (at least in part because of societal misconceptions around who gets anorexia), and so they often enter treatment in a more serious condition than their female counterparts.

What is the difference between anorexia and bulimia?

Anorexia and bulimia share some similarities, but tend to present quite differently. Both are types of eating disorders that involve a preoccupation with body size and weight and a fear of gaining weight. For those with anorexia, the primary eating disorder behavior is restriction. For those with builimia, the hallmark is binge-purge cycles, which are characterized by eating large quantities of food, followed by purging through vomiting, laxatives, compulsive exercise, or other unhealthy means. It is important to note, though, that restriction is often a symptom in bulimia, and bingeing and purging may be present in anorexia. You can learn more about anorexia and bulimia on our blog.

What is atypical anorexia?

Atypical anorexia is a common yet underdiagnosed type of anorexia, in which a person has all of the symptoms of anorexia except for being at a low body weight. Instead, people with atypical anorexia may be in medium or large bodies. Atypical anorexia is a very serious condition, carries almost all the same health risks as “regular” anorexia, and should be treated the same way as anorexia.

At Equip, we don’t use the term “atypical anorexia”—it is simply anorexia. Any manifestation of anorexia, regardless of weight, is serious and life-threatening and needs the same treatment.

What are the causes of anorexia? As frustrating as it is, there is rarely one identifiable cause of an eating disorder, and anorexia is no different. More often than not, it is a constellation of biological, psychological, and environmental factors: in other words, someone has a genetic predisposition to developing an eating disorder, and then the eating disorder is “turned on” by environmental factors such a diet, over-exercise, social stress, or even a stomach bug. But the good news is that we don't need to know the exact cause of your child's eating disorder to treat it effectively. You can learn more about the causes of eating disorders on our blog.
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