Anorexia nervosa (often shortened to “anorexia”) is a serious medical and psychological illness related to eating. People with anorexia nervosa do not eat enough and have an intense fear of being fat. Although anorexia nervosa is a Latin term meaning “no appetite, caused by nervousness,” most people with anorexia do feel hunger but take extreme steps to ignore it and diet anyway, often to the point of starvation. Therefore, anorexia nervosa can lead to serious medical problems, and even death in the most severe cases.
Although this problem has existed since at least the 17th century, people are more aware of it in recent years, especially in cultures where being thin is considered attractive. The problem usually begins in adolescence, often as puberty starts and body shapes change, and is less common than bulimia. Almost all cases of anorexia nervosa are in adolescent girls or young women. However, adolescent boys and young men also can develop it.
There are two types of anorexia nervosa: (1) restricting and (2) binging followed by purging. The person with the restricting type of anorexia limits how much food she takes in by dieting and fasting, whereas the person binging followed by purging eats large quantities of food, and then uses laxatives, vomiting or exercise to get rid of the food. Many individuals go back and forth between these two patterns.
The cause of anorexia nervosa is not known. Eating disorders tend to run in families and are likely related to a combination of biological, psychological and social factors. Some examples include peer and societal pressure to be thin, fear of becoming an adult, family conflicts, depression and obsessive-compulsive tendencies.
It is common for teens to worry about their weight and appearance, but this does not mean that they have an eating disorder. Those with an eating disorder such as anorexia usually have taken these worries to an extreme. Parents and friends may notice some of the following behaviors:
- Strict dieting, severely limiting calories or skipping meals
- Intense exercising
- Drive for perfection, often a high achiever in school
- Difficulty concentrating, making decisions or thinking
- Depression or social withdrawal
- Fainting, dizziness, lack of energy
- Feeling cold when others feel warm
The diagnosis of anorexia is made by a health professional, typically either your teen’s pediatrician or a psychiatrist. In addition to the above behaviors, which have been noticed by parents and friends, the specific medical and psychological criteria include:
- Significant weight loss, defined as more than 15 percent below ideal body weight, as predicted on standard height and weight charts
- Lack of menstrual periods (amenorrhea), either primary (never started) or secondary (three or more missed cycles)
- Distorted body image, feeling fat despite being thin
- Intense fear of gaining weight or becoming fat
Some of the physical signs of anorexia nervosa include low blood pressure, slow heart rate, low body temperature, dry skin, pale or yellow skin, fine body hair (lanugo), and constipation. Blood tests also may be ordered to look for some of the complications of prolonged starvation, such as anemia (low iron) or thyroid problems. Other medical complications of anorexia may include stress fractures, bone loss (osteopenia), growth delay, short stature and heart problems.
If you suspect your adolescent may have an eating disorder, please seek medical help immediately. Severe weight loss or starvation is a medical emergency, so early treatment is important. Anorexia nervosa usually is treated by a combination of psychotherapy, medication and nutritional counseling. In some cases, teens need to be hospitalized, either to address any problematic behaviors that cannot be handled well as an outpatient or to treat medical complications.