Anorexia nervosa (commonly known as anorexia) is an eating disorder that can seriously damage a person’s health if it is not treated properly. It affects more girls than boys. About ninety per cent of those who are known to develop anorexia are female. It is most common in teenagers and young adults (though it can occur in children as young as eight years old).

Currently it is thought that up to one per cent of young women aged 15-25 have anorexia. The condition has many similar characteristics to another eating disorder, called bulimia nervosa (commonly known as bulimia).

What causes anorexia nervosa and who can get it?

We do not yet know what causes anorexia, but it is likely to be a combination of factors involving your genes, biological factors, what is happening in your life and your social environment. These things interact in different ways for each person, so that the pathway to developing anorexia is different for each individual. Sometimes it can start after someone says something to you about your appearance, which then sparks off the fear of being fat, but that in itself is not the ‘cause’ of anorexia.

Sometimes young people feel that modern society puts pressure on them to be thin – lots would like to look like celebrities and supermodels on the television and in magazines. In societies that do not associate thinness with attractiveness, eating disorders are rare. But anorexia is more complex than this and is often linked to feelings of low self-esteem and a wish to try to cope with things that are beginning to feel unmanageable.

People with anorexia often see their eating habits as one of the things they can control in their life. This can occur in a whole range of different situations, ranging from people experiencing severe trauma or difficult family situations, to those who feel they are a failure because they don’t fit in with friends. People with anorexia often set themselves high standards, which they try hard to meet.

What are the signs and symptoms of anorexia nervosa?

If you have anorexia you may have a distorted image of your body. For example, when you look in the mirror, you might see a fat person, even though you are actually extremely thin. This extreme fear of being overweight makes you unwilling to maintain a healthy weight. This is because you feel fat, no matter what the scales say.

Other tell-tale signs include:

• Losing weight (younger teenagers with anorexia may not necessarily lose large amounts of weight, but if they are still growing, they effectively become more underweight)
• Eating as little as possible and taking ages to eat food due to strict calorie counting and chewing food over and over again
• Eating normal portions of food, but then exercising to burn off the calories
• Trying to control weight by getting rid of the food, for example by vomiting (which actually does not get rid of everything and can be very dangerous)

• Starting to wear lots of baggy clothes
• Denying feeling hungry
• Withdrawing from your family and friends, not wanting to go out
• Using laxatives or diuretics
• Fainting, feeling dizzy and or cold
• Swollen stomach and stomach pains
• Constipation or diarrhoea

• Dry skin and thin hair that breaks or falls out easily
• Growth of ‘down-like’ hair on your body
• Feeling tired and having problems sleeping
• Feelings of depression and mood swings
• Losing interest in normal hobbies and interests
• Periods stopping – or failing to start

How is anorexia nervosa normally diagnosed?

Identifying that you have anorexia might be difficult if you don’t believe that you are ill or have a problem. Often it might be a parent who insists that you see a doctor about your difficulties with eating.

Alternatively, it might not be the weight loss but other symptoms that mean you end up seeing your doctor – like stomach ache, irregular periods or constipation.

A diagnosis of anorexia is usually made if you weigh 15 per cent less than you should for your height and age, and you have particular beliefs and behaviours related to your eating, weight and shape. Doctors will also use something called your body mass index (BMI) centile to as part of the decision whether you might have anorexia. They are likely to want to make sure that low weight is not being caused by something like diabetes or a problem with your thyroid gland.

In making a diagnosis, a doctor will also take into account how you feel about food and the way you look, or feel you should look. The earlier you are diagnosed with anorexia, the better. This means that your treatment can start sooner.

How is anorexia nervosa treated?

Treating anorexia isn’t simple, and treatment is likely to be different for different individuals. An important step is to accept that you have a problem. Talk to someone you trust, like your parents, teacher, brother or sister. They can then help you make an appointment with your GP, who will then refer you to a specialist who deals with anorexia. Sometimes people with anorexia take longer than others to recognize that something is wrong, and you may find your parents insist that you go to see your GP before you feel that is necessary. 

Once your treatment starts you will be helped and encouraged to put on weight. Most people who work with young people with anorexia realize that this can feel very scary. You and your parents may talk to a dietician, who will work out how much you need to eat each day. You may also see the specialist regularly. They will weigh you and be there to give you and your parents support.

Your treatment aims to try to help you return to health, and to try to help you manage worries about your weight and eating. Usually it will involve encouraging weight gain and a return to healthy eating habits so that you are a normal weight for your age and height. However, because anorexia is not just about weight and eating, but about other things in your life that can be difficult to untangle, you will probably be seen with your parents as well as on your own to try to explore some of these things further, and to help you manage things without damaging your health. As a teenager, your family will be involved in your care and treatment, including family sessions with specialists.

Sometimes medications, such as antidepressants, are used if you have depressive or anxious symptoms. Actively wanting to get better will help enormously in your treatment.

When should I seek medical help?

With anorexia it’s important to ask for help as early as possible. This is because anorexia can cause serious health problems without treatment. If they don’t seek help, girls with anorexia may stop having periods and delay puberty, which may lead to problems having a baby later in life. It can also affect your growth and your bones, making them break more easily, and can result in osteoporosis even as a teenager.

Looking forward

Treatment can take a long time and can be difficult but most people get back to a normal weight and make a full recovery. Really wanting to be well again will have a very positive impact on your treatment. Remember, it’s not true that people with anorexia can never really ‘fully’ recover. There are many people who lead perfectly normal lives and no longer have problems with eating that affect them from day-to-day.

For more help and information

• Visit Anorexia & Bulimia Care or call their helpline on 01934 710336       
• The charity beat (formerly the Eating Disorders Association) have loads of resources. You can call the adult Helpline on 0845 634 1414 or the Youth Helpline on 0845 634 7650.
• Young Minds provides information and advice on child mental health issues. You can ring on 0800 018 2138.

Last reviewed by the charity beat and Great Ormond Street Hospital: 30 June 2008

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