Anorexia nervosa is a serious, potentially life-threatening disorder characterized by a refusal to maintain a healthy body weight.  Symptoms include an excessive fear of gaining weight, altered body image, denial of the seriousness of the disorder, and, in girls, the absence of at least three consecutive menstrual cycles when they are otherwise expected to occur.  Psychologically, the disorder appears to be one of control where the drive to become thinner is secondary to the sense of control and/or fears about one’s body.

While anorexia can occur in males, it is far more common in females with 90% of cases involving teenage girls and young adult women.  It is estimated that one out of every 100 girls is anorexic.  The exact cause is unknown, but it is thought to involve a combination of genetic and environmental factors.  As anorexia tends to run in families, a relative of someone with anorexia nervosa is 10 times more likely to develop an eating disorder than someone without a family history.   Low self-esteem, perfectionism, depression, and anxiety are common personality traits associated with the development of this disorder. Obsessive dieting behaviors are also thought to reflect today’s societal pressure to be thin.  One reason young girls and women tend to go on strict diets is an attempt to achieve the “ideal figure” associated with body types seen on television, in movies and in magazines.  Athletes, dancers, actors, models, and TV personalities have a higher incidence of anorexia nervosa where thinness has become a professional requirement.

Anorexia nervosa can be divided into two subtypes and many people alternate between the two forms.

• Restrictive
• Binge eating/purging  

In the restrictive type, low body weight is maintained by limiting food intake and, possibly, by excessive exercise.  Limiting food intake to fewer than 1,000 calories per day is common.  There is a preoccupation with food and weight even when body weight is below what is considered healthy.  In severe cases, the individual will actually refuse to eat (self starve).

Binge eating/purging is characterized by periods of restricting food intake in addition to regularly binge eating and/or purging (self-induced vomiting or the misuse of diet pills, laxatives, diuretics, or enemas). 

Signs and symptoms of anorexia nervosa include:

• Being obsessed with food and being thin 
• Refusing to eat and denying hunger
• Intense fear of gaining weight
• Negative or distorted self-image
• Exercising excessively
• Lack of emotion
• Preoccupation with food
• Withdrawing socially
• Dizziness or fainting
• Presence of soft, downy hair on the body
• Irregular menstruation or amenorrhea (loss of menstruation)
• Constipation
• Abdominal pain
• Dry skin
• Frequently being cold
• Heart rhythm irregularities
• Low blood pressure
• Dehydration

Treatment should be started as soon as the condition is recognized since early diagnosis and treatment is the most effective.  Treatment involves a coordinated team of professionals and may include a physician, psychiatrist, psychologist or other mental-health therapist, nurse practitioner, and a nutritionist.  The focus of therapy must be more than weight restoration as the underlying emotional issues need to be addressed for treatment to be successful.