Anorexia Nervosa: Diagnosis, Treatment, and Resources

Anorexia nervosa is marked by self starvation with food refusal, food rules, rigid eating behaviors, and a persistent irrational fear of gaining weight that does not resolve with continued weight loss. It lies on the restrictive end of the eating disordered spectrum and many times people who suffer with this disorder are not able see or experience how much weight they are losing. Often it can feel like the eating disorder and your brain are congratulating you for ignoring your body’ signals to feed yourself; society reinforces this with compliments at lower weight. However, anorexia and other eating disorders are the most fatal mental illness, and it is important to seek treatment from a health professional. Learn about anorexia nervosa diagnosis and treatment below.

Definition, Symptoms, and Diagnosis

What is anorexia nervosa? Anorexia nervosa (AN) is the restriction of food intake leading to reduction of body weight to below what is deemed acceptable and normal for the individual’s age and height. Additionally, this is accompanied by a fear of gaining weight or becoming overweight, despite the person being significantly under a healthy weight. Individuals with anorexia nervosa typically do not realize and have difficulty acknowledging that they are seriously and dangerously underweight.  

Anorexia has the highest mortality rate of all psychiatric illnesses due to starvation and malnutrition; however, full recovery is possible and early treatment is the best step.

How common is anorexia nervosa?

Anorexia nervoa affects 0.9% of American women at some point in their lives. 50-80% of the risk for anorexiais genetic, and nearly half of anorexia patients have a co-occuring mood disorder such as depression.


What are the signs and symptoms of anorexia nervosa?

  • Avoiding or skipping meals
  • Pushing food around on a plate or hiding it under a plate or napkin
  • Adopting a restrictive or extreme diet and sometimes under the guise of trying to be healthy. For example, become a vegetarian and using this as the reason why they aren’t eating certain things.
  • Worry and shame about eating and getting fat
  • Eating meals alone and refusing to eat in front of others
  • Significant and sudden weight loss disguised by wearing baggy clothes to hide these changes
  • Defensiveness about any comments that indicate noticing these behaviors  

How do you diagnose anorexia nervosa?

The best way to assess whether you or your loved one is suffering from anorexia nervosa is to meet with an eating disorder specialist and get a full psychological and physical exam. Your therapist or psychiatrist will use the DSM-V (Diagnostics and Statistics Manual), a manual to diagnose mental health conditions. According to the DSM-V, the criteria for diagnosing anorexia nervosa includes:

  • Restriction of food relative to the individual’s height, weight, age, gender, physical health, and development that leads to significantly low body weight.
  • Intense fear of gaining weight and persistent behavior that prevents weight gain, despite being underweight.
  • Distortion of one’s body weight or shape, or a lack of insight into the seriousness of how low the person’s weight is.
  • Restriction of food intake without the use of any means of eliminating the food (vomiting or using laxatives, diuretics, or enemas) or without any episodes of binge eating. The weight loss is due primarily to severe dieting, fasting, and/or excessive exercising.

Additionally, there are specifications about the severity of the condition, determined by the individual’s Body Mass Index (BMI).

What is atypical anorexia nervosa?

Atypical anorexia is defined by the DSM-V as having met all criteria for anorexia except for meeting a normal or above normal weight, which makes this difficult to diagnose.  Individuals with this condition often go without treatment or are even turned away from doctors because they don’t “look sick”.

What are medical complications of anorexia nervosa?

  • Damaged to major organs: heart, brain, and kidneys.
  • Bradycardia- heart rate dropping to a dangerously low rate of under 60 beats per minute
  • Drop in blood pressure, pulse, and breathing rates.
  • Loss of hair.
  • Thinning of bones, (osteoporosis).
  • Dehydration and Fluid-electrolyte imbalance.
  • Death from starvation
  • Loss of meneses
  • Infertility

Treatment for anorexia nervosa

What is the best treatment for anorexia nervosa?

Most eating disorder treatment includes team approach: nutritionist, physician, psychiatrist, counselor etc. There are different levels of care depending on the severity of the eating disorder. The best approach to treatment is holistic and encompasses all of the different aspects and complexities of an eating disorder. physical and mental as well as social and interpersonal function.

Cognitive behavioral therapy (CBT) has been proven through decades of research to be one of the most effective treatments for anorexia nervosa. CBT helps with negative and distorted thinking patterns, which are part of the reason for restrictive behaviors. Residential treatment centers as well as hospitalization may also be necessary depending on the severity of the condition. Self-help and support groups are also helpful with recovery.

Helping a friend with anorexia nervosa

How can you help someone with anorexia nervosa?

The most important way to help a friend or loved one with anorexia is to be compassionate and understanding, even if you may not be able to fully understand what the individual may be experiencing. Let the person know that you are there to listen and that you won’t judge them. Avoid advising; rather, think more about listening and validating feelings. Researching the disorder to understand it better can be helpful, too. Ask if they are in treatment and what you can do as their friend or loved one to help support their treatment.

Here are some things to keep in mind when helping someone with anorexia nervosa.

Do

  • Do be empathetic and express your love and support.
  • Do be honest about your own struggles to understand.
  • Do recognize there is no a quick and easy solution or cure.
  • Do listen and validate their feelings.
  • Do be patient and at the same time know your own limits.

Don’t

  • Don’t try to be a therapist.
  • Don’t tell them to just eat something and to stop obsessing.
  • Don’t use shame or guilt to convince them to eat or change their behavior.
  • Don’t gossip to other people about what they are going through.
  • Don’t make critical or mean comments about their eating.

How to help a friend struggling with bulimia nervosa >>
How to help a friend struggling with binge eating disorder >>

Additional resources for anorexia nervosa

What advocacy organizations exist for anorexia nervosa?

National Eating Disorders Association: The National Eating Disorders Association (NEDA) is a nonprofit organization dedicated to supporting individuals and families affected by eating disorders. NEDA offers our programs and services to raise awareness, build communities of support and recovery, and fund research.

National Association of Anorexia Nervosa and Associated Disorders (ANAD): The National Association of Anorexia Nervosa and Associated Disorders (ANAD) is a non-profit organization headquartered in Illinois, providing support, awareness, advocacy, referral, education, and prevention work for people struggling with eating disorders.

Project HEAL: Project HEAL is a non-profit organization that advocates for everyone who is seeking treatment for eating disorders, regardless of their race, income, insurance plan, age, education level, sex, or sexual orientation. They provide financial assistance in accessing treatment for highly motivated applicants who want to recover from an eating disorder but cannot afford to pay for treatment. They also have a peer mentorship program called Communities for HEALing, in which they offer one-on-one support and local weekly support groups. Communities for HEALing is undergoing a research study that will demonstrate whether different kinds of mentorship can help people recover from an eating disorder, whether that is through peer mentorship or social support mentorship.

International Association of Eating Disorders Professionals (IAEDP): The International Association of Eating Disorders Professionals (IAEDP) provides ethical and professional standards for therapists, nutritionists, and other medical and mental health professionals  that treat eating disorders. They provide educational classes, and trainings in order to promote a standard of excellence in the field of eating disorders. They also certify that professionals have met prescribed requirements, help raise public and professional awareness for eating disorders, and assist in prevention efforts.

Find therapists specializing in anorexia nervosa

What should I look for in a therapist who treats anorexia nervosa?

Most eating disorder treatment includes team approach: nutritionist, physician, psychiatrist, counselor etc. There are different levels of care depending on the severity of the eating disorder. The best approach to treatment is holistic and encompasses all of the different aspects and complexities of an eating disorder: physical and mental as well as social and interpersonal function.


Sources

  • Indeed, anorexia nervosa has the highest mortality rate of any psychiatric disorder, likely due to these medical complications.
    • Mehler, P. S., & Brown, C. (2015, March 31). Anorexia nervosa – medical complications. Retrieved August 18, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381361/
  • 0.9% of American women suffer from anorexia in their lifetime.
    • Eating Disorder Statistics • National Association of Anorexia Nervosa and Associated Disorders. (n.d.). Retrieved August 18, 2018, from http://www.anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/
  • Numerous family and twin studies indicate that genetic factors make up 50-80% of the risk of developing an eating disorder.
    • The Role of Genetics in Eating Disorders. (n.d.). Retrieved August 18, 2018, from https://www.feast-ed.org/page/genetics
  • The DSM-5 diagnostic criteria for anorexia nervosa are similar to the previous DSM-IV criteria with respect to behavioral and psychological characteristics involving restriction of food intake resulting in low body weight, intense fear of gaining weight or becoming fat, and disturbance of body image.
    • Harrington, B. C., Jimerson, M., Haxton, C., & Jimerson, D. C. (2015, January 01). Initial Evaluation, Diagnosis, and Treatment of Anorexia Nervosa and Bulimia Nervosa. Retrieved August 18, 2018, from https://www.aafp.org/afp/2015/0101/p46.html
  • The eating disorders provide one of the strongest indications for cognitive behavioral therapy (CBT).
    • Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010, September). Cognitive Behavioral Therapy for Eating Disorders. Retrieved August 18, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928448/

About the contributors

Dr. Marianna Kessimian, MD

Dr. Marianna Kessimian is a child, adolescent, and adult psychiatrist in Providence, RI. She received her MD from Boston University where she was also selected for the Gold Humanism in Medicine society as well as the Ruth J Hunter Johnson Prize for excellence in psychiatry. Dr. Kessimian completed her adult psychiatry training and child psychiatry fellowship at Brown University, where she served as chief resident. Previously, she was a staff psychiatrist at the Young Adult Behavioral Health clinic, and in this role was afforded the opportunity to work on campus at the Rhode Island School of Design providing psychiatric care to their students.

 

Hannah Goodman, LMHC

Hannah Goodman is a Licensed Mental Health Counselor in Barrington, RI. She specializes in anxiety, including panic disorder, Obsessive Compulsive Disorder and worry. She also has expertise in depression, adolescent issues, life transitions, couples counseling, and family counseling. Outside of her counseling practice, Hannah works as a writing coach and college counselor, drawing on her years of experience in the school system to help individuals of all ages with writing projects and prospective college and graduate students with their applications.