What is anorexia nervosa?

Anorexia nervosa is an eating disorder and a serious mental health condition.

People with anorexia nervosa:

• have an intense fear of gaining weight or becoming overweight
• limit the amount of food they eat to avoid gaining weight
• might do other things to avoid gaining weight, like vomiting, using laxatives or diuretics, or over-exercising
• often have an unhealthy body image and think their body is bigger than it is.

People with anorexia nervosa need a lot of support from family and health care professionals.

Types of anorexia nervosa

There are 2 main types of anorexia nervosa.

Restricting

This is the most common type of anorexia nervosa. People with restricting anorexia nervosa limit their food intake by:

• limiting the number of meals they eat
• reducing the number of calories (kilojoules) they eat
• cutting out certain foods.

Sometimes they might also have obsessive rules about food, like eating only at specific times, not eating some types of food, eating from particular plates and bowls, or recording details of everything they eat.

People with restricting anorexia nervosa might also over-exercise to control their weight and might ‘strive to be thin’.

Binge eating/purging

People with binge eating/purging anorexia nervosa limit the amount of food they eat and then binge eat or purge, or both:

• Binge eating is when you regularly eat very large amounts of food very quickly.
• Purging can include vomiting up food or misusing laxatives, diuretics or enemas.

People with binge eating/purging anorexia nervosa might purge after eating only a small amount of food.

Anorexia nervosa symptoms and signs

Anorexia nervosa is a serious medical condition. It can have physical, psychological and behavioural signs and symptoms.

Physical symptoms and signs

These include:

• low body weight
• abdominal pain
• dehydration
• fine downy body hair
• tiredness, weakness and muscle aches
• loss of or irregular periods
• failure to start puberty
• dizzy spells
• shortness of breath
• heart palpitations
• feelings of cold
• constipation
• hair loss and thinning.

Psychological symptoms and signs

These include:

• unhealthy body image
• obsessive thoughts about food, weight and body shape
• intense desire for weight loss
• low self-esteem
• mood swings
• depression or anxiety
• suicidal thoughts
• refusal to accept that their weight is dangerously low.

Behavioural symptoms and signs

These include:

• over-exercising and/or limiting food all the time
• behaving secretly about eating or exercise
• avoiding social situations that involve food
• weighing themselves all the time
• often wearing baggy or oversized clothes
• behaving aggressively if forced to eat ‘forbidden foods’
• being obsessive about planning and preparing food, but having no interest in eating
• withdrawing from family, friends and other social relationships
• self-harming.

The long-term complications of anorexia nervosa can be severe. They include:

• osteoporosis and risk of increased bone fractures
• inability to get pregnant
• problems with the heart and kidneys
• a higher risk of suicide.

You don’t have to be underweight to have anorexia nervosa. Rapid weight loss in overweight people can be a sign of an eating disorder called atypical anorexia nervosa. People with atypical anorexia nervosa can also have many of the symptoms described above. And they can be just as unwell as people with typical anorexia nervosa. They can be even more distressed too.

What to do if your child has anorexia nervosa symptoms

If you notice that your child’s eating habits have changed, or you see a change in their mood and behaviour in relation to food, it’s important to talk with your child and your GP as soon as you can.

It might be a difficult conversation with your child, but it will help you understand more about what’s going on. Try to stay calm and non-judgmental. Focus on your child’s health and wellbeing, not your child’s weight and appearance.

If you’re not sure how to talk with your child about these issues, you could ask your GP or a mental health professional for help. You can also contact the Butterfly Foundation by calling the free national helpline on 1800 334 673 or using the Butterfly Foundation webchat.

Early assessment and help from a health professional can stop problem eating turning into an eating disorder. It might be easier to get your child to see a health professional now. If you step in early, you might be able to save your child from intensive treatment and a very long recovery time.

How is anorexia nervosa diagnosed?

There’s no single test to diagnose anorexia nervosa.

If your GP thinks your child might have anorexia nervosa, the GP will talk with your child about eating behaviour, habits and thoughts. The GP will also do a full physical examination and tests including a blood test, a urine test or an ECG. They might order a scan to check your child’s bone health.

The GP might then refer your child to a specialist service to confirm the anorexia nervosa and recommend appropriate treatment.

How is anorexia nervosa treated?

There’s no single treatment for anorexia nervosa.

Anorexia nervosa treatment involves a team of health professionals with expertise in different areas. They’ll prescribe or suggest a treatment plan that’s specific to your child’s needs. The plan will depend on things like:

• your child’s age
• the type of anorexia nervosa your child has
• the causes, severity and stage of your child’s anorexia nervosa.

The plan will include regular visits to your child’s GP and a dietitian who specialises in eating disorders. It’s also likely to include some of or all the following.

Psychological therapy

This is a common way to treat anorexia nervosa. It might include family sessions, one-on-one sessions with your child, and group-based sessions. This treatment aims to help you and your child understand anorexia and how it affects your lives. It also aims to help your child:

• learn about anorexia nervosa and how it develops
• manage their emotions
• develop healthy eating behaviour
• work on things like over-exercising and laxative misuse
• build self-esteem
• feel more comfortable in their body
• re-engage with family, friends and social activities.

Medicines

There are no medicines for anorexia nervosa. But if your child has depression or anxiety as well as anorexia nervosa, there are medicines that might help with these other conditions.

Your doctor or dietitian might prescribe nutritional supplements if your child needs them.

Hospital

Your child might need to go to hospital to be treated for the physical effects of anorexia nervosa. This will depend on your child’s weight, symptoms and other health issues.

Hospital treatment usually focuses on supporting people to eat at regular mealtimes and gain weight.

Early intervention and treatment will give your child a better chance of recovery from anorexia nervosa, but it’s also possible for your child to develop it again. If you notice that your child is showing anorexia nervosa symptoms again, see your doctor as soon as possible.

How to help your child with anorexia nervosa at home

One of the most important things you can do to support your child with anorexia nervosa is to show that you love and care for them. This can be as simple as:

• stopping to listen when your child wants to talk
• spending one-on-one time with your child
• giving your child a hug.

It’s also a good idea to ask your child’s mental health professional for specific things you can do at home to support your child’s recovery from anorexia nervosa.

And in addition to any strategies that the mental health professional suggests, here are strategies you can try at home with your child:

• Encourage self-compassion. When your child is hard on themselves, encourage them to speak to themselves as they’d speak to a close friend or someone they love in a similar situation.
• Encourage your child to do things they enjoy, like reading, doing craft or spending time with friends. Activities like these shift your child’s focus from their appearance and can improve your child’s self-esteem.
• Use active listening. Let your child tell you how they feel about their appearance. Try to accept your child’s feelings and avoid making judgments.
• Encourage limits on your child’s use of mirrors and scales. This can help if your child spends a lot of time checking their appearance or weighing themselves.
• Talk about social media. Appearance-based social media content can make anorexia nervosa worse. Talk about the type of content that your child sees online, and offer to help your child hide unhelpful content.
• Challenge harmful online and offline appearance-based messages. For example, for a message like ‘You have to be skinny to be beautiful’, you could say, ‘Beauty comes in all shapes and sizes, and it’s about more than appearance. It’s also about the positive things you do, like being kind and helping others’.

Anorexia nervosa causes and risk factors

There’s no known cause of anorexia nervosa. But there are factors that can put pre-teens and teenagers at higher risk for anorexia nervosa.

These risk factors include:

• being a girl, although boys can get anorexia too
• being a perfectionist or high achiever
• thinking in an obsessive way
• experiencing a stressful life event, like a family separation
• dieting
• being in settings where thinness is valued
• having a family history of anorexia nervosa.