Anorexia Nervosa

Anorexia is not dieting, eating healthily, or being careful about weight management. The person gradually eats less and less, tries to exert more and more control, may perceive their body differently from how it is, and weight loss can reach a level that creates medical risk.

Some people follow a restrictive pattern and simply reduce food intake. Others display behaviors such as binge eating followed by vomiting, laxative use, or excessive exercise. Behavior that looks like "willpower" from the outside can be driven from the inside by fear, guilt, estrangement from the body, and a sense of losing control.

Falling significantly below the weight expected for age, sex, and developmental level; intense fear of gaining weight or ongoing behaviors that prevent weight gain; and placing excessive meaning on body weight and shape are the core features of this picture.

Excessive exercise, sharply categorizing foods, skipping meals, counting calories, covert vomiting, or weight control behaviors may also be present. Physically, dizziness, fainting, irregular periods, hair loss, feeling cold, heart rhythm and blood pressure problems, and vitamin and mineral deficiencies can accompany the disorder.

Anorexia is among the mental health conditions that can be life-threatening through direct physical complications. If there is rapid weight loss, fainting, severe weakness, suspected heart rhythm irregularity, or thoughts of self-harm, urgent medical evaluation is needed.

It cannot be reduced to a single cause. Genetic predisposition, temperament, perfectionism, the need for control, low self-esteem, peer pressure, family relationships, cultural body ideals, social media, and developmental transitions can all play a role together.

Adolescence is a particularly vulnerable period. As the body changes rapidly, peer approval becomes more important. If a person turns to controlling the body in response to relational or emotional areas they cannot control, weight loss can give a temporary sense of achievement. But over time this sense of achievement tightens the trap.

Treatment must always be approached in a multidisciplinary way. Medical evaluation, the safe restoration of nutritional intake, psychotherapy, and family support are addressed together. Family-based approaches are especially important for children and adolescents. For adults, eating disorder-focused cognitive behavioral therapy, interpersonal therapy, and when needed, longer-term psychotherapies may be used.

Medical safety and nutritional risk are assessed first. Body perception, fear of weight gain, and beliefs about control are worked on in psychotherapy. The family is not seen as a system to be blamed, but as a resource to be carefully included in treatment. Gaining weight is the first step in treatment. The goal is the transformation of the person's relationship with their body, their sense of worth, their relationships, and with control.