Medically Reviewed by Smitha Bhandari, MD on June 14, 2021
Eating disorders are not uncommon among teens. Take "Kerri" (not her real name) for example. Upset with a sudden weight gain, the 15-year-old forced herself to throw up after eating her school lunch. It seemed harmless. After all, most of the kids at her lunch table had done it before, and they seemed OK. Then, after doing it five times, Kerri had a new ritual of vomiting right after eating. She did it at school and then again at home. No one knew -- until Thanksgiving. She had eaten more than usual and told her parents she felt sick. She tried to vomit but couldn't even gag. Suddenly, there was a tap on the bathroom door. Kerri's parents were standing outside the door, asking how long she'd been throwing up her food. "Mason," 14, was also obsessed about his weight. Short and chunky most of his life, Mason had a growth spurt. Now tall and thin, he was determined to never to be "the fat kid" again. Mason hated throwing up. So, he started eating salads with no dressing, running miles each day, and taking laxatives to keep his weight down. It worked. He looked trim and athletic. But he felt exhausted, fatigued, and irritable. In the middle of the night last winter, Mason became violently ill with stomach cramps and a high fever. His doctor admitted him into the hospital and began running tests to figure out his mystery illness. Weight obsession affects millions of teenagers today, especially girls. At any given time, one out of every seven women has or is struggling with an eating disorder. One study a few years ago found that 36% of adolescent girls - more than one out of every three -- believed they were overweight, while 59% were trying to lose weight. More than 90% of people with an eating disorder are girls. Teenage boys, though, also have body image concerns. Many boys strive for the perfect body by dieting or by doing compulsive exercise. Eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, are psychological disorders that involve extreme disturbances in eating behavior. A teen with anorexia refuses to stay at a normal body weight. Someone with bulimia has repeated episodes of binge eating followed by compulsive behaviors such as vomiting or the use of laxatives to rid the body of food. Binge eating is characterized by uncontrolled overeating.
Anorexia nervosa affects as many as one in every 100 females. Teens with anorexia fear gaining weight and are at least 15% below their ideal body weights. They believe the main gauge of self-worth is their body image. Experts believe many American girls are bulimic and have kept the problem a secret. Bulimia often starts in the late teens and early adulthood. People with bulimia go through cycles of eating enormous amounts of foods followed by purging by vomiting, using laxatives, or diuretics or hours of aerobic exercise. Warning signs of bulimia include: There is no one cause of an eating disorder. Experts link eating disorders to a combination of factors, such as family relationships, psychological problems, and genetics. The teen may have low self-esteem and be preoccupied with having a thin body. Sometimes, being part of a sport such as ballet, gymnastics, or running, where being lean is encouraged, is associated with eating disorders in teens. In one study, researchers linked anorexia with an obsession with perfectionism -- concern over mistakes, high personal standards, and parental expectations and criticism. Symptoms of eating disorders may include the following:
- A distorted body image
- Skipping most meals
- Unusual eating habits (such as eating thousands of calories at one meal or skipping meals)
- Frequent weighing
- Extreme weight change
- Insomnia
- Constipation
- Skin rash or dry skin
- Dental cavities
- Erosion of tooth enamel
- Loss of hair or nail quality
- Hyperactivity and high interest in exercise
Teens with eating disorders are often in denial that anything is wrong. They may be moody, anxious, depressed. They may withdraw from friends, and become overly sensitive to criticism. The problem arises when parents are not aware of these symptoms because the teen keeps them hidden -- just like the trauma, insecurities, depression, or low self-esteem that may help trigger the disorder.
Although there is no easy treatment for eating disorders, they are treatable. A combination of treatments, including cognitive behavioral therapy and antidepressant medication, can be used to help teens overcome bulimia. Cognitive behavioral therapy helps by identifying and replacing inaccurate thoughts to help change behavior and emotional state. Anorexia treatment usually involves nutritional feeding, medical monitoring, and psychological treatment. If left untreated, eating disorders can lead to serious illness and even death. Along with the lower body weight, girls with anorexia nervosa can lose their menstrual periods (amenorrhea). The loss of periods is associated with osteopenia, early bone loss that can lead to painful fractures. Eating disorders are also linked to other serious health problems, such as kidney disease and heart disease. Each of these health problems requires specific tests and treatment. If you think you have an eating disorder, talk to your doctor. The sooner you get medical and psychological treatment, the faster you will be on your way to recovery. If you suspect a family member or friend has an eating disorder, talk with them about the problem.
Anorexia nervosa is an eating disorder and a serious mental illness. A person with anorexia nervosa restricts their energy intake, has a distorted body image and an intense fear of gaining weight. The restriction in energy intake can cause a significant amount of weight loss in a short period of time and may result in a person having a very low weight.
Anorexia nervosa is most common in women and usually starts in adolescence. It is the third most common chronic illness in girls and young women and affects up to 1 in 200 girls. One in 11 people who develop anorexia after puberty are male.
People with anorexia nervosa may see themselves as being heavy or large when they are actually severely underweight. Their perceived body weight or shape can have a significant influence on how they evaluate or feel about themselves. Out of a fear of gaining weight, they follow restrictive diets and may undertake harsh, excessive exercise routines.
Anorexia falls into 2 general types:
Restricting type
People with this type of anorexia nervosa place severe restrictions on the quantity and type of food they consume.
This could include counting calories, skipping meals, restricting certain foods (such as carbohydrates) and following obsessive rules, such as only eating foods of a certain colour.
These behaviours may be accompanied by excessive exercise.
Binge eating/purging type
People with this type of anorexia also place severe restrictions on the food they eat. But this is accompanied by binge eating and then purging.
When binge eating, someone eats a large amount of food and has feelings of being out of control. The person then 'compensates' for this eating by purging the food through vomiting or misusing laxatives, diuretics or enemas.
Atypical anorexia nervosa
Atypical anorexia nervosa is a subtype of other specified feeding or eating disorders (OSFED) in which a person’s body weight is still in the normal weight range despite having significant weight loss from their restricted energy intake. They also have a distorted body image and an intense fear of gaining weight. Apart from the normal weight range, they have all the other characteristics, and similar complications, of anorexia nervosa.
What are the symptoms of anorexia nervosa?
The most obvious sign that someone has anorexia nervosa may be that they are underweight, they have lost weight very quickly, or their weight fluctuates dramatically.
A BMI of less than 18.5 is considered underweight. But being very thin is not the only sign of anorexia. There are also other signs that a person may have anorexia nervosa.
Physical signs
- loss of menstruation in women, decreased libido (sex drive) in men
- fainting or dizziness
- always feeling cold
- bloating, constipation or developing food intolerances
- poor sleep
- lethargy and tiredness
- looking pale
- dry, yellow skin
- sunken eyes
- fine hair on the face and body
Psychological signs
- being preoccupied with eating, food, body shape and weight
- being extremely dissatisfied with their body, or having a distorted body image
- being anxious and/or irritable at meal times
- depression and anxiety
- difficulty concentrating
- having rigid thoughts about food
- low self-esteem and perfectionism
Behavioural signs
- intense dieting (counting calories, avoiding foods)
- deliberately misusing laxatives, appetite suppressants, enemas and diuretics
- obsessive behaviour around body weight or shape (weighing themselves obsessively, pinching waist or wrists)
- binge eating
- avoiding eating with other people and secrecy around food
- wanting to be alone
- excessive exercising
- obsessive rituals around food
- preoccupation with cooking, recipes and nutrition
- self-harm, substance abuse or suicide attempts
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What causes anorexia nervosa?
The causes of anorexia nervosa are not fully understood.
There may be genetic risk factors and a combination of environmental, social and cultural factors. It's likely that some people are more vulnerable to anorexia because of particular personality traits.
The causes that may contribute to a person developing anorexia nervosa include:
Psychological factors, such as a high level of perfectionism or obsessive-compulsive personality traits, feeling limited control in life and low self-esteem, a tendency towards depression and anxiety and a poor reaction to stress.
Environmental factors, including the onset of puberty, stressful life events and relationship problems.
Cultural pressures to be thin stemming from media and pop culture such as magazines, TV shows and movies.
Occupations that demand a thin physique may increase the risk of anorexia nervosa, such as certain sports, ballet, or the television and fashion industries.
Brain chemistry, because extreme dieting can affect the balance of hormones in the body, affecting how the brain functions.
Genetic predisposition, which arises from the genes inherited from parents. Anorexia nervosa often runs in families, suggesting there may be a genetic cause.
When should I see my doctor?
Many people with anorexia nervosa think they’re not sick enough or thin enough to need treatment. But seriously restricting calorie intake is dangerous and can have a serious impact on health. If you have anorexia nervosa, the earlier you seek help, the better your chances of recovery.
If you are worried about your eating, it’s important to speak someone. Your doctor is a good place to start, or you could talk to someone you trust like a friend, family member or teacher. They will help you take the first steps towards treatment and recovery.
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How is anorexia nervosa diagnosed?
After ruling out that weight loss is caused by another condition, your doctor or another medical or mental health professional may diagnose anorexia nervosa based on your thoughts, feelings and eating behaviours. They will also check for any other mental or physical complications.
How is anorexia nervosa treated?
The first step to recovery is restoring good nutrition and a healthy weight. This allows treatments to work effectively. If the person has life threatening medical complications or is extremely low weight, they may need to spend time in hospital.
A psychologist can help a person with anorexia nervosa learn behaviours that will help them to return to and maintain a healthy weight. Someone with anorexia nervosa may also see a dietitian, family therapist, psychiatrist or other members of a healthcare team.
Antidepressants and other medicines are sometimes used to treat anorexia nervosa along with psychological therapy.
On average, people have anorexia nervosa for 5 to 7 years. It's common for people with the condition to relapse, so follow-up and treatment for anorexia nervosa is important.
Complications of anorexia nervosa
When people with anorexia nervosa enter a state of starvation, their brain stops functioning properly. They are at risk of self-harm, substance abuse, suicide attempts, depression and anxiety.
Anorexia nervosa can also cause physical complications including:
Unfortunately, around 1 in 5 people eventually die of the consequences of anorexia nervosa, and one in 5 will attempt suicide.