Conditions

Navigating Anorexia Nervosa: Finding Hope and Healing on the Recovery Journey

Anorexia nervosa, a severe mental health condition, affects the body and mind. Diagnosis isn’t always straightforward. Treatment requires multidisciplinary care. Recovery is possible with professional support and understanding.

therapist sean abraham By Sean Abraham, LCSW

Updated on May 24, 2024

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Anorexia nervosa is a serious and life-threatening mental health condition, one that encompasses much more than just a warped relationship with food and weight. Anorexia goes deep into the individual’s mind, heart, genetics, and personal history, and it manifests in profound physical and psychological symptoms.

In this article, we delve into these complexities and consider the comprehensive support systems needed on the path toward recovery, restoration, and healing. By shedding light on this heartbreaking illness, we hope to foster empathy, sensitivity, and hope for people struggling with anorexia and their loved ones.

What Is Anorexia Nervosa?

Anorexia nervosa is a serious illness. Its hallmarks are significantly low weight due to restricting food intake, an intense fear of weight gain, and a distorted body image, according to the National Eating Disorders Collaboration’s (NEDC) article on anorexia.

To diagnose and treat clients with anorexia, mental health providers use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The official DSM-5 criteria for anorexia include:

However, the criteria aren’t everything. The National Eating Disorder Association (NEDA) emphasizes that a serious eating disorder may be present even if not all points are met. Also, ED diagnoses aren’t always as clear-cut as the manual suggests. Christy Barongan, a licensed clinical psychologist with Grow Therapy, notes that symptoms may overlap across disorders. “[People with anorexia] primarily restrict, but they also may binge and purge,” she says.

Subtypes of Anorexia

Generally, people with anorexia can be classified into one of two subtypes:

Atypical Anorexia Nervosa

Atypical anorexia is a subtype of the DSM category other specified feeding or eating disorders (OSFED). Someone with atypical anorexia meets the diagnostic criteria for anorexia nervosa, including significant weight loss; however, their weight is within or above the “normal” BMI range, according to the NEDC.

Don’t be fooled by the name. Atypical anorexia is life-threatening and has similar medical complications as anorexia nervosa. Also, NEDA’s anorexia resource page reiterates that someone doesn’t have to be underweight or emaciated to be severely struggling.

How Common Is Anorexia Nervosa?

Anorexia is the least common eating disorder. About 0.9% of women will struggle with this disorder in their lifetimes compared to 1.5% with bulimia and 3.5% with binge eating, according to Eating Disorder Hope’s (EDH) statistics. Also, anorexia is clinically more common among women than men. The National Institute of Mental Health reports that lifetime prevalence is three times higher in women (0.9%) than men (0.3%).

However, there’s a persistent, inaccurate notion that anorexia only affects thin, white adolescent girls and women. As a result, doctors ask Black, Indigenous, and People of Color about eating disorder symptoms significantly less than they ask white people, according to National Association of Anorexia Nervosa and Associated Disorders (ANAD) statistics. This negligence can have life-changing implications. Research on race and eating disorders found that Black people are less likely to be diagnosed with anorexia than white people but may experience the condition longer.

Where Is Anorexia the Most Common?

Our World in Data’s research in 2019 on eating disorder prevalence reports that India had the most people affected by anorexia nervosa at over half a billion people (570,752 cases). China followed with 467,965 people with anorexia and then the United States at 370,503.

Not all countries produce regular publications or reports of eating disorders, and not all cultures have rigid expectations of body shape and size. But the Eating Disorder Hope’s blog on EDs around the world notes that the predominance of Western media — and therefore culture — may be partly to blame for rising case counts around the world.

Anorexia recovery is possible

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Signs and Symptoms of Anorexia

This condition deeply affects both the body and the mind. NEDA reports that anorexia symptoms —what the individual experiences — include:

Signs of anorexia — what providers and loved ones can perceive — include:

What’s Happening Mentally in Those Suffering From Anorexia?

The causes of anorexia are as diverse as the people who experience this mental disorder. The Mayo Clinic suggests that, while the exact cause is unknown, biological, psychological, and environmental factors likely all play a role.

Unfortunately, the physical symptoms of anorexia can complicate recovery. Barongan explains, “Changes that happen in the brain because of starvation and malnutrition can make it hard for a person with anorexia nervosa to recognize that they are unwell, or to understand the potential impacts of the illness.”

Complications of Anorexia

Anorexia is a severe disorder that can be fatal, even when the person isn’t severely underweight. Eating Disorder Hope reports that about 4% of people with anorexia die from the disease’s medical complications.

About one-third of these deaths are due to cardiac events, noted an International Archives of Internal Medicine case study. Anorexia often causes “cardiac alterations” (changes to the heart’s functioning), including bradycardia (low heart rate), hypotension, arrhythmia, and sudden death.

Anorexia affects bone density, as well. When someone isn’t eating enough, their body stops producing hormones (e.g., estrogen) that increase bone production. Starvation also increases cortisol in the body, a stress response, which accelerates bone loss. Osteoporosis sets in when bone loss is happening faster than bone production. The result? As Barongan puts it, “[They] have the bone density of a much older person.”

Lastly, anorexia compromises the reproductive health of female patients. However, a Diseases meta-analysis published in 2020 offered hope for survivors. Appropriate treatment and weight restoration appeared to reverse these effects, although the authors note more research into anorexia and infertility is needed.

Anorexia and Menstruation

Anorexia can stop your period by disrupting your body’s hormonal cycle, according to Eating Disorder Hope’s page on anorexia and the menstrual cycle. Clinicians call this condition amenorrhea, when starvation causes the body to stop producing the estrogen that triggers ovulation. Not all women with anorexia skip periods. Research in the Journal of Eating Disorders reports that about 25% won’t, and the DSM’s diagnostic criteria for anorexia no longer requires missing cycles. But for those who experience amenorrhea, it’s a serious concern that can have a lasting impact. A treatment team is crucial in identifying and treating your concerns.

How Does Anorexia Affect Relationships?

As shared on NEDA’s anorexia resource page, the condition can affect people’s social lives — in fact, changes in social behavior can be a warning sign. For example, someone with anorexia may withdraw from their friends and usual activities; they may become isolated, secretive, and withdrawn, or have limited social spontaneity (e.g., never joining spontaneous plans).

The Emily Program’s blog on EDs and relationships elaborates that active eating disorders are incompatible with the vulnerability, honesty, and open communication needed for healthy intimate relationships. Part of anorexia treatment is re-learning how to have healthy relationships, and loved ones can be key supports as someone recovers.

Treatment for Anorexia

If you or a loved one are struggling with anorexia, know that making a full recovery is possible. Treating this condition requires an interdisciplinary team who can evaluate your needs and recommend the best level and type of care for you.

A treatment team for anorexia recovery usually includes at a minimum:

During intake and throughout treatment, this team will evaluate the individual’s needs and recommend the appropriate level of care. ED treatment has different levels of care including:

How to Help Someone with Anorexia

Resources exist to guide you through supporting a loved one who may be anorexic. Check out NEDA’s guide on helping a friend or family member. Know that this conversation is delicate and may not be received well.

Barongan offers context for loved ones: “It’s very hard to have an intervention with someone who has anorexia because they are ambivalent about being seen,” she says. “Their bodies are the obvious sign that they have a problem, but they get defensive if you point it out and it may damage the relationship.”

The critical thing is connecting them with professionals who can guide them through their next steps.

Recovering From Anorexia Is Possible

Anorexia recovery can be a long, back-and-forth process — but it’s absolutely possible and completely worthwhile. Healing requires both a qualified treatment team and the support of family and friends. If you’re searching for professional support, you can search for a therapist that specializes in eating disorders through Grow Therapy.

Frequently Asked Questions

About the author
therapist sean abraham Sean Abraham, LCSW

Sean Abraham is a licensed clinical social worker who works with those who have struggled with substance use, depression, anxiety, loss, communication problems, student life, as well as other mental health concerns.

This article is not meant to be a replacement for medical advice. We recommend speaking with a therapist for personalized information about your mental health. If you don’t currently have a therapist, we can connect you with one who can offer support and address any questions or concerns. If you or your child is experiencing a medical emergency, is considering harming themselves or others, or is otherwise in imminent danger, you should dial 9-1-1 and/or go to the nearest emergency room.

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