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Characteristics of Anorexia Nervosa

Bridget Engel, Psy.D., edited by Kathryn Patricelli, MA

Anorexia Nervosa is the primary eating disorder associated with food restriction and self-starvation. It can be very dangerous, even lethal, if not treated. Anorexia is more common in teenage girls and young women, particularly among celebrities.

teen staring at piece of bread Symptoms/Criteria

The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) is the handbook used by clinicians to diagnose an eating disorder. It outlines three major criteria for diagnosis of anorexia. These are:

  • Restriction of food eaten - eating less than the body needs, which leads to significantly low body weight for the person's age, sex, and physical health
  • Intense fear of gaining weight or becoming fat or having ongoing behaviors that stop weight gain, even when already underweight
  • Issues with the way the person thinks about their body weight or shape. These thoughts affect how they view themselves. They also do not see the seriousness of their current low weight.

There are also subtypes of Anorexia Nervosa that can be indicated. Behavior over the past 3 months is examined and one of the following is assigned:

  • Restricting Type - Weight loss is being accomplished through dieting, fasting (not eating), and excessive exercise.
  • Binge-eating/purging type - The person has had ongoing episodes of binge eating (eating more than normal in one sitting) or purging behaviors (vomiting or the misuse of laxatives, diuretics, or enemas to cleanse the body of food eaten).

Approximately 90-95% of those with anorexia are female. The prevalence rate of anorexia among young females is 0.4% according to current research.

Anorexia is one of the deadliest of all mental disorders. It is estimated that 5-20% of those who have untreated anorexia nervosa will not survive the disorder. The annual death rate for females between 15 and 24 years old from anorexia is 12 times higher than the annual death rate for all other causes combined. When a person receives treatment, the rate of death drops to approximately 2-3%.

Secrecy is very common in girls who are struggling with anorexia nervosa. They don't want their weight loss to be interrupted if they are found out. They also are typically ashamed and embarrassed about their behavior. They may skip meals by forgetting, being busy, or falling asleep at mealtimes. People with anorexia often make many excuses about why they are not hungry. They also avoid social occasions in which food will be readily available. They may spend lots of time making meals for others without eating the food they've prepared. People with anorexia may wear baggy or over-sized clothing to hide their thin bodies. In order to lose more weight and give the impression to others that they are eating, they often restrict their intake to fluids and low-calorie food choices such as plain lettuce. They may also use laxatives, diet pills, and excessive exercise in secret to continue shedding pounds.

Another common symptom of anorexia is obsessive thinking about food and weight. Their weight and body image is directly tied to their self-worth. They experience intense fear and anxiety about gaining any weight, as well as not losing enough weight. Obsessive, frequent weighing is a common behavior for people with anorexia, as is obsessive meal planning and counting of calories or fat grams.