Table of Contents

Definition of Anorexia Nervosa

Anorexia nervosa is an eating disorder characterized by an intense fear of gaining weight, distorted body image, and severe restrictions on food intake, often leading to dangerously low body weight. Individuals with anorexia typically have an obsessive preoccupation with controlling their weight and may engage in extreme behaviors such as severely limiting calorie intake, excessive exercise, or misuse of diet pills or diuretics.

This disorder can have severe physical, emotional, and social consequences, including but not limited to malnutrition, organ damage, hormonal imbalances, cardiovascular issues, depression, anxiety, social withdrawal, and disruptions in daily life functioning. Anorexia nervosa requires comprehensive treatment, often involving medical, nutritional, and psychological interventions to address both the physical and psychological aspects of the condition.

Anorexia Nervosa

History of Anorexia Nervosa

The history of anorexia nervosa dates back centuries, but it was formally recognized as a medical condition relatively recently in the late 19th century. Here’s an overview of its historical progression:

Early Observations:

Historical accounts suggest that behaviors resembling anorexia nervosa have existed for centuries, with references to self-imposed fasting and severe food restriction found in various cultures. Instances of religious fasting, asceticism, and self-starvation were observed in different societies throughout history.

19th Century:

The term “anorexia nervosa” emerged in the 19th century. In 1873, Sir William Gull, a British physician, coined the term to describe a condition characterized by self-imposed starvation and peculiar nervous symptoms. He referred to it as “anorexia nervosa” to denote the lack of appetite associated with a nervous origin.

Late 19th to Early 20th Century:

During this period, anorexia nervosa was primarily viewed through a psychiatric lens and was considered a manifestation of hysteria or neurosis rather than primarily an eating disorder. It was seen as a psychological condition rather than one rooted in food restriction or body image concerns.

Mid-20th Century:

In the mid-20th century, there was a shift toward recognizing anorexia nervosa as an eating disorder with complex psychological and physiological aspects. Medical professionals began to understand the significance of severe weight loss, malnutrition, and their impacts on various bodily systems.

Late 20th Century to Present:

Research and understanding of anorexia nervosa expanded significantly. The Diagnostic and Statistical Manual of Mental Disorders (DSM) included anorexia nervosa as a specific diagnostic category in its third edition in 1980, further solidifying its recognition as a distinct mental health condition. Over time, there has been progress in treatments, including psychotherapy, nutritional counseling, medical interventions, and family-based therapies.

Throughout history, societal attitudes, cultural norms, and medical understanding of anorexia nervosa have evolved. Increased awareness and ongoing research have led to improved diagnostic criteria, better treatment approaches, and a greater understanding of the complex interplay between biological, psychological, and sociocultural factors contributing to the development and maintenance of this disorder.

DSM-5 Criteria of Anorexia Nervosa

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), outlines specific criteria used for the diagnosis of anorexia nervosa. To receive a diagnosis of anorexia nervosa, a person must meet the following criteria:

Restriction of Energy Intake Relative to Requirements:

Persistent restriction of energy intake, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health. This can be indicated by a significantly low body weight compared to what is considered normal for the individual, or a failure to gain weight expected for growth (in children and adolescents).

Intense Fear of Gaining Weight or Becoming Fat, or Persistent Behavior That Interferes with Weight Gain:

The individual experiences an intense fear of gaining weight or becoming fat, or they persistently engage in behavior that interferes with weight gain, even though they are at a significantly low weight.

Disturbance in the Way Body Weight or Shape Is Experienced:

There is undue influence of body weight or shape on self-evaluation, or the individual’s perception of their body weight or shape is significantly distorted.

Additionally, there are two subtypes of anorexia nervosa outlined in the DSM-5:

Restricting Type: The person has not regularly engaged in binge eating or purging behavior (such as self-induced vomiting or the misuse of laxatives, diuretics, or enemas) during the current episode of anorexia nervosa.

Binge-Eating/Purging Type: The person has regularly engaged in binge eating or purging behavior during the current episode of anorexia nervosa.

These criteria are used by mental health professionals to diagnose anorexia nervosa and differentiate it from other eating disorders or conditions. It’s essential to consult a qualified healthcare professional for a comprehensive evaluation and diagnosis, as well as to determine appropriate treatment options.

Etiology of Anorexia Nervosa

The development of anorexia nervosa is multifaceted and involves a combination of genetic, biological, psychological, environmental, and sociocultural factors. Understanding the etiology of anorexia nervosa involves recognizing these complex interactions:

Genetic Factors:

There is evidence to suggest a genetic predisposition to anorexia nervosa. Individuals with a family history of eating disorders may have a higher risk of developing the condition, indicating a genetic component in its susceptibility.

Biological Factors:

There are biological aspects linked to anorexia nervosa, including abnormalities in neurotransmitter pathways (such as serotonin, dopamine, and norepinephrine) that play a role in mood regulation, appetite, and satisfaction. Hormonal irregularities, particularly involving the hypothalamus-pituitary-adrenal axis, can contribute to disruptions in hunger and fullness signals.

Psychological Factors:

Psychological factors often play a significant role. Anorexia nervosa is associated with certain personality traits like perfectionism, obsessive-compulsive tendencies, low self-esteem, body dissatisfaction, and difficulties in managing emotions and stress. Traumatic life events or experiences, such as childhood trauma or bullying, may also contribute.

Environmental Factors:

Sociocultural pressures and environmental influences can significantly impact the development of anorexia nervosa. Cultural ideals that emphasize thinness, diet culture, social media, and societal pressures to achieve unrealistic body standards can contribute to body dissatisfaction and drive disordered eating behaviors.

Family Dynamics and Social Influences:

Family dynamics, upbringing, and relationships can also influence the development of anorexia nervosa. This may involve overemphasis on weight, appearance, or control within the family, or difficulties in communication and coping mechanisms.

Dieting and Weight-Control Behaviors:

Engagement in strict dieting, especially at a young age, and the use of extreme weight-control behaviors (such as fasting, excessive exercising, or misuse of diet pills) can trigger and perpetuate anorexia nervosa in susceptible individuals.

It’s important to note that the interaction between these factors can vary significantly among individuals. Anorexia nervosa is a complex mental health condition, and its development often involves a combination of these factors. Treatment approaches typically involve addressing these multifaceted aspects through a combination of medical, nutritional, and psychological interventions tailored to the individual’s needs. Early intervention and comprehensive treatment are crucial for recovery.

Theories related to Anorexia Nervosa

Anorexia nervosa is a complex and serious eating disorder characterized by an intense fear of gaining weight, distorted body image, and self-starvation leading to extreme weight loss. Several theories attempt to explain the development and perpetuation of anorexia nervosa, including:

Biological factors:

Genetic predisposition plays a role in the development of anorexia nervosa. Studies suggest that individuals with a family history of eating disorders are at a higher risk. Additionally, imbalances in neurotransmitters like serotonin and dopamine may contribute to the disorder.

Psychological factors:

There are various psychological theories associated with anorexia nervosa, including:

  • Body image disturbance:

Anorexia nervosa often involves a distorted perception of body image, where individuals see themselves as overweight despite being underweight.

  • Perfectionism and control:

Some theories suggest that anorexia nervosa may develop as a coping mechanism in individuals seeking control over their lives, often stemming from feelings of inadequacy or a desire for perfection.

  • Low self-esteem and negative emotions:

Factors such as low self-esteem, anxiety, depression, and difficulty in handling emotions may contribute to the development and maintenance of anorexia nervosa.

Environmental factors:

Sociocultural influences, such as societal pressures for thinness, media portrayal of idealized body shapes, and cultural emphasis on thinness, can significantly impact the development of anorexia nervosa, particularly in vulnerable individuals.

Family dynamics:

Certain family dynamics and interpersonal relationships can contribute to the development of anorexia nervosa. This could include high levels of family conflict, overprotectiveness, criticism about weight or appearance, or dysfunctional communication patterns within the family.

Neurobiological factors:

Research suggests that alterations in brain structure and function, especially in regions associated with reward processing, emotional regulation, and perception, may contribute to the development and maintenance of anorexia nervosa.

It’s important to note that these theories are not mutually exclusive, and an interplay of multiple factors often contributes to the onset and perpetuation of anorexia nervosa in individuals. Treatment typically involves a combination of therapies, including psychotherapy, nutritional counseling, medical intervention, and support from a multidisciplinary team to address the physical, psychological, and social aspects of the disorder.

Risk factors of Anorexia Nervosa

Anorexia nervosa is a complex disorder influenced by a variety of factors. Several risk factors increase the likelihood of developing this condition. These can be categorized into various domains:

Biological Factors:

  • Genetics: Individuals with a family history of eating disorders are more susceptible to developing anorexia nervosa. Genetic factors play a role in predisposing someone to the disorder.
  • Neurobiological Factors: Certain brain chemistry imbalances involving neurotransmitters like serotonin and dopamine may contribute to the development of anorexia nervosa.

Psychological Factors:

  • Perfectionism: High levels of perfectionism, rigidity, and an intense desire for control are associated with an increased risk of developing anorexia nervosa.
  • Negative Body Image: Dissatisfaction with body image, distortions in perceiving body size or shape, and a strong desire to be thin contribute to the risk.
  • Low Self-Esteem: Individuals with low self-esteem or those who tie their self-worth to their body shape or weight may be at higher risk.
  • Emotional Factors: Anxiety, depression, difficulty in handling emotions, or stressful life events can be contributing factors.

Environmental and Sociocultural Factors:

  • Media and Societal Pressures: Societal emphasis on thinness, media portrayal of idealized body shapes, and cultural expectations regarding appearance can significantly influence the development of anorexia nervosa.
  • Dieting and Weight-Related Teasing: Participation in weight-related activities or being subjected to teasing or criticism about weight or appearance can increase the risk.
  • Professions or Activities: Participation in activities or professions that prioritize thinness or weight control (e.g., modeling, dancing, gymnastics) might elevate the risk.

Family Dynamics:

  • Family History: Dysfunctional family dynamics, high levels of family conflict, overprotectiveness, or a history of certain family members having eating disorders can increase susceptibility.
  • Parental Attitudes: Parents who are overly concerned about weight, appearance, or dieting can contribute to the risk.

It’s crucial to understand that these risk factors may not directly cause anorexia nervosa but rather increase vulnerability. Not everyone with these risk factors will develop the disorder, and the interplay of various factors likely contributes to its onset. Early intervention, psychoeducation, supportive environments, and appropriate mental health care are important in addressing and mitigating these risks.

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Treatment for Anorexia Nervosa

Treatment for anorexia nervosa typically involves a multidisciplinary approach aimed at addressing the physical, psychological, and social aspects of the disorder. The severity of an individual’s condition, their overall health, and specific needs influence the type of treatment required. Here are some components commonly incorporated into the treatment plan:

Medical Management:

  • Medical Assessment: An initial evaluation to assess physical health, including weight, vital signs, laboratory tests to check for complications (electrolyte imbalances, organ function, etc.).
  • Nutritional Rehabilitation: Working with a registered dietitian or nutritionist to create a structured meal plan aimed at restoring healthy eating habits and weight.
  • Monitoring and Medical Care: Regular monitoring of physical health and medical complications associated with anorexia nervosa. Hospitalization might be necessary in severe cases to address immediate health risks.


  • Cognitive-Behavioral Therapy (CBT): A widely used therapeutic approach that helps individuals identify and modify dysfunctional thoughts and behaviors related to food, body image, and self-esteem.
  • Family-Based Therapy (FBT): Particularly effective for adolescents, this therapy involves the family in the treatment process to support weight restoration and address family dynamics contributing to the disorder.
  • Other Psychotherapies: Dialectical Behavior Therapy (DBT), Interpersonal Psychotherapy (IPT), and other modalities might also be used to address specific aspects of the disorder.


  • Antidepressants or other medications: These may be prescribed to manage associated conditions like depression, anxiety, or obsessive-compulsive disorder (OCD) that commonly coexist with anorexia nervosa.
  • Medications to Address Physical Complications: Medications might be necessary to manage medical complications such as osteoporosis, irregular heartbeat, or gastrointestinal issues.

Supportive Care:

  • Support Groups: Participation in support groups or group therapy sessions can provide peer support, encouragement, and a sense of belonging.
  • Individual Counseling: Ongoing individual therapy to address underlying psychological issues, improve coping skills, and manage emotions.

Long-Term Care and Relapse Prevention:

  • Continued Monitoring: Regular follow-ups with healthcare providers to monitor progress, prevent relapse, and address any emerging issues.
  • Education and Support for Families: Helping families understand the disorder and teaching supportive behaviors to aid in long-term recovery.

Successful treatment often requires a comprehensive, individualized approach that takes into account the specific needs and circumstances of the person with anorexia nervosa. Early intervention, a supportive environment, and a team approach involving mental health professionals, physicians, dietitians, and family members are crucial for effective management and recovery.

Therapies for Anorexia Nervosa

Several therapeutic approaches have been used to treat anorexia nervosa, each targeting different aspects of the disorder. These therapies can be effective both in individual and group settings. Here are some of the prominent therapies used in treating anorexia nervosa:

Cognitive-Behavioral Therapy (CBT):

  • CBT-E (Enhanced): Specifically designed for eating disorders, CBT-E targets the core beliefs and thoughts related to eating, body shape, and weight. It aims to modify dysfunctional thinking patterns and behaviors.

Family-Based Treatment (FBT) or Maudsley Approach:

  • Adolescent-Focused Therapy: FBT involves the family in treatment, primarily for adolescents. It emphasizes parental involvement in refeeding, weight restoration, and addressing problematic family dynamics related to the eating disorder.

Dialectical Behavior Therapy (DBT):

  • DBT focuses on enhancing emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness. It can help individuals manage emotions and behaviors related to their eating disorder.

Interpersonal Psychotherapy (IPT):

  • IPT concentrates on resolving interpersonal issues and improving communication skills. It helps individuals understand the connection between their relationships and the eating disorder.

Acceptance and Commitment Therapy (ACT):

  • ACT aims to help individuals accept their thoughts and feelings rather than trying to change or control them. It focuses on values clarification and commitment to behavioral changes.

Psychodynamic Psychotherapy:

  • This therapy explores unconscious thoughts, emotions, and past experiences that may contribute to the development and maintenance of anorexia nervosa.

Nutritional Counseling:

  • In addition to psychological therapies, working with a registered dietitian is essential to help individuals establish healthy eating patterns, normalize eating behaviors, and address any fear or anxiety related to food.

Mindfulness-Based Therapies:

  • Practices like mindfulness meditation can help individuals develop a non-judgmental awareness of their thoughts, emotions, and bodily sensations related to food and body image.

Supportive Therapy and Group Counseling:

  • Support groups or group therapy sessions provide a sense of community and understanding among individuals facing similar challenges. It offers peer support and encouragement.

Therapies for anorexia nervosa are often integrated into a comprehensive treatment plan tailored to an individual’s specific needs, severity of the disorder, and underlying psychological factors. It’s common for therapists and treatment teams to combine multiple approaches or use a stepped-care model where different therapies are implemented at various stages of treatment. The goal is to address the complex nature of the disorder and promote long-term recovery and improved quality of life.

Preventions of Anorexia Nervosa

Preventing anorexia nervosa involves addressing multiple factors, including promoting positive body image, healthy eating behaviors, and fostering a supportive environment. While not all cases can be prevented, several strategies can reduce the risk and contribute to a healthier relationship with food, body image, and self-esteem:

Promoting Body Positivity and Healthy Body Image:

  • Encourage self-acceptance and appreciation of diverse body shapes and sizes.
  • Educate individuals, especially adolescents, about media literacy to critically analyze and challenge unrealistic body ideals portrayed in media.
  • Promote positive discussions about body image, emphasizing that worth is not solely determined by appearance.

Encouraging Healthy Eating Habits:

  • Educate about balanced nutrition and healthy eating without focusing excessively on weight or appearance.
  • Discourage dieting behaviors and instead promote a balanced approach to food and eating.
  • Teach intuitive eating, emphasizing listening to internal hunger and fullness cues.

Addressing Sociocultural Influences:

  • Advocate for body-positive representations in media and challenge harmful messages or images that glorify extreme thinness.
  • Promote awareness in schools and communities about the dangers of unrealistic body ideals and the importance of healthy lifestyle choices.

Early Intervention and Education:

  • Provide education and awareness programs about eating disorders, their warning signs, and where to seek help.
  • Train educators, parents, healthcare providers, and counselors to recognize early signs and risk factors of eating disorders.

Fostering Supportive Environments:

  • Create supportive and open environments where individuals feel comfortable discussing concerns about body image or eating habits.
  • Encourage open communication within families and peer groups to reduce stigma and shame associated with seeking help for mental health concerns.

Stress Management and Coping Skills:

  • Teach stress management techniques and healthy coping strategies to deal with emotions and stressors without turning to disordered eating behaviors.

Professional Intervention and Treatment:

  • Seek professional help early if there are concerns about disordered eating behaviors or body image issues. Timely intervention can prevent the worsening of symptoms.

Prevention efforts involve a combination of societal, familial, educational, and individual factors. By promoting a positive body image, healthy eating habits, and providing education and support, it’s possible to mitigate some of the risk factors associated with the development of anorexia nervosa and other eating disorders. Creating an environment that values overall health and well-being rather than strict adherence to unrealistic standards can significantly contribute to prevention.

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