What is anorexia nervosa?

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What is anorexia?

Anorexia nervosa, usually referred to as just anorexia, is an eating disorder characterized by extreme food restriction and an intense fear of gaining weight. Many people with anorexia are at a low weight and appear extremely thin, but anorexia also affects people who appear to be at a “normal” weight, as well as those in large bodies. Despite the focus on weight, anorexia isn’t a vanity issue or a choice. Like all eating disorders, anorexia is caused by a complex interplay of neurological, biological, and psychological factors, which is why we refer to it as a brain disorder. Social and environmental influences—like social media, family dynamics, and diet culture—can play a role, but they’re never the one “cause” of anorexia (nor is anything else). Rather, anorexia emerges out of a perfect storm of different causes. Anorexia is serious and can be life-threatening if left untreated, but lasting recovery is possible with the right treatment.

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Symptoms Treatment Atypical Anorexia FAQ Outcomes

Signs and symptoms of anorexia

Anorexia nervosa is perhaps the most commonly known eating disorder, but that doesn’t necessarily make it easy to spot. Like all eating disorders, anorexia thrives in secrecy, and most people struggling will go to great lengths to hide their disordered behaviors. This can make anorexia particularly tricky to detect—but understanding the many different red flags and subtle signs can go a long way toward helping you recognize a problem in yourself or someone you love.

Significant or rapid weight loss
Lack of expected weight gain (or falling off the growth chart for kids and teens)
Irregular or absent menstrual cycle
Growth of soft, downy hair all over the body (known as lanugo)
Constipation, abdominal pain, or other gastrointestinal issues
Lightheadedness
Low blood pressure
Fatigue
Feeling cold often

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People who exhibit some of these symptoms but don’t meet criteria for an official diagnosis are said to have “subthreshold anorexia.” A subthreshold eating disorder is still dangerous and should be treated.

Anorexia treatment

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Anorexia has the highest mortality rate of all eating disorders. The most common causes of death for anorexia are suicide and cardiac issues.

Anorexia is a serious eating disorder that requires professional treatment from eating disorder specialists. There’s no one-size-fits-all approach to treating anorexia, but rather a variety of different options that can work for different people depending on their symptoms, goals, challenges, and lifestyle. Regardless of where treatment takes place, the first step of anorexia treatment is always normalizing eating behaviors and achieving weight restoration (if necessary). As disordered eating behaviors decrease and a healthier weight is reached, patients often experience significant mental relief as a natural result. By addressing malnourishment and eating behaviors upfront, patients are also better able to participate in therapy and make psychological and emotional progress—a malnourished brain doesn’t think clearly or take in new information well, so doing things in this order is important. Effective treatment for anorexia requires a multidisciplinary approach, with support from specialists including a therapist, dietitian, and medical provider. Depending on the program and setting, treatment might also include support groups, therapeutic activities (like art or music therapy), and medication management. Some treatment approaches may involve a patient’s loved ones, while others don’t.

of the population has OSFED

Virtual treatment for anorexia

For decades, the default treatment for anorexia has been in-person care, which can be in an inpatient hospital setting, a residential facility (where patients live 24 hours a day), or a partial hospitalization or intensive outpatient program. But as we’ve come to better understand what actually works for treating anorexia, more and more evidence-based practitioners are moving away from this model. While some patients do require inpatient hospitalization in order to become medically stable, once they’re cleared by a doctor, there’s no reason to pursue in-person treatment over virtual care. In fact, research suggests that when people recover at home alongside their loved ones, it may improve their odds of achieving lasting recovery. The virtual treatment model eliminates many of the hurdles to traditional treatment, including logistical, geographical, and financial barriers. It also means that patients don’t need to press pause on work, school, or the other things that matter in their lives in order to get better.

What to expect from anorexia treatment at Equip

At Equip, we treat patients of all ages and acuity levels who are affected by anorexia. The specifics of treatment are tailored to each patient’s unique needs, challenges, and life circumstances, but all Equip treatment includes certain components, like nutritional support, therapy, and a dedicated multidisciplinary care team. Our care teams supports patients with the following services throughout the recovery process.

Your therapist will help you address the emotional and psychological factors that may be contributing to disordered behaviorals, as well as identify triggers and develop healthy coping strategies. They’ll also help you work through any co-occurring conditions, like anxiety or depression. All Equip therapists are licensed practitioners who have specialized experience and training in eating disorders.

Lasting recovery is possible

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of people seeking inpatient treatment for eating disorders have atypical anorexia

Atypical anorexia

Atypical anorexia is characterized by the same symptoms that define anorexia nervosa—fear of gaining weight, severe food restriction, and excessive physical activity, among others—but without low body weight. Someone with atypical anorexia meets all the diagnostic criteria for anorexia, except they’re at what’s considered a normal or above-normal weight. Because most people (including many medical providers) associate anorexia only with people who are underweight, atypical anorexia has long been underdiagnosed. Many medical providers fail to recognize the telltale signs of anorexia in patients simply because they have a medium- or larger-sized body. This is a concerning reality, because atypical anorexia is just as serious as anorexia and carries almost all of the same health risks. Every case of anorexia needs to be addressed with evidence-based treatment, regardless of a patient’s weight.

At Equip, we discourage the use of the term “atypical anorexia.”

While creating a separate diagnostic term might seem helpful, we believe that it actually does more harm than good. We avoid using the term “atypical anorexia” because:

One of the reasons why we avoid using the term “atypical anorexia” is that it creates a distance from anorexia, leading people to believe that atypical anorexia is somehow a less severe version. But weight doesn’t always indicate an eating disorder’s severity: someone’s illness can still be debilitating and even life-threatening without them reaching a critically low body weight. People who have “atypical anorexia” experience the same physical complications as anorexia patients and possibly even higher rates of mental health complications.

Separating “atypical anorexia” from anorexia fuels the myth that anorexia only affects people with dangerously low body weight. Anorexia in people who have medium to large bodies is very real and just as dangerous. Making attempts to distinguish the two creates unnecessary confusion and contributes to the concerningly high rates of underdiagnosis.

If someone is suffering through all of the symptoms of anorexia (besides low body weight) but doesn’t receive an anorexia diagnosis, it can feel deeply invalidating and perpetuate the dangerous idea that they’re “not sick enough” for treatment. The term “atypical anorexia” can contribute to the false narrative that this version of anorexia is somehow less urgent and, therefore, less deserving of treatment.

The word "atypical" suggests that this condition is uncommon, when in fact it's estimated to be more common than anorexia (we don’t know the exact numbers because atypical anorexia so frequently goes undiagnosed).

Including a weight requirement in the diagnostic criteria for anorexia is more harmful than helpful, and prevents patients from seeking the treatment they need to achieve recovery. Breaking down weight stigma and stereotypes about size is key to helping people get the care they need and deserve. At Equip, we’ll continue to use the term anorexia to refer to all patients struggling with anorexia regardless of their weight.

Common questions about anorexia

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The initial focus of anorexia treatment is normalizing eating habits, stopping restriction, and restoring weight as necessary. As the patient's body and brain become more adequately nourished, they may be better equipped to then address other important areas. At this point, treatment might then shift to other areas like body image, social life, learning to handle triggers, and addressing co-occurring conditions.

To accomplish all this, our clinicians use a variety of different evidence-based treatment modalities, including CBT-E (a form of cognitive behavioral therapy designed specifically for eating disorders), DBT (dialectical behavioral therapy), and ERP (exposure and response prevention). For younger patients who live with their family, we generally use FBT (family-based treatment).

Male anorexia is far more common than most people think, with men and boys accounting for up to 25% of all patients with anorexia. Men and boys with anorexia often go undiagnosed for a long time (at least in part because of societal misconceptions around who gets anorexia), and so they often enter treatment in a more serious condition than their female counterparts.

Anorexia and bulimia share some similarities, but tend to present quite differently. Both are types of eating disorders that involve a preoccupation with body size and weight and a fear of gaining weight. For those with anorexia, the primary eating disorder behavior is restriction. For those with builimia, the hallmark is binge-purge cycles, which are characterized by eating large quantities of food, followed by purging through vomiting, laxatives, compulsive exercise, or other unhealthy means. It is important to note, though, that restriction is often a symptom in bulimia, and bingeing and purging may be present in anorexia. You can learn more about anorexia and bulimia on our blog.

Atypical anorexia is a common yet underdiagnosed type of anorexia, in which a person has all of the symptoms of anorexia except for being at a low body weight. Instead, people with atypical anorexia may be in medium or large bodies. Atypical anorexia is a very serious condition, carries almost all the same health risks as “regular” anorexia, and should be treated the same way as anorexia.

At Equip, we don’t use the term “atypical anorexia”—it is simply anorexia. Any manifestation of anorexia, regardless of weight, is serious and life-threatening and needs the same treatment.

As frustrating as it is, there is rarely one identifiable cause of an eating disorder, and anorexia is no different. More often than not, it is a constellation of biological, psychological, and environmental factors: in other words, someone has a genetic predisposition to developing an eating disorder, and then the eating disorder is “turned on” by environmental factors such a diet, over-exercise, social stress, or even a stomach bug. But the good news is that we don't need to know the exact cause of your child's eating disorder to treat it effectively. You can learn more about the causes of eating disorders on our blog.

Anorexia is serious—but treatable

Anorexia is a deadly condition, but lasting recovery is possible. If you think you or a loved one might be struggling with anorexia, it’s important to find treatment promptly.

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Over the past few decades, rates of anorexia have increased significantly among young people.

Our patients are experiencing an early and sustained response to Equip treatment

Patients requiring weight restoration who reached their target weight

After 16 weeks

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