What is anorexia nervosa?
Anorexia nervosa is an eating disorder that is caused by a biological disorder of the brain. Children and adolescents with anorexia nervosa have an overpowering fear of being overweight and an extreme desire to be thin. They may also have a distorted body image which causes them to see themselves as overweight when they are not. This can cause them to engage in behaviours that will result in weight loss such as dieting or restricting their food intake, over-exercising, and/or using medication to control their appetite.
Anorexia nervosa can affect anyone regardless of body shape, size, weight, age, gender, ethnicity and socioeconomic background. Anorexia nervosa is not a choice; it is a serious and life-threatening biologically influenced illness.
A person with anorexia nervosa:
- restricts their food intake and develops a very low body weight for their age, sex and developmental growth and development
- has an intense fear of gaining weight
- has behaviors that interfere with weight gain
- is dissatisfied with their body weight, shape and size and cannot accurately see or understand their real body size
- may have difficulty recognizing the seriousness of their low body weight
What are the signs and symptoms of anorexia nervosa?
When someone has anorexia nervosa, they may not want to share how they’re feeling. Young people with anorexia nervosa can develop many medical problems when they don’t take in the nutritious food that provides their body with the energy or fuel it needs to grow and develop. When this happens, the young person can experience a variety of signs and symptoms.
Physical signs
- weight loss or failure to gain weight
- failure to gain height normally
- delay in the onset of puberty
- feeling cold all the time
- feeling dizzy
- lacking energy
- constipation
- irregular or missed periods
- fine hair on the back, upper arms, thighs and face and/or loss of head hair
- heart palpitations or low heart rate
- shortness of breath
- swelling of feet
- poor concentration
- low mood or feeling anxious
Eating behaviors
- dieting or restricting food intake
- changes in the types of food eaten
- skipping meals
- cutting out whole food groups
- counting calories and grams of fat
- weighing or measuring food
- following specific food rules
- eating alone
- increased interest in all things to do with food
Social or personal behaviors
- denying weight loss or not feeling that it’s a problem
- having a distorted body image
- comparing body weight, size, shape or appearance to unrealistic ideals
- spending time alone
- increasing social isolation from friends
- poor concentration
- poor self-esteem
- wearing baggy clothing
- experiencing mood swings, including increased irritability, sadness and anxiety
What if I think I may have anorexia nervosa?
- Tell someone. Tell a trusted adult such as a parent, caregiver, teacher, coach or therapist. Explain your concerns and ask for their help.
- Don’t feel alone. It can be hard to tell someone about your eating disorder thoughts and behaviors. You might be concerned about how they will react. However, it can help to have an open and honest conversation about your eating disorder with those you trust. It will help you feel less alone.
- Get help early. It is important for you to see your health-care provider as soon as possible. Your health-care provider can help to determine whether you have an eating disorder and can also assess how serious the situation is. The sooner a diagnosis is made, the quicker you can start treatment, and the better chance for recovery.
It’s important to see a health-care provider if:
- you are experiencing any of the signs or symptoms for anorexia nervosa listed above
- you notice that you’re starting to fear eating or weight gain
- your parents/caregivers, friends or others are worried about your weight loss, your thoughts or feelings about food, or mood even if you don’t think it’s a problem
What will the health-care provider do during an assessment for anorexia nervosa?
A health-care provider will do a complete history (medical, nutritional and psychosocial history) and a thorough physical examination including:
- measuring your weight and height (plotting measurement on a growth curve)
- taking your blood pressure and heart rate both lying and standing
- taking your temperature
- assessing pubertal growth development
They may also do some initial tests including laboratory studies to check the blood and urine for abnormalities and an electrocardiogram to check how the heart is functioning.
People with anorexia nervosa can also develop anxiety or depression. The treatment team will assess and monitor for other mental health disorders that may occur with anorexia nervosa.
How is anorexia nervosa treated?
If the health-care provider determines that a person has anorexia nervosa, they will arrange for appropriate care. Eating disorder care is usually done with multiple health-care professionals including paediatrician or adolescent medicine doctor or family doctor or nurse practitioner, dietitians, psychologists, psychiatrists, and social workers who specialize in treating children and teens with eating disorders.
The health-care provider will decide if the patient can be managed as an outpatient (outside of the hospital), either in their office or in a specialized eating disorder program.
The first treatment recommended for outpatients is called family-based treatment, which focuses on recovery of the eating disorder. Parents/caregivers play an essential role in the treatment and recovery of their child. Family-based treatment includes 3 treatment phases.
- Phase 1 focuses on weight restoration. Parents, supported by the therapist, take responsibility for making sure that the patient is eating sufficiently and also takes on all meal planning and preparation.
- Phase 2 is when substantial weight recovery has occurred and the adolescent gradually assumes responsibility for their own eating.
- Phase 3 is when weight is restored and the focus is on general issues of adolescent development.
If the health-care provider finds that the patient is too sick, they may refer the patient for urgent hospitalization.
The goal of inpatient treatment is to:
- ensure that the adolescent is medically safe
- achieve a weight and medical stability that guarantees the patient can be treated safely as an outpatient
- begin to help manage any emotions about eating, including any worries about weight
- prepare for outpatient treatment
If you are experiencing depression or anxiety in addition to anorexia nervosa, your health-care team may suggest other treatments for those mental health disorders once the eating disorder is under control. Sometimes, the health-care team may also suggest medication. Antidepressants can help with depression or anxiety. If the adolescent’s thoughts about food and weight are really strong, their doctor may suggest other medications.
Full recovery from anorexia nervosa is possible. It is important to remember that an early diagnosis and treatment and an early response to treatment may be associated with better outcomes.
SickKids has an eating disorder program that treats children and teens who are struggling with symptoms of anorexia nervosa, bulimia nervosa and avoidant restrictive food intake disorder. For more information on our program visit: www.sickkids.ca/en/care-services/clinical-departments/adolescent-medicine/
NEDIC – National Eating Disorder Information Centre (Canada)
NEDA – National Eating Disorder Association (United States)
B-EAT – Beating Eating Disorders (United Kingdom)
Kelty Eating Disorders (Kelty Mental Health Resource Centre, BC Children's Hospital)
ANAD - National Association of Anorexia Nervosa and Associated Disorders (United States)
