Commonly Asked Questions: Anorexia Nervosa 1
Garret D. Evans, Psy.D., and Samuel F. Sears, Ph.D., and Heidi Radunovich, Ph.D.2

What is It?
Anorexia nervosa is an eating disorder that has been gaining a lot of attention in the last 20 to 25 years. People with anorexia use extreme measures to lose weight. They often become dangerously thin and suffer significant health problems as a result.
Sometimes people confuse anorexia nervosa with bulimia nervosa, or binge eating disorder. While people with anorexia may binge eat from time to time, they tend to exercise, diet, or eliminate food from their system so frequently that their body weight becomes dangerously low. In contrast, people with bulimia usually stay at an average or above average weight for their height despite the fact that they purge after binging on large quantities of food.


Who Has It?
Approximately 90 percent of the people diagnosed with anorexia are female, although the incidence of anorexia in adolescent males is increasing. Currently, males make up about 20 to 30% of the cases of anorexia among youth. Anorexia is a condition that is seen most commonly in industrialized countries. It rarely is diagnosed in children before puberty or adults over age 40. In fact, anorexia is diagnosed most commonly in females ages 14 to 18. In the past, this disorder occurred more commonly among Caucasian women, but now it occurs just as frequently among Hispanic women, and the incidence among African-American women is rising.

What causes Anorexia?
There does not appear to be one specific cause of anorexia, and researchers still are not sure why some people get anorexia while others do not. A combination of many factors, including genetic factors, metabolism, personality issues, coping skills, family functioning, psychological issues, and social factors appear to contribute to the risk for anorexia. People who have a close relative with anorexia have an increased risk of getting the disorder. Young people involved in sports, particularly those in which weight is a consideration, such as gymnastics or wrestling, also are more at risk for developing anorexia.

What are the Symptoms?
If you are wondering if someone you know may have anorexia, here are critical characteristics to look for. To be diagnosed with anorexia, a person must display all of the following symptoms.

Extremely Low Body Weight and Related Behaviors
Health practitioners use 85 percent of the expected weight for a person's height and age as a minimum weight standard. These figures usually are taken from the Metropolitan Life Insurance Height and Weight Tables or pediatric growth charts. Those who fall below 85% of their expected weight are showing a symptom of anorexia.
Another characteristic is that people with anorexia typically go to extreme measures in order to lose weight. One sub-group, called the Restricting Type, attempts to lose weight through extreme dieting. When they eat, they typically eat only very low calorie foods. They also may stop eating entirely for extended periods of time. People with anorexia may exercise several times a day to burn off calories.

A second sub-group, the Binge-Eating /Purging Type, also may attempt to lose weight through diet or exercise regimens. However, these people also occasionally eat excessive amounts of high-calorie foods and may attempt to purge any food they have eaten. Purging is defined as trying to eliminate any recently eaten food from the body. Purging includes such activities as self-induced vomiting, and use of laxatives, enemas, and diuretics (medications that make one urinate). While the person with this subtype of anorexia may binge more than once a week, they continue to succeed in their attempts to lose weight to the point that they become dangerously thin.


Intense Fear of Gaining Weight or Becoming Fat
Another symptom of anorexia is an extreme fear of gaining weight or becoming fat. While many of us are concerned, or even fearful, about becoming overweight, individuals with anorexia seem to be consumed by this fear. They may weigh themselves several times per day to be sure they have not gained weight. Ironically, their success in losing weight often makes them more fearful of gaining it back in the future.

Distorted Views of Body Weight and Shape
Some people believe that very thin people are just trying to attract attention or compliments when they complain about being "too fat." This kind of thinking is dangerous when it comes to dealing with anorexia. Regardless of how thin they are, people with anorexia are sincere when they say that they believe they are too fat. They might admit that they are thin in most places but are troubled by a "flabby tummy" or "sagging thighs." They focus on these "imperfections" and ignore the thinner parts of their bodies. Their view of their body shape is truly distorted and not based in reality.