Anorexia nervosa

Learn about anorexia, signs to look for, how your doctor determines if you have anorexia and treatment options.
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Found in: Mental Health Conditions
Date: March 2023

About anorexia nervosa

Anorexia is an eating disorder that affects the way you eat and the way you feel about food and your body. People with anorexia severely restrict how much they eat, leading to weight loss that can be life-threatening, and may also exercise excessively, binge eat or purge (e.g., by vomiting).  

You may want to read this article on eating disorders first, and then come back here for anorexia nervosa in particular. The article explains that eating disorders are much more than an extreme focus on diet and exercise. They are not a ‘phase’ or a ‘choice’, and it is extremely hard to recover from them without professional help. However, with the right treatment and support, you can make a full recovery.

Who gets anorexia nervosa?

Anorexia most often begins in adolescence or early adulthood, but it can affect people of all ages, genders, races and social groups. Sadly, the stereotype of anorexia affecting only young women can sometimes stop other people from getting the help they need. In reality, about 5–10% of sufferers are men. They often begin with a focus on a muscular look, leading to compulsive exercising, which then progresses into weight loss and food restriction. 

Not everyone with anorexia looks underweight. If you have ‘atypical anorexia’, you may have a higher weight initially and lose significant weight from there, without reaching a level that is officially considered underweight. The physical and emotional impacts of atypical anorexia are just as serious, and the fact that you don’t fit the stereotype of what a person with anorexia looks like may make it harder to ask for – and receive – help.

Anorexia is often associated with other mental health conditions. If you have anorexia, you may also experience symptoms of anxiety, depression, body dysmorphia or obsessive-compulsive disorder (OCD). You may do self-harming behaviours. Your clinician can help design a treatment plan for you that takes all these factors into account.


These symptoms are usually present in people with a diagnosis of anorexia nervosa:

  • Restricting how much you eat
  • Weighing less than is considered healthy for your age, sex and height 
  • Intense fear of gaining weight, or persistent behaviour that stops you from gaining weight or leads to ongoing weight loss
  • A perception of your body/weight that doesn’t match how others see you, a strong belief that your body size or shape impacts your value as a person, or a lack of recognition that your low body weight is negatively impacting your health

As well as restricting how much you eat, you may have binge episodes, where you eat large amounts and feel that you have no control, usually followed by purging (vomiting or using laxatives, enemas or diuretics) to compensate for the food you have eaten. This can make you feel very guilty and lead to more severe food restriction and/or compulsive, excessive exercising.

Signs to look for (symptoms)

If you are experiencing anorexia, you – or the people around you – may also notice some of the following behaviours, feelings and physical symptoms.

  • The way you eat: Skipping meals, preferring to eat alone or secretly, hiding or secretly throwing away uneaten food, having rituals around eating, following strict rules about what you eat, weighing or measuring your food, developing new ‘intolerances’, eating only ‘diet’ or ‘low-fat’ products, paying close attention to calorie content, being dishonest about what you’ve eaten, drinking water or chewing gum instead of eating, feeling anxious or irritable during mealtimes, having a strong interest in cooking/cookbooks/what other people are eating but not eating yourself
  • Your attitude towards your body: Low self-esteem, feeling dissatisfied with your body, thinking or talking a lot about losing weight or being ‘fat’, wearing baggy or layered clothes to disguise weight loss, asking people for reassurance about your body size, weighing/pinching/looking in the mirror obsessively, strong interest in images and information about weight loss/thin people.
  • The way you exercise: Exercising in secret, exercising intensely with no pleasure, developing rituals around exercise, exercising to compensate for eating.  
  • Signs of purging: Sore throat, tooth decay, bad breath, a rounder face from swollen glands, swollen/red marks on fingers or knuckles, using diet pills/laxatives/diuretics/enemas, going to the bathroom straight after meals, running water in the bathroom to cover vomiting sounds, using mints or gum to cover the smell of vomit.   
  • Physical symptoms: Fluctuations in weight, weight change after illness/travel/increased involvement in sport or exercise, brittle nails, hair thinning/breaking/falling out, dry skin, downy hair on body, abnormal blood count, irregular heart rhythms, low pulse, low blood pressure, constipation, stomach pains, periods stopping/becoming irregular/delayed in starting, dehydration, loss of bone mass, feeling cold (especially hands and feet), fainting/dizziness, skin problems, lethargy/tiredness. 
  • Other behaviours: Struggling to sit still, having rigid (black-and-white) thinking, increased perfectionism, seeing other people as judgmental, becoming more isolated and socially withdrawn, difficulty talking about emotions.


Losing weight rapidly and not getting the nutrition you need can lead to low blood pressure, a low heart rate and many other risk factors, which can be life-threatening. Purging can lead to electrolyte imbalances that stop your heart from functioning properly. Treatment for anorexia nervosa will include regular visits to the GP, for medical monitoring, and sometimes admission to hospital.

Treatment options

There are several types of therapy and treatment settings that can be used in treating eating disorders. Largely, treatment consists of specialist evidence-based psychological treatments. This includes individual therapy and family therapy. It can at times also include group therapy, provision of nutritional advice and meal planning with a dietician, and education for you and your family/whānau.

Depending on how severe the eating disorder is, you may attend a clinic for residential or day treatment for a number of weeks to provide a more structured setting for support. You may be admitted to hospital for medical stabilisation as an in-patient if you are at risk and medically compromised.

There is no specific medication to treat eating disorders, but you may be prescribed medication to assist with treatment. Some medications may make your eating disorder thoughts less intense and help with depression or anxiety symptoms.

Talking therapies

Below are some of the specialist evidence-based psychological therapies used to treat eating disorders. Your clinician can help you decide which one is right for you. 

General counselling has not been shown to be effective in treating eating disorders. Make sure your clinician is trained in specialist eating disorder treatment, experienced in treating your type of symptoms, and being supervised for their work.

  • Family Based Treatment (FBT) is the first line of treatment for adolescents and young adults with anorexia (and bulimia). Recovery rates of FBT for treatment of adolescents with up to three-year illness duration are about twice as high as individual treatment (AFT). Therapists and parents work together to help the young person’s recovery, restoring weight and addressing the eating disorder behaviour. The treatment lasts for one year, with the parents gradually supporting the adolescent to learn how to take on more responsibility in the management of eating behaviour.
  • Adolescent Focused Therapy (AFT) is also effective for anorexia in young people and is used in circumstances where FBT is not possible or has not been taken up by the family. In individual sessions across about 12–18 months, with some parental involvement, the therapist works with the young person to strengthen their sense of self and help them find new ways to handle the challenges of adolescence other than through their eating disorder.
  • Cognitive Behavioural Therapy (CBT-E) is the first line of treatment for bulimia nervosa and binge eating disorder but has now also been expanded to treat anorexia nervosa. It focuses on patterns of thought and behaviour that are happening in the present day, rather than experiences in your past. You will work together with your therapist with a focus on behavioural change, using daily monitoring forms, introducing regular eating, challenging patterns of thought and behaviour that contribute to disordered eating, and learning techniques to change these.
  • Integrative Cognitive Affective Therapy (ICAT) is a structured short-term treatment for bulimia and binge eating disorder, over 20 sessions. It focuses on development of emotion awareness in the very moment before a binge in order to learn and apply different skills to manage these situations. 
  • Maudsley Anorexia Treatment for Adults (MANTRA) In addition to working on weight recovery and challenging eating disorder behaviour, MANTRA addresses the function of the eating disorder in the person’s life more fully and focuses on strengthening the person’s ability to develop better emotional and interpersonal skills and address unhelpful thinking styles.
  • Specialist Supportive Clinical Management (SSCM) is less structured than CBT or MANTRA. It is a practical approach that combines supportive therapy, information, advice and encouragement.

All types of therapy should be provided to you and your family/whānau in a manner that is respectful of you, and that helps you feel comfortable and free to ask questions. It should be consistent with and incorporate your cultural beliefs and practices. All psychological therapies are designed to be done without disrupting study or work.

Other strategies to support recovery

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and which may be used to complement and support it.
Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress. However, you should not rely on these therapies alone to treat eating disorder symptoms.

Family/whānau support and involvement

If someone you love is experiencing anorexia, you are likely feeling many emotions: fear, sadness, worry, frustration and more. It’s important to remember that eating disorders are strongly influenced by biology: it is not your fault that your loved one has anorexia, and it’s not something they can change or recover from without professional help.

As a family/whānau member, you have an important role to play. Learning as much as you can about anorexia and its treatment will reassure you and help you support both their recovery and your own wellbeing. Reach out to your own support network for practical help, seek counselling for yourself, and remember to care for your own physical and mental health. The groups listed below, under ‘Resources and links’, offer valuable support to parents and caregivers of people with anorexia.

Thanks to Dr Roger Mysliwiec, Director New Zealand Eating Disorders Clinic, for reviewing this content. Date last reviewed: March 2023