Anorexia Nervosa

Anorexia nervosa is a serious and potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.

The condition is more prevalent among females (95 per cent are women) and usually begins in early or mid adolescence The typical individual with anorexia nervosa is also a high achiever. A common characteristic of persons with anorexia is a tendency toward perfectionism and difficulty adapting to change. Between 0.5 and one percent of American women suffer from anorexia.

Anorexia has three primary symptoms:

  • Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
  • Intense fear of weight gain or being “fat” even though underweight
  • Disturbance in the experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight

Anorexia nervosa may develop from dieting and continue into a cycle of losing weight and not eating. Individuals with anorexia may exhibit a combination of restrictive and purging behaviors (laxatives, diuretics, self-induced vomiting) to maintain a low weight.

Restrictive behaviors include under-eating, avoidance of high-calorie food and engaging in strenuous exercise. These behaviors undermine an individual’s physical health, self-esteem and feelings of competency.

Eating disorders experts have found that prompt, intensive treatment significantly improves the chance of recovery. Therefore, it is important to be aware of some of the warning signs of anorexia.

Warning signs of anorexia nervosa:

  • Dramatic weight loss
  • Preoccupation with weight, food, calories, fat grams and dieting
  • Resistance to eating certain foods, progressing to restrictions against whole categories of food (e.g. No carbohydrates, etc.)
  • Frequent comments about feeling “fat” or overweight despite weight loss
  • Anxiety about gaining weight or being “fat”
  • Denial of hunger
  • Development of food rituals (e.g. Eating goods in certain orders, excessive chewing, rearranging food on plate)
  • Consistent excuses to avoid mealtimes or situations involving food
  • Excessive, rigid exercise regimen despite weather, fatigue, illness or injury (need to burn off calories taken in)
  • Withdrawal from usual friends and activities
  • In general, behaviours and attitudes indicating that weight loss, dieting and control of food are becoming primary concerns

Between five and 20 percent of people who develop anorexia die. The probability of death increases in relation to the length of time the person has had the condition. Anorexia has one of the highest death rates of any mental health condition.


Treatment for anorexia nervosa should be individualized and may include: hospital inpatient programs, outpatient day programs, medication—in particular, antidepressants to alleviate symptoms of depression—individual or group psychotherapy.

Therapists use different approaches and some of the more common ways to treat anorexia nervosa include behavior therapy, cognitive therapy, cognitive-behavior therapy, family therapy, psycho-dynamic or expressive art therapies.

More features of anorexia nervosa are:

  • Refusal to maintain body weight over a minimum normal weight for age and height
  • Intense fear of weight gain or being “fat”
  • Feeling fat or overweight despite dramatic weight loss
  • Extreme concern with body weight and shape
  • Weight loss of 15 per cent or more of one’s original body weight
  • Fear that weight gain is out of one’s control
  • Distorted body image
  • Loss of menstrual periods (for females)
  • Dietary restriction
  • Hoarding, concealing, picking at, crumbling or throwing away food
  • Engaging in compulsive or ritualistic behavior such as cutting food into small pieces, or rearranging food
  • Preoccupation with food, reading recipes, preparing food only for others
  • Wearing baggy or layered clothing to conceal weight loss
  • Compulsive activity and exercise
  • Social withdrawal, secretiveness
  • Compulsive repetitive activity and exercise

Health consequences of weight loss are:

  • Abnormally slow heart rate and low blood pressure, which means that the heart muscle if changing. The risk for heat failure rises and the heart rate and blood pressure sink lower.
  • Reduced bone density (osteoporosis), which results in dry, brittle bones
  • Muscle loss and weakness and shrinking of organs such as the brain
  • Severe dehydration, which can result in kidney failure, constipation and dry, cracked skin
  • Fainting, fatigue and overall weakness
  • Dry hair and skin—hair loss is common
  • Difficulty concentrating and thinking clearly
  • Sensitivity to cold
  • Anemic skin tone
  • Development of lanugo (downy hair) on face and arms in an attempt to keep the body warm

If you think you may have an eating disorder, contact our office to find out more about services available in the Ottawa Community.

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