Anorexia nervosa is often misunderstood as an extreme diet, a phase or a matter of vanity. It is none of these. It is a serious mental health condition that can affect the body, mind and relationships, and it has one of the highest death rates among mental health conditions. It is also treatable, and many people recover, especially when help comes early.
This guide explains what anorexia nervosa is, its warning signs, causes, health risks, how it is diagnosed and treated, and how families can help. It deliberately avoids numbers such as weights or calories, and describes no behaviours in detail. It is general information, not medical advice or a diagnosis.
In short
- Anorexia nervosa is an eating disorder in which a person restricts what they eat or otherwise prevents weight gain, has an intense fear of gaining weight and sees their body or weight in a distorted way.
- It is not a lifestyle choice, a diet or vanity. Biology, psychology and social pressures all play a part, and families are not to blame.
- It can cause serious physical harm, including problems with the heart, bones, hormones and brain, and carries a risk to life.
- It is treatable. Early help from a team of doctors, therapists and dietitians gives the best chance of full recovery.
- You don’t need to be “sick enough” to deserve help. If you are worried about yourself or someone else, speak to a doctor.
What is anorexia nervosa?
Anorexia nervosa is an eating disorder recognised in the DSM-5-TR and the WHO’s ICD-11. According to the DSM-5-TR, its main features are:
- Restricting energy intake in ways that lead to a body weight that is significantly lower than expected for the person’s age, sex, development and physical health
- An intense fear of gaining weight or becoming fat, or persistent behaviour that stops weight gain, even when weight is already low
- Disturbance in how weight or body shape is experienced: weight or shape has an undue influence on self-worth, or the person doesn’t recognise how serious their low weight is
There are two subtypes. In the restricting type, weight loss comes mainly from limiting food and, sometimes, excessive exercise. In the binge-eating/purging type, the person also has episodes of binge eating or purging behaviours. People of any gender, age, size and background can be affected, although it most often begins in the teenage years or early adulthood.
Anorexia nervosa and other eating disorders
| Condition | What it involves |
|---|---|
| Anorexia nervosa | Restriction leading to significantly low weight, intense fear of weight gain and distorted body image |
| Bulimia nervosa | Repeated binge eating followed by behaviours to prevent weight gain, with body weight often in a typical range |
| Binge-eating disorder | Recurrent episodes of binge eating with distress, without regular compensating behaviours |
| Avoidant/restrictive food intake disorder (ARFID) | Limited eating because of sensory sensitivity, fear of choking or vomiting, or lack of interest, not because of body image concerns |
| Other specified feeding or eating disorders | Serious eating disorders that cause significant distress but don’t match the other categories exactly |
People may move between these over time. All are serious and treatable.
Warning signs
Signs vary, and people often hide their difficulties because of shame, fear or the illness itself. No single sign proves an eating disorder, but a combination, especially over weeks, is a reason to seek help.
| Area | What you may notice |
|---|---|
| Thoughts | Preoccupation with food, weight, body shape or “being good” with eating. Harsh self-criticism. Fear of weight gain. Distorted view of the body. |
| Behaviour | Skipping meals or making excuses not to eat, rigid rules about food, eating in secret or avoiding eating with others, intense exercise routines, wearing baggy clothes, withdrawing from friends and activities |
| Emotions | Anxiety around meals, irritability, low mood, perfectionism, mood swings, denial that anything is wrong |
| Body | Noticeable weight change, tiredness, dizziness or fainting, feeling cold, hair thinning, dry skin, stomach complaints, and, in girls and women, missed or stopped periods |
| Misuse of products | Use of diet pills, laxatives, stimulants or other substances to control weight. This is dangerous and a serious warning sign. |
If you are worried about yourself, please don’t wait until things feel bad enough. Early help works best.
Health risks
Prolonged under-nourishment affects almost every part of the body. Possible complications include:
| Area | Possible effects |
|---|---|
| Heart and circulation | Slow or irregular heartbeat, low blood pressure, fainting, and in severe cases heart failure |
| Blood and body chemistry | Dangerous imbalances in salts such as potassium, which can affect heart rhythm, as well as anaemia |
| Bones | Thinning of bones, with a higher risk of fractures, sometimes lasting into later life |
| Hormones and fertility | Missed periods, delayed puberty or reduced growth in young people, and fertility problems |
| Brain and mind | Difficulty concentrating, rigid thinking, low mood and anxiety, which often worsen with under-nourishment |
| Digestion and other systems | Constipation, bloating, weakness, poor immunity, hair and skin changes |
| Risk to life | From medical complications and from suicide, which is why prompt assessment is so important |
Many of these effects improve with treatment, but some, such as bone loss, can last, which is a strong reason to seek help early.
What causes anorexia nervosa?
There is no single cause. It usually arises from a combination of:
- Genetics and biology: eating disorders run in families, and brain systems for appetite, reward and anxiety may play a part
- Personality and mental health: perfectionism, anxiety, obsessive traits, low self-esteem and difficulty coping with change
- Dieting: deliberate dieting is a common starting point for people who are vulnerable
- Social and cultural pressures: thin ideals, weight stigma, social media, and comments about weight or appearance
- Activities with a focus on weight or shape, such as some sports, dance or modelling
- Stressful or traumatic experiences, bullying, loss, abuse or major life changes
It is not caused by bad parenting, and the person isn’t choosing it or being difficult.
Myths about anorexia nervosa
| Myth | What’s true |
|---|---|
| “It’s about vanity or wanting attention.” | It is a serious illness, often driven by anxiety, perfectionism and a need for control, and the person is usually suffering a great deal. |
| “Only young, white girls get it.” | It affects people of all genders, ages, ethnic groups and backgrounds, including in India, although boys, men and many others are under-recognised. |
| “You can tell by looking.” | People can be seriously unwell at any body size, and the physical risks don’t always match how someone looks. |
| “They just need to eat.” | If it were that simple, they would. Treatment addresses the fears, thoughts and habits driving the illness, alongside nutrition. |
| “It’s the parents’ fault.” | Families don’t cause it, and they are vital allies in recovery. |
| “It’s a phase that will pass.” | It rarely resolves on its own and can become entrenched. Early treatment gives the best outcomes. |
How is anorexia nervosa diagnosed?
A doctor or mental health professional usually assesses both the body and the mind. This typically includes:
- A conversation about eating, thoughts about food and body, mood, behaviour and history
- A physical examination, including pulse, blood pressure and growth in young people
- Blood tests and sometimes an ECG (heart tracing) to check for complications
- Screening for other conditions such as depression, anxiety, OCD, trauma and substance use
- Information from family members, especially in teenagers
- Comparison with the DSM-5-TR or ICD-11 criteria
Many people with eating disorders are afraid or ashamed to talk about it. A good clinician will be non-judgemental. If you’d like a private starting point for mental health concerns, our confidential self-screening is available. It is not a diagnosis of an eating disorder.
How is anorexia nervosa treated?
Treatment is usually delivered by a team, which may include a doctor, a psychiatrist, a psychologist or therapist and a dietitian, and it addresses both physical and psychological recovery.
| Approach | What it does |
|---|---|
| Medical monitoring and stabilisation | Checks vital signs, blood tests and heart function. If someone is physically unstable, hospital care may be needed to keep them safe. |
| Supported nutritional recovery | Guided by a professional team. Restarting nutrition after a period of under-nourishment needs medical supervision, because it can carry risks, so it should never be attempted alone. |
| Family-based treatment | The leading approach for children and teenagers. Parents and family are actively supported to help restore healthy eating at home, under professional guidance. |
| Psychological therapy for adults | Specialist therapies, including enhanced cognitive behavioural therapy (CBT-E), help change the thoughts, fears and behaviours that maintain the illness. See our schools of therapy. |
| Treating other conditions | Depression, anxiety, OCD, trauma and substance use often accompany eating disorders and need treatment too |
| Medication | No medicine is proven to treat the core illness. Doctors may prescribe medicines for co-occurring depression or anxiety. |
| Levels of care | From outpatient treatment to day programmes and inpatient care, matched to physical and psychological needs |
Recovery takes time, and it is rarely a straight line. With treatment, many people recover fully, especially when it begins early, and others learn to manage their illness and live well. Relapse can happen, and doesn’t mean treatment has failed.
How to help someone you are worried about
| Helpful | Not helpful |
|---|---|
| Choose a private, calm time. Say what you’ve noticed and that you care: “I’ve noticed you seem stressed around meals, and I’m worried about you.” | Confronting them at the table, or in front of others |
| Listen without judging or arguing | Lecturing, threatening, pleading or blaming |
| Focus on feelings, health and wellbeing | Commenting on their weight or appearance, even as a compliment |
| Encourage a visit to a doctor, and offer to go along | Trying to force or trick them to eat |
| Learn about eating disorders, and ask professionals how to support them | Treating food as a battle or a reward |
| Be patient, and keep checking in. Denial is part of the illness. | Giving up after one conversation |
| Look after your own wellbeing | Carrying it alone or blaming yourself |
For a teenager or child, speak to a doctor as soon as possible. Parents are a central part of effective treatment.
If you recognise this in yourself
- You are not alone, and it is not your fault. Eating disorders are illnesses, and they are not a failure of willpower.
- You don’t need to be “sick enough.” Please don’t wait until you feel bad enough, or until someone says you are.
- Tell someone you trust, such as a family member, friend, teacher or doctor. You can start with “I’m struggling with food and I need help.”
- See a doctor. They can check your health and help you find the right support.
- Be careful with online content. Websites and social media that promote extreme dieting, “thinspiration” or tips to hide behaviours can make the illness worse. Avoid them, and consider muting or unfollowing accounts that make you feel worse.
Practical tips for India
- “She’s just fussy” or “it’s a phase.” Eating disorders are often dismissed or mistaken for stomach problems, stress or religious fasting. If changes in eating are persistent and worrying, ask for a medical check.
- Fasting and religious practice. Fasting for faith is common and, by itself, is not an eating disorder. It becomes a concern when it is driven by fear of weight gain, is extreme, or continues despite health problems.
- Diet culture and comparison. Social media, fitness trends, weight-related comments in families and pressure around marriage and appearance can fuel the illness. Avoid commenting on weight at home.
- Boys and men. Often under-recognised and less likely to seek help.
- Specialist services. Dedicated eating disorder services are limited and mostly in larger cities. Your family doctor, a psychiatrist or a paediatrician can be a starting point, and online consultations may help.
- Exams and competition. Academic pressure and perfectionism can contribute. Early support helps.
- Stigma and “log kya kahenge.” Fear of judgement delays help. Choose confidential services.
- Free support. Tele-MANAS (14416) offers free tele-mental-health support in India. The National Alliance for Eating Disorders (allianceforeatingdisorders.com) is a US-based organisation with a helpline and information, although services may not be available from India.
When to get urgent help
Call 112 or go to the nearest hospital if the person:
- Faints, collapses or is very dizzy or weak
- Has chest pain, a very slow, fast or irregular heartbeat, or trouble breathing
- Is confused or very drowsy
- Can’t keep fluids down, or is refusing all food and drink
- Has swelling in the legs or a sudden change in health
- Talks about ending their life or hurting themselves
Stay with them. In India, Tele-MANAS (14416) is a free national helpline for mental health support.
Anorexia nervosa and mental health or substance use
Anorexia nervosa often occurs alongside other conditions, including anxiety, depression, OCD, trauma and substance use. Some people misuse stimulants, diet pills, laxatives, caffeine or alcohol to control weight or cope with distress, and these carry serious risks. When an eating disorder and another condition occur together, treating them together works best. See dual diagnosis, is anxiety a psychological disorder, how can I know if I have OCD and is depression a mental disorder.
Special situations
Children and teenagers. Early treatment gives the best outcomes, and family involvement is key. Speak to a paediatrician or psychiatrist promptly.
Athletes and performers. Pressure around weight and appearance raises risk. Coaches and teachers can play a protective role.
Adults. Anorexia nervosa can begin or continue in adulthood, and treatment is effective at any age.
Pregnancy. Eating disorders can affect both parent and baby. Speak to a doctor early.
Diabetes and other conditions. Eating disorders in people with medical conditions carry extra risks and need specialist care.
Looking after yourself as a family member
Supporting someone with an eating disorder can be exhausting and frightening, and many parents blame themselves. You are not to blame. Talk to a counsellor or a trusted friend, share responsibilities, keep your own routines and ask the treatment team how to look after yourself. See how to stay mentally healthy.
How Thamarai can help
Anorexia nervosa needs specialist, team-based medical and psychological care, and Thamarai Healing Center is not a substitute for an eating disorder service. At our Pollachi centre, our mental health program offers confidential assessment and guidance, and support for co-occurring conditions such as anxiety, depression and substance use, with family involvement, in a calm setting among the foothills of the Western Ghats. If you are worried about someone, a confidential conversation can help you understand the next step and where to find appropriate specialist care.
Speak to our team confidentially →
Frequently asked questions
What is anorexia nervosa?
Anorexia nervosa is a serious eating disorder in which a person restricts food or otherwise prevents weight gain, has an intense fear of gaining weight and sees their body or weight in a distorted way. It is a mental health condition, not a diet or a choice.
What are the signs of anorexia nervosa?
Preoccupation with food, weight and body shape, skipping meals, rigid food rules, avoiding eating with others, excessive exercise, withdrawal, anxiety around meals and physical signs such as tiredness, dizziness, feeling cold and, in girls and women, missed periods.
What causes anorexia nervosa?
A mix of genetics and biology, personality traits such as perfectionism and anxiety, dieting, social pressures around weight and appearance, and stressful or traumatic experiences. It isn’t caused by bad parenting.
Is anorexia nervosa dangerous?
Yes. It can seriously affect the heart, bones, hormones and brain, and has one of the highest death rates among mental health conditions. Early treatment greatly improves outcomes.
Can people recover from anorexia nervosa?
Yes. Many people recover fully, especially with early treatment from a specialist team, and others learn to manage the illness and live well. Relapse can happen, and doesn’t mean treatment has failed.
How do I help a family member with anorexia nervosa?
Speak privately and calmly, express care without commenting on weight or appearance, avoid blaming or forcing, encourage a doctor’s visit and learn about the condition. For a child or teenager, seek professional help promptly.
Does anorexia only affect girls and women?
No. It affects people of all genders and backgrounds, although boys and men are less often recognised and may be slower to seek help.
Is treatment at Thamarai confidential?
Yes. Enquiries, assessments and treatment are handled confidentially, and you can call to ask questions without committing to anything.
This article is for general information and isn’t a substitute for professional medical advice, diagnosis or treatment. If you or someone you know is in danger, call 112.
Sources
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2022. Feeding and Eating Disorders.
- World Health Organization. International Classification of Diseases, 11th Revision (ICD-11), 6B80 Anorexia nervosa.
- National Institute for Health and Care Excellence (NICE). Eating disorders: recognition and treatment (NG69). 2017.
- Treasure J, Duarte TA, Schmidt U. Eating disorders. The Lancet, 2020.
- Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of General Psychiatry, 2011.
- Lock J, Le Grange D. Treatment Manual for Anorexia Nervosa: A Family-Based Approach. 2nd ed. Guilford Press, 2012.
- Fairburn CG. Cognitive Behavior Therapy and Eating Disorders. Guilford Press, 2008.
- Ministry of Health and Family Welfare, Government of India. Tele-MANAS (14416). National Alliance for Eating Disorders (allianceforeatingdisorders.com).