Anorexia nervosa (often called anorexia) is a serious eating disorder defined by significant food restriction and an overwhelming fear of gaining weight. While many people with anorexia are at a low body weight, it’s important to know that the disorder can affect people of all ages, genders, and backgrounds. Someone who has lost a significant amount of weight and restricts food while staying at a typical weight or higher may be diagnosed with atypical anorexia, which is just as serious. Sessions are available in person and online.
Anorexia is not about vanity or a lifestyle choice. It is a complex condition resulting from a combination of genetic, biological, and psychological factors. While environmental pressures like diet culture and social media can be contributing factors, they are never the sole cause. Anorexia develops from a unique convergence of influences.
Anorexia can be life-threatening, but recovery is possible with the right treatment and support.
Some physical signs, such as fainting, chest pain, or a very slow heart rate, need prompt medical attention.
Physical Symptoms
Behavioral Symptoms
Emotional Symptoms
The physical signs of anorexia are primarily due to malnutrition and starvation. They can be severe and life-threatening.
Weight Loss: Significant or rapid weight loss is a common sign.
Lack of Expected Weight Gain: Kids and teens may halt in their expected growth curve, "falling off the growth chart".
Fatigue and Weakness: Persistent tiredness and lack of energy are common.
Gastrointestinal Issues: Symptoms can include constipation, bloating, abdominal pain, and an intolerance to certain foods.
Intolerance to Cold: Feeling cold frequently, even in normal temperatures, due to a lower body temperature and loss of body fat.
Hair and Skin Problems: Hair may become thin, brittle, or fall out. A fine, downy hair called lanugo may grow on the body. Skin can become dry and yellowish.
Brittle Nails: Nails may become weak and break easily.
Menstrual Irregularities: In females, there may be a loss of menstrual periods (amenorrhea) or irregular cycles.
Dizziness and Fainting: These can occur due to low blood pressure and dehydration.
Swelling: Swelling in the arms, legs, or face can be a sign of fluid and electrolyte imbalances.
Sleep Disturbances: Difficulty sleeping or insomnia is common.
Cardiovascular Issues: These can include a slow heart rate (bradycardia), low blood pressure (hypotension), and in severe cases, heart failure.
Food and Dieting Obsession: Preoccupation with food, calories, fat grams, and dieting.
Restrictive Eating Patterns: Severely limiting the quantity of food eaten, often to the point of starvation. This may involve skipping meals or adopting rigid eating rituals.
Fear of Gaining Weight: An intense and overwhelming fear of gaining even a small amount of weight.
Distorted Body Image: Seeing oneself as larger than one is, or feeling that weight loss is never enough.
Excessive Exercise: Compulsive and excessive exercise, even when ill or injured, as a way to burn calories.
Food Rituals: Developing unusual habits around food, such as cutting food into tiny pieces, eating in a specific order, or refusing to eat in front of others.
Use of Purging Methods: May engage in self-induced vomiting, or the misuse of laxatives, diuretics, or enemas after eating.
Denial of Hunger: Refusing to acknowledge feelings of hunger.
Social Withdrawal: Avoiding social situations, especially those involving food.
Wearing Baggy Clothes: Hiding weight loss or body shape by wearing loose or layered clothing.
Frequent Weighing: Obsessively weighing oneself.
Cooking for Others but Not Eating: Preparing elaborate meals for others but not consuming them.
These symptoms reflect the internal struggles and distorted thinking patterns associated with anorexia.
Intense Fear of Being “Fat”: This fear is often irrational and does not align with the individual’s actual body weight.
Low Self-Esteem: Self-worth is often heavily tied to body weight and shape.
Depression: Feelings of sadness, hopelessness, and a loss of interest in previously enjoyed activities are common.
Anxiety: High levels of anxiety, particularly around mealtimes and food.
Irritability and Mood Swings: Frequent changes in mood and increased irritability.
Perfectionism: Striving for flawlessness in all areas of life, not just weight.
Obsessive-Compulsive Tendencies: Displaying rigid thinking and repetitive behaviors.
Difficulty Concentrating: Malnutrition can impair cognitive function, leading to problems with focus and memory.
Denial of the Seriousness of the Illness: A lack of insight into the severity of the illness and its health consequences.
Learn More About Anorexia
This video from the Stanford Center for Health Education explains anorexia nervosa and how it affects the body and mind.
Anorexia Treatment
Anorexia is a significant eating disorder that is hard to overcome without expert support. Recovery is a personal journey, so treatment plans are customized to fit the individual’s unique goals, challenges, and lifestyle. The path to healing begins with two key steps: normalizing eating habits and, when necessary, restoring body weight. As these physical goals are met, many individuals find that their mental and emotional state naturally improves. A well-nourished brain functions more clearly, making this foundational step vital before a person can fully benefit from therapy.
Comprehensive care involves a team of experts, typically a therapist, dietitian, and medical doctor, working together. Treatment can also include support groups and medication management, and it may include the participation of loved ones, especially for children and teens.
What to Expect
Initial Consultation
You tell us about your concerns, and we talk through next steps.
Assessment
We learn about eating, health history, and safety, and may ask for a medical evaluation.
Treatment Plan
We agree on goals, who will be involved, and how often to meet.
Ongoing Review
We check progress regularly and discuss whether a higher level of care is needed.
Care That Connects Across Specialties
Anorexia often overlaps with other concerns, and our clinicians coordinate care when it does.
Anorexia nervosa is a serious eating disorder involving significant food restriction, an intense fear of gaining weight, and a distorted view of body weight or shape. It can affect people of any age, gender, or background.
What are the early warning signs of anorexia?
Early signs can include skipping meals, new food rules, a preoccupation with calories or weight, frequent weighing, compulsive exercise, and withdrawing from social events that involve food. In children and teens, a drop in expected weight or growth is also a sign. A consultation can help you decide whether an evaluation is needed.
Can someone have anorexia without being underweight?
Someone can lose a significant amount of weight and restrict food but remain within or above a typical weight range. This is called atypical anorexia and is classified under OSFED. It can be just as serious, including medically, and it is treated in similar ways.
What does anorexia treatment involve?
Treatment usually starts with normalizing eating and, if needed, restoring weight, alongside therapy for the thoughts and behaviors that keep the eating disorder going. Care is coordinated among a therapist, a dietitian, and a medical doctor, and it is tailored to the person’s age and needs.
Is Family-Based Treatment used for anorexia?
Yes. Family-Based Treatment has the strongest research support for adolescents with anorexia. Parents and caregivers take an active role in restoring health, with guidance from the therapist.
When is a higher level of care needed?
Outpatient therapy is not enough for everyone. If a person is medically unstable, such as having a very low heart rate, fainting, or rapid weight loss, they may need a higher level of care first. We work with your medical provider and help you find the right setting.
What if my loved one says nothing is wrong?
Many people with anorexia have difficulty seeing how serious it is, and that is part of the illness. Speaking calmly about specific behaviors you have noticed, without arguing about weight or food, can help. A consultation can also give you guidance on how to approach the conversation.
Do you offer anorexia treatment online?
Yes. Sessions are available in person at our Chappaqua and Hartsdale offices and by secure video.
What if there is an emergency?
PPG provides outpatient care and is not an emergency service. If you are having thoughts of harming yourself, call or text 988, the Suicide & Crisis Lifeline, at any time. If you or someone you care about has fainting, chest pain, or trouble breathing, or you are in immediate danger, call 911. For eating disorder information, support, and referrals, you can also call the National Alliance for Eating Disorders helpline at 866-662-1235, Monday through Friday, 9 a.m. to 7 p.m. Eastern Time.
