Also known as anorexia nervosa

Key points about anorexia

  • Anorexia is an eating disorder that most commonly affects young women, but also affects some men.
  • Anorexia is defined as being 15% or more below your ideal weight for your height.
  • People with anorexia have a fear of putting on weight or of getting fat, even if they are already slim or underweight.
  • They will avoid eating or eat only small amounts of certain foods, even if this leads to becoming dangerously thin.
  • Low body weight puts your body’s vital organs at risk.
  • Ask for help as soon as you notice signs you or someone you care for may have anorexia.
  • Early treatment leads to better outcomes.
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Anorexia most commonly occurs during adolescence. People with anorexia often start with dieting, which develops into an obsession to control food intake. You develop obsessive eating habits such as avoiding eating, eating only small amounts of certain foods, or weighing and measuring your food extremely carefully, despite suffering hunger pangs.

Other habits to maintain low body weight may also include frequent, intense exercise, purging mechanisms such as forced vomiting, and abuse of laxatives, enemas and diuretics. 

Anorexia includes physical and emotional symptoms such as:

  • an intense fear of becoming fat or putting on weight, even if already underweight
  • distorted views of weight or shape image
  • denying the seriousness of extremely low body weight
  • resistance to maintaining a normal body weight
  • severe sensitivity to cold
  • growth of down-like body hair
  • delayed onset, infrequent or no menstrual periods in females who have reached puberty
  • irritability, inability to concentrate/think clearly
  • obstinate behaviour, unhappiness, depression.

Factors involved can include:

  • low self-esteem
  • poor body image
  • a reluctance to mature – physically, sexually and emotionally
  • a feeling of not being in control of your life
  • life crises, eg, changed relationships, death, childbirth.

If you have anorexia, it's important to realise this is a serious problem. Because of the complexities of eating disorders, treatment should be started as early as possible for the best outcome and should involve comprehensive specialist care. 

Treatment for anorexia is usually tailored to your individual needs. This usually includes medical oversight (either by a GP or psychiatrist), who carry out regular medical assessments and psychological treatment. The medical professional and the psychologist keep in regular contact to ensure your welfare is being looked after as much as possible.

Psychological treatment can include looking at factors that contribute to the eating disorder (thoughts and behaviours) and learning ways to reduce or change these. If the person with anorexia is a child or young person, the best treatment seems to be family systems therapy.

If you have a dangerously low weight, you might need to restore your weight to a healthy level. Weight restoration could be required when it is clear that your health is in danger, eg, your potassium is so low that your heart is of risk of developing problems, or your psychological health is at risk, eg, if you get too low in weight your brain will literally eat itself to survive and your thinking will become very distorted.

You and your team work together to decide what "weight restoration" means in your case.

Selective serotonin re-uptake inhibitors (SSRIs) – a class of antidepressants – have been used to maintain weight gain, treat mood and anxiety symptoms associated with anorexia and prevent relapse. SSRIs are generally used only after you have recovered your weight loss.

Family, whānau and friends should try to encourage you to take personal responsibility in seeking help, and to learn to accept your strengths and limitations and your successes and failures as being a normal part of life.

It is important to remember the following:

  • Early recognition can help prevent more serious eating disorders developing.
  • While dietary monitoring and advice are important, effective treatment must address any underlying psychological issues.
  • The same approach will not work for all people with an eating disorder.
  • Don't give up if the first treatment approach does not work – most people with an eating disorder make a good recovery, even it takes a while.

Learning how to take good care of yourself and manage your emotions is key to recovering from an eating disorder. The following steps can help you on your road to recovery. 

  • Learn about eating disorders to help you make sense of how you feel.
  • Seek help early. The longer you leave it, the harder it is to get well.
  • Make a decision to recover – see your doctor and get the treatment you need.
  • Don’t be so hard on yourself – seek support and learn strategies to help you deal with difficult emotions and thoughts.
  • Learn about nutrition and develop a healthy relationship with food.
  • Learn ways to improve your body image – self-acceptance and kindness to yourself are important to help you recover.
  • Feeling good about yourself is key – make time for pleasurable activities and spend time with people who can boost your mood.

The outcome for people with anorexia varies from recovery after a single episode, fluctuating weight gain and loss, or chronic illness that causes health deterioration over many years.

Sometimes the condition can cause death. The most common fatal complications of anorexia are imbalances in electrolytes (your body's essential fluids and salts), which can lead to cardiac arrest and suicide. Kidney, bladder, bowel and brain function can also deteriorate.

For these reasons, getting help early is really important. If you do, you have a good chance of getting better. 

In My Mind: Anorexia

Three-years ago teenager Arley Gower was diagnosed with anorexia. It’s been a long and challenging road to recovery, but through her personal diaries we learn of the strength it took, and the vital role her family played in the journey. Watch the video here(external link).

Video: Living with anorexia: Dominique's story

Dominique has lived with severe anorexia since she was 9. Now a psychology student, she has a unique insight into her illness. She’s determined to survive and to help others to overcome this condition. This video may take a few moments to load.

(Attitude Live, NZ, 2016)

James's story

25-year-old James has been struggling with anorexia for over five years. He had to put his studies on hold and move back in with his parents. Panorama has met men, boys and their families across the UK to hear their moving accounts of the devastating impact of anorexia and bulimia. Watch the video here(external link).

Seeking help(external link)(external link) Central Region Eating Disorder Services, NZ
Disordered eating(external link)(external link) Centre for Clinical Interventions, Australia
Just a Thought(external link)(external link) NZ
Treatments and drugs(external link)(external link) Mayo Clinic, US
Eating disorders explained(external link)(external link) Eating Disorders Association of NZ (EDANZ)
Online NZ support to strengthen wellbeing Ignite(external link)(external link), NZ


Note: Some resources below are from overseas so some details may be different in NZ, eg, phone 111 for emergencies or, if it’s not an emergency, freephone Healthline 0800 611 116.

The following information is taken from the New Zealand Doctor

Take-home messages regarding anorexia nervosa

  1. Anorexia is an important problem for young people in New Zealand and it is important to screen for it during clinic appointments. HEEADSSS assessment and brief questions are as useful as validated questionnaires. 
  2. Early intervention is important – if in doubt about a young person's weight or eating, either refer them to a specialist service for an assessment without delay or monitor them and their weight and physical observations very closely (weekly not monthly).
  3. Urgent treatment (usually inpatient) may be required if there are signs of medical instability, particularly bradycardia (<50 beats/minute), hypotension (systolic <80 mmHg) or postural drop (>20 mmHg or heart rate >30 beats/minute between standing and lying). 
  4. Family-based treatment is the treatment of choice for young people with anorexia and is currently offered by specialist ICAMHS and eating disorders services nationally. 
  5. The GP has a vital role in identifying anorexia and in supporting young people and families while they progress through treatment to recovery. If in doubt, please check the Starship Clinical Guidelines(external link), EDANZ(external link) or link) websites for up-to-date information and research about eating disorders. 

Clinical resources

Eating disorders – management of(external link) Starship Children's Hospital, NZ, 2021
RANZCP clinical practice guidelines for eating disorders(external link) Royal Australia and New Zealand College of Psychiatrists, 2016
Managing frequently encountered mental health problems in young people – non-pharmacological strategies(external link) BPAC, NZ, 2015

See our page Youth health for healthcare providers

Continuing professional development 

Anorexia – Hiran Thabrew(external link) Goodfellow Unit, NZ, 2016
"Dr Hiran Thabrew talks about anorexia nervosa. Hiran is a dual-trained child and adolescent psychiatrist and paediatrician. He is a senior lecturer within the department of psychological medicine at the University of Auckland, and clinician."

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Courtney Cline, registered clinical psychologist, Nelson

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