Cause

The cause of anorexia nervosa is not fully understood. It is thought to develop from a mix of physical, emotional, and social triggers.

• Extreme dieting changes how the brain and metabolism work, and it stresses the body. These changes may make you more likely to develop an eating disorder.
• Genetics play a big part in anorexia and bulimia. Compared with people who don't have these disorders, people who have eating disorders are more likely to have a family history of an eating disorder, obesity, or a mood disorder (such as anxiety or depression).
• A combination of certain personality traits (such as low self-confidence along with perfectionism) and cultural and social pressures can play a part in anorexia.
• For some teens, anorexia may be a way of coping with stress and the challenges of the teen years. Stressful life events, such as moving, divorce, or the death of a loved one, can trigger anorexia.

Symptoms

Feelings and actions

Common feelings and actions that are linked to anorexia nervosa include:¹

• Having an intense fear of gaining weight.
• Restricting food or types of food, such as food that contains any kind of fat or sugar.
• Weighing less than 85% of your expected body weight. (In a child or teen, losing or not gaining weight during a growth spurt is a concern.)
• Seeing your body as overweight, in spite of being underweight. This is called having a distorted body image.
• Exercising too much.
• Being secretive around food and not recognizing or wanting to talk about having a problem with eating or weight loss.

Some people who have anorexia also make themselves vomit or use laxatives or diuretics to lose weight (bulimia). Breakdown of the enamel on the teeth is a common symptom of long-term vomiting.

Physical signs

Common physical signs of malnutrition from anorexia include:²

• A low body weight.
• Constipation and slow emptying of the stomach.
• Thinning hair, dry skin, and brittle nails.
• Shrunken breasts.
• Stopping or never getting a monthly menstrual period.
• Feeling cold, with a lower-than-normal body temperature.
• Low blood pressure.

Food rituals

People who have anorexia often form rituals associated with eating. These may include:

• Having special ways to eat food, hoarding food, collecting recipes, and preparing elaborate meals for other people but not eating the meals themselves.
• Spending a lot of time cutting and rearranging food on their plates to make it look as though they have eaten. They may also hide food or secretly get rid of it during meals.

Suicidal feelings

In some cases, people who have eating disorders can feel suicidal.

• Warning signs of possible suicide in children and teens can include making suicide threats, being preoccupied with death or suicide, giving away belongings, withdrawing, being angry, or having failing grades.
• Warning signs and possible triggers of suicide in adults can include suicide threats, alcohol or substance abuse, depression, giving away belongings, a recent job loss, or divorce.

If someone you know shows warning signs of suicide, make sure that the person is not left alone. Seek help from a mental health professional immediately.

If you are having suicidal thoughts, talk to someone about it. Call a local suicide hotline, your local health department, or the national suicide hotline (1-800-273-TALK or 1-800-273-8255), or seek help at a local hospital emergency room.