Anorexia nervosa is a mental illness that has serious physical, emotional and social impacts.  

Anorexia nervosa is characterised by body image distortion with an obsessive fear of gaining weight, which manifests itself through depriving the body of food. It often coincides with increased levels of exercise. When identifying anorexia nervosa, it’s important to remember that:

• Anorexia nervosa occurs in people of all genders. Men and boys are more likely to go undiagnosed because of stigma and misinformation.
• Anorexia nervosa can present differently for different people
• Anorexia nervosa impacts people in all body shapes and sizes
• Anorexia nervosa is serious and requires medical and psychological intervention

Restrictive anorexia nervosa 

This is the most commonly known type of anorexia nervosa, whereby a person severely restricts their food intake. Restriction may take many forms (e.g. maintaining very low-calorie count, restricting types of food eaten, eating only one meal a day) and may follow obsessive and rigid rules (e.g. only eating food of one colour). 

Binge-eating or purging anorexia nervosa

This type of anorexia nervosa forms when a person restricts their intake as above, but also has regularly engaged in binge-eating or purging behaviour (e.g. self-induced vomiting, over-exercise, misuse of laxatives, diuretics or enemas). 

Atypical anorexia nervosa

This diagnosis falls under the category of eating disorders known as OSFED (Other Specified Feeding or Eating Disorders) on the basis that individuals may still experience weight loss, however their weight will not fall into a low category.  

Many professionals and advocates believe that the term ‘atypical’ is unhelpful and stigmatising. Atypical anorexia nervosa is actually found to be more prevalent than ‘typical’ anorexia nervosa. People with atypical anorexia nervosa are just as likely to have worrying symptoms, such as psychological distress, low heart rate and nutritional deficiencies. It is important that those with atypical anorexia nervosa seek help, and that health professionals validate these experiences and provide appropriate treatment.  

There is no single cause of anorexia nervosa, but there are risk factors that increase the likelihood of it developing. These can be biological, psychological and social.

Biological risk factors 

Evidence tells us that anorexia nervosa has a moderate-high genetic heritability. Ongoing research into this field is analysing hundreds of genes that may influence the chance of developing an eating disorder with the hope of improving treatment and even preventing illness. You can learn more about the Eating Disorders Genetic Initiative (EDGI), the world’s largest ever genetic investigation of eating disorders, here.   

Anorexia nervosa usually develops during adolescence and generally has an earlier age of onset compared to bulimia nervosa and binge eating disorder (the latter are often developed during late adolescence or early adulthood). However, like all eating disorders, anorexia nervosa can develop at any age or stage of life, and for people of any gender, including males. It is a myth that only adolescent girls experience anorexia. 

Other research also shows that women with autism may have a higher chance of developing anorexia nervosa. It appears that up to 20-35% of women with anorexia meet the diagnostic criteria for autism. Symptoms and treatment for people with autism and anorexia nervosa may differ from other populations, with research into this field still ongoing. You can learn more about eating disorders and autism here. 

Psychological risk factors

Some psychological risks for anorexia nervosa encompass feelings of inadequacy, personality traits of perfectionism and anxiety, a fear or avoidance of conflict, low self-esteem, competitiveness, and impulsive or obsessive behaviours. 

It is important to note that psychological symptoms can also be present as the result of an eating disorder and the impact of starvation syndrome. Psychological symptoms may resolve with adequate re-nourishing and subsequent recovery. 

Social risk factors

The cultural emphasis on ‘thinness’ or smaller bodies as a moral and health imperative, along with the normalisation of intentional dieting, contributes to the valuation of individuals based on outward appearance. Not conforming to these narrow standards can lead to shame and subsequently, the development of eating disorders. 

Media and popular culture play a significant role in shaping perceptions of ‘ideal’ or ‘acceptable’ body shapes, further influencing societal norms and the pressure to conform. 

Professions such as dancers, models, and athletes, which prioritise certain body shapes and sizes, can also be at increased risk of anorexia nervosa and other eating disorders.  

You can learn about risk factors for all eating disorders here. 

Some of the more common signs and symptoms of anorexia nervosa are listed below. Remember, anorexia nervosa is a mental illness. You can’t tell if someone has an eating disorder based on physical appearance alone.

Mental health symptoms

• Preoccupation with body shape, weight and/or appearance 
• Intense fear of gaining weight 
• Preoccupation with food or food related activities 
• Negative or distorted body image, perceiving self to be fat when at a healthy weight or underweight 
• Low self-esteem (e.g. guilt, self-criticism, worthlessness) 
• Rigid thinking (‘black and white’, ‘good and bad’ foods) 
• Feeling out of control 
• Mood swings 
• Anxiety or depression 
• Heightened anxiety around mealtimes 
• Heightened sensitivity to comments or criticism about body shape, weight, appearance, eating or exercise habits 
• Suicidal or self-harm thoughts or behaviours 

Behavioural symptoms

• Constant or repetitive dieting, restrictive or rigid eating patterns 
• Excessive or compulsive exercise
• Obsessive rituals around food
• Changes in food preferences
• Repetitive or obsessive body-checking behaviours
• Deceptive or secretive behaviour around food 

Social symptoms

• Frequent avoidance of eating meals, making excuses not to eat 
• Social withdrawal or avoidance of social situations involving food 
• Changes in clothing style 
• Impaired school or work performance 

It is important to emphasise that anorexia nervosa is a serious mental illness and has the highest mortality rate of any psychiatric illness. Extreme food restriction can lead to starvation, malnutrition, severe mental distress and suicidality.  

Anorexia nervosa can affect the functioning of the entire body. The below graphic outlines some of the key systems and organs that can be impacted when someone is experiencing anorexia nervosa.

There are several evidence-based treatments available for anorexia nervosa. While accessing treatment early is preferable, it is important to know that it is recovery from longer-term anorexia nervosa is possible.

At EDV, we understand that recovery from an eating disorder is an individual and unique process. How someone defines and experiences recovery is often inclusive of their life stage, intersectional life experiences, priorities, responsibilities, support systems, and access to services. You can read more about recovering from an eating disorder here.   

The first step towards recovery is to talk about what you are experiencing. This may start with a health professional, a helpline, a trusted family member or friend, a teacher, a coach, or a spiritual leader. If you find that the person you speak to doesn’t validate your feelings, or have much knowledge about eating disorders, it’s important not to ignore your symptoms. We encourage you to reach out to Eating Disorders Victoria (EDV) for a conversation, which can include next steps for receiving treatment.   

Ego-syntonic nature of anorexia nervosa

One of the defining features of anorexia nervosa is often a belief that behaviors, such as restricting food intake or engaging in excessive exercise, are rational and necessary. This is despite psychological and physical evidence from health professionals and loved ones that this is not the case. The ego syntonic nature of anorexia nervosa can complicate treatment efforts, as individuals may be reluctant to acknowledge or address the harmful consequences of their eating disorder behaviours.

Types of treatment for anorexia nervosa

Treatment for anorexia nervosa is rarely a one-size-fits-all approach. It can involve working with a range of health professionals and trying several different approaches. While formal treatment is important, ongoing recovery also involves personal exploration and commitment. This can include learning to identify triggers for your eating disorder and to take actions to avoid or counteract them, reading and learning about your disorder, learning and applying coping skills, learning about ways to improve your self-esteem, attending support groups and developing a support system to rely on when necessary. 

In Australia, commonly prescribed treatment approaches for anorexia nervosa include: 

For children and young people:  

• Family Based Treatment (FBT)
• Adolescent Focused Therapy for Eating Disorders

For adults: 

• Cognitive Behavioural Therapy for Anorexia Nervosa (CBT-AN)
• Specialist Supportive Clinical Management (SSCM) for eating disorders
• Maudsley Model of Anorexia Treatment in Adults (MANTRA)
• Focal psychodynamic therapy for eating disorders

You can learn more about evidence-based treatment approaches here.

Accessing treatment for anorexia nervosa

Accessing treatment requires navigating different parts of the health care system. Treatment options are available in both the public and private health system. We understand this can be confusing and encourage you to reach out if you have any questions.

For most people, treatment will start with a visit to a GP. A GP is normally a central point of contact during treatment and recovery, and can provide diagnosis, medical monitoring and referral to specialist services.

We encourage you to learn more about accessing treatment by visiting the following pages: 

• Talking to my doctor  
• Treatment pathways for children and young people 
• Treatment pathways for adults 
• Medicare and eating disorders  

 Find out how EDV can help guide and support your recovery: 

• EDV Hub – helpline service providing information, navigation and general support. Open Mon – Fri, 9.30am – 4.30pm. 
• Telehealth Counselling – up to five, free 30–45-minute sessions with a trained counsellor to help you take the next step in your recovery.  
• Telehealth Nurse – free and expert guidance with registered nurses who specialise in eating disorders.  
• Online Support Groups – peer-led groups that provide an open space to discuss what you are struggling with, reflect on current challenges and discuss coping tools. Different groups are available depending on your needs. You are welcome to attend multiple groups.  
• Peer Mentoring Program – 1:1 recovery support with an EDV mentor who has experienced and recovered from an eating disorder. The program allows for 13 mentoring sessions over a six-month period. 
• Severe and Enduring Eating Disorder Program (SE-ED) – group-based program focusing on quality of life for those with long-term eating disorders
• Carer and Family Support – carer specific services including 1:1 coaching and online courses
• LearnED eLearning platform – for self-paced education and online courses 
• EDV Podcast – for lived experience perspectives and professional insights 
• EDV Newsletters – for recovery support delivered directly to your inbox