Anorexia Nervosa

Anorexia nervosa is a serious eating disorder that can become life-threatening without treatment. At UT Southwestern Medical Center, our experienced team of eating disorder specialists – psychiatrists, psychologists, and other providers – works closely with each patient for personalized care to help them regain their health – in body, mind, and spirit.

Compassionate Care and Support to Treat Anorexia Nervosa

Anorexia nervosa is an eating disorder that causes people to lose more weight than is healthy for their height, sex, and age. Some people with anorexia nervosa have an intense fear of weight gain, while others may want to gain weight and strength but find it difficult to engage in the behaviors required for weight gain.

Anorexia nervosa and other eating disorders are mental health conditions that some people use as coping strategies to manage emotions. With treatment, people with anorexia nervosa can learn better coping skills, build healthier eating habits, and reverse serious complications of the disorder.

At UT Southwestern, we take a team approach in our eating disorders program, working closely with multiple specialties to provide compassionate care. Our team includes psychiatrists, psychologists, psychiatric nurse practitioners, psychiatric physician assistants, and social work therapists. With advanced training and years of experience, we create personalized care plans for each patient, using the latest approved treatments.

Symptoms of Anorexia Nervosa

Anorexia nervosa causes a wide range of physical, emotional, and behavioral signs and symptoms, which can affect each person differently. Not everyone with anorexia nervosa has all the signs and symptoms, but malnourishment is a common consequence, and nutritional rehabilitation is critical for treatment.

Physical signs and symptoms of malnourishment:

• Extreme weight loss or inability to maintain a healthy weight
• Fatigue or exhaustion
• Dizziness or fainting
• Hair on the head that thins or falls out
• Yellow or blotchy skin covered with soft, downy hair
• Low blood pressure
• Sensitivity to cold and low body temperature
• Digestive disorders, such as upset stomach, constipation, and abdominal pain
• Dry skin and dehydration
• Swelling in hands, arms, legs, or feet
• Tooth decay from induced vomiting
• Dysregulation of appetite (can be very low or very high)

Behaviors that are common in anorexia nervosa:

• Low food intake
• Exercising excessively, even when tired, sick, or injured
• Compensatory behaviors related to food: vomiting or taking laxatives, diuretics (water pills), or diet aids
• Frequently skipping meals
• Eating only a few types of foods
• Eating only low-calorie foods
• Not eating high-fat/high-calorie foods
• Not attending events that include food (birthdays, holidays)
• Frequent weighing
• Cooking for others but not eating

Emotional signs and symptoms include:

• Thinking about food or eating
• Thinking about body size or shape
• Listlessness, depression, or flat mood
• Social withdrawal
• Irritability
• Difficulty sleeping
• Reduced interest in sex
• Difficulty concentrating on activities (work, school)
• Reduced interest and enjoyment from previously valued activities

Types of Anorexia Nervosa

Anorexia nervosa has two types:

• Restricting: The person cannot eat enough food to maintain a healthy body weight but does not have either binge-eating or compensatory eating behaviors.
• Binge-eating/purging: In addition to restricting food intake, the person can experience loss-of-control eating episodes in which a lot of food is consumed and/or experience compensatory behaviors after eating (vomiting, excessive exercise, or taking laxatives, diuretics, or enemas).

Complications From Anorexia Nervosa

As an eating disorder, anorexia nervosa can significantly interfere with a person’s daily activities, relationships, and life in general. The disorder can also lead to many physical and mental health problems – or even death.

Physical complications of anorexia nervosa include:

• Malnutrition (lack of vitamins, minerals, protein, and other nutrients)
• Imbalance of electrolytes (minerals such as sodium, calcium, and potassium) in the blood
• Anemia (low red blood cell count)
• Heart conditions, such as irregular heartbeats (arrhythmia), heart valve disease, or heart failure
• Loss of muscle
• Loss of bone mass, which can increase the risk of osteoporosis and fractures
• Organ damage due to severe malnourishment
• Seizures due to dehydration
• Thyroid disease

Anorexia nervosa can lead to emotional and mental health issues such as:

• Mood disorders, such as depression or bipolar disorder
• Anxiety disorders, including generalized anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD)
• Personality disorders such as borderline personality disorder
• Alcohol or substance dependence or abuse
• Self-injury and suicidal thoughts or attempts

Diagnosing Anorexia Nervosa

It’s important for people to see a licensed mental health specialist with experience in diagnosing anorexia nervosa and other eating disorders. If someone concerned about anorexia nervosa is experiencing acute medical issues, such as inability to walk, feeling dizzy, uncontrolled vomiting, severe abdominal distress, chest pain, or rapid weight loss, then an Emergency Department evaluation is the first step. However, if physical complications from this illness are not acute – or occur intermittently in response to behaviors – then an outpatient evaluation is appropriate.

The psychiatrists and psychologists at UT Southwestern carefully evaluate each patient, beginning with a:

• Discussion of symptoms, personal medical history, and family medical history
• Psychiatric evaluation to screen for mental health conditions and assess cognitive and social functioning
• Psychological assessment to discuss thoughts, feelings, and eating patterns

Depending on each patient’s symptoms and overall health, the individual might also see a physician for:

• A physical exam
• Lab tests to measure levels of blood electrolytes and assess liver, kidney, and thyroid function
• An electrocardiogram (EKG/ECG) to check for heart symptoms
• X-rays to evaluate bone density and check for pneumonia or other health issues

Treatments for Anorexia Nervosa

At UT Southwestern, our team approach brings together specialists from several fields of medicine for comprehensive care. Based on our evaluation, the team tailors a treatment plan based on each patient’s specific symptoms and overall health.

For people with anorexia nervosa, we provide outpatient treatment that includes:

• Medications to treat medical and psychiatric symptoms common in anorexia nervosa
• Individual psychotherapy, which can include cognitive behavioral therapy for eating disorders, dialectical behavioral therapy, interpersonal psychotherapy, and supportive therapy
• Group psychotherapy
• Psychoeducation sessions
• Referral and coordination for nutritional counseling with a registered dietitian for nutrition education and meal planning
• Coordinated care with primary care providers and specialists, as needed, for physical health related to other conditions