Anorexia nervosa is one of the most common eating disorders in teens, and a condition that has risen in prevalence over the last few decades. It’s largely characterized by unhealthy and unsustainable weight loss, a consistently below-average body mass index (BMI), and a very low body weight in the absence of any contributing diseases or conditions.
Anorexia is commonly mentioned in contrast to bulimia. Where bulimia is characterized by binge eating and purging behavior (i.e. laxative use, induced vomiting, etc.), anorexia is characterized by controlling and reducing body weight largely via exercise and self-induced starvation. Women are more often affected by anorexia nervosa, but men can also struggle with eating disorders and associated body image issues.
While eating disorders are most often diagnosed among teens and young adults, they can occur (or persist) later in life too. Because teens are learning to take care of themselves and taking concepts such as nutrition and healthy living into their own hands, it’s important for parents and educators to differentiate between healthy lifestyle changes and potential symptoms of an eating disorder.
A Key Characteristic of Anorexia Nervosa
There are several signs and symptoms for anorexia nervosa, the most important being self-induced starvation, physical symptoms of extreme malnutrition, and a fear of gaining weight, particularly fat. However, it often comes back to a central point: The need to always lose more weight.
Teens who struggle with anorexia nervosa constantly perceive themselves as fat in some way, and often suffer from symptoms of body dysmorphia, a compulsive mental health issue wherein someone constantly perceives flaws within themselves even when these flaws aren’t present. More than any other symptom, teens with anorexia nervosa will insist that they need to lose more weight even while they’re unhealthily underweight.
Other Warning Signs of Anorexia
Teens with anorexia nervosa will go through extreme lengths to avoid eating food or making up for meals with excessive and intense exercise. While there is certainly a benefit to intense exercise, the level of exercise that is characteristic for someone with anorexia is destructive and harmful, particularly in the absence of much needed nutrition and critical recovery.
At the very least, a growing teen body needs plenty of sleep and plenty of food. This is doubly important when undergoing training. If your teen is obsessed with sports alongside unrealistic calorie restrictions, they may be struggling with anorexia. Other important signs and symptoms include:
- Denying hunger
- Eating in secret to avoid being judged
- Developing certain rituals during meals (centered around reducing intake, such as excessive chewing)
- Extreme dietary rulesets (completely avoiding one type of food or nutrient)
Aside from behavioral symptoms, anorexia can lead to the development of serious physical symptoms because of malnutrition and intense physical stress. These symptoms include:
- Amenorrhea, or the absence of menstruation
- Signs of osteoporosis, or brittle bones
- Abnormally dry and flaking skin
- Hair loss
- The development of very fine facial and body hair, known as lanugo
- Frequent fainting spells
- Low blood pressure
These are not surefire signs of anorexia, and any one of these symptoms should prompt a visit to a doctor. But in the absence of a different medical condition, they may be caused by malnutrition and stress because of an eating disorder – especially in combination with the aforementioned behavioral signs.
What Causes Anorexia?
The causes of anorexia are complex, consisting of both environmental triggers and potential heritable traits that overlap with symptoms of obsessive-compulsive disorder (eating disorders and OCD can cooccur), anxiety, and depression. Psychiatric causes, including abuse and exposure to certain media, also play a large role. Other identified causes range from genetics to bacterial infection.
Given that eating disorders are more common in developed or Western countries, and are rising in prevalence in developing or non-Western countries, one theory is that the growing rate of eating disorders among teens is at least partially a result of Western beauty standards, media, and advertising (from TV to Instagram).
In the age of fitness models and influencer culture, teens are more inundated with unrealistic bodies and beauty standards than ever and may adopt unhealthy diets or exercise regimens not understanding what goes on behind the scenes. They may not be aware of how dangerous it is to remain at a certain low bodyfat outside of competition or aren’t aware of the use of things like fake weights, imperceptible image manipulation, and performance-enhancing drugs.
However, whether these environmental factors simply trigger an innate potential for anorexia or contribute to its development is still unclear. Research into eating disorders has shed a lot of light on just how complex they are, as well as revealing the many internal and external factors that play a role in their origin.
Signs of Anorexia in Boys
When eating disorders are brought up in the context of boys and men, other body image issues – such as muscle dysmorphia – are more commonly talked about. Indeed, “bigorexia” is a more common issue among boys than girls. However, that doesn’t mean anorexia nervosa does not exist in men. An estimated 20 percent of anorexics are male, presenting with all the same symptoms – starvation, a heavily distorted body image, and extremely restrictive dietary habits.
Again, symptoms of anorexia in boys overlap with symptoms of anxiety, depression, and obsessive-compulsive behavior. It’s a disorder that claims lives across gender lines, and while women are more heavily affected than men, the cases of boys with anorexia are rising, or at least becoming more known to clinicians and researchers.
How Anorexia Is Treated?
Some cases are far more severe than others. Because anorexia nervosa can sometimes go untreated until hospitalization occurs (because many teens refuse treatment), one of the most important steps to treating anorexia is first ensuring an anorexic teen’s survival. Teens with anorexia are carefully monitored to ensure that their hydration and electrolyte levels are improved, that their heart health hasn’t deteriorated too much, and they may require a feeding tube if they can’t keep down solid food. In extreme cases, hospitalization plays a vital role in the long road towards recovery and improvement.
Because the causes for anorexia may be neurological as well, treatment differs from individual to individual depending on how effective certain approaches are deemed to be. Teens with anorexia will usually work with a therapist to overcome and deny delusions of fatness and accept that they need help to work towards a healthier bodyweight. Different types of behavioral therapy such as CBT may help teens with anorexia confront their own thought patterns and avoid re-engaging in self-induced starvation.
Sadly, anorexia has the highest mortality rate of any mental disorder, in large part because of the risk of cardiovascular failure and the effects of starvation. Treating this disorder can be difficult, and requires a holistic approach addressing a teen’s psychological and physical symptoms. Family members often work with specialists to provide critical support, and a registered dietitian will help a teen learn to rethink their eating habits and slowly return to a healthier weight.