Anorexia Nervosa

Anorexia nervosa is an eating disorder that can affect how an individual perceives their physical appearance, potentially causing them to go to extreme lengths to avoid gaining weight. This eating disorder can affect those of all genders, races, body weights, and ages, meaning there can be more to a diagnosis than physical appearance alone. 

Avoid assuming that someone is experiencing anorexia nervosa or any other eating disorder due to physical appearance. Only through a proper evaluation with a licensed mental health or medical professional can someone be diagnosed with anorexia and treated accordingly.

What are eating disorders?

An eating disorder can be any type of disordered eating that significantly and negatively impact’s an individual’s functioning. Eating disorders -- such as anorexia -- can vary in how they are expressed and tend to differ from person to person, ranging from an intense fear of weight gain, poor body image, limiting food intake through dieting, and so on. 

Below are the most common types of eating disorders and their typical characteristics.

Anorexia nervosa

Anorexia nervosa is marked by restrictive eating patterns, which may lead to weight loss. In the later stages of the disorder, the individual may develop insomnia, fainting episodes, and fatigue throughout the day. Anorexia can lead to physical illness or death, so early treatment is essential. 

Bulimia nervosa

Binge eating disorder 

Eating disorder not otherwise specified (EDNOS)

Other eating disorders resemble anorexia nervosa, bulimia nervosa, or binge eating disorder, which do not fit the full criteria of these disorders. These conditions are often referred to as ED-NOS. 

Avoidant-restrictive food intake disorder (ARFID) 

ARFID is an eating disorder categorized by restrictive eating habits and an aversion to many foods. It can occur in children and adults and is linked to ADHD. The difference between ARFID and anorexia is that ARFID does not accompany a desire to lose weight or a fear of gaining weight.  

Are eating disorders real? 

While eating disorders were once considered uncommon and were not recognized as mental health conditions, an increasingly large body of evidence has legitimized disorders like anorexia. Eating disorders are real and often require treatment. 

Eating disorders and stereotypes 

Body weight often plays a significant role in stereotypes, and there has been a misconception that those living with eating disorders are always thin. Although some eating disorders such as anorexia nervosa can be marked by low body weight (along with other symptoms), a person’s physical appearance does not necessarily indicate an eating disorder. For example, some people may have a high metabolism that allows them to eat more food without weight gain. It could be harmful to assume that such a person has an eating disorder because they are small or even underweight. 

Not all body types and sizes may respond in the same way or in the same time frame to restricted eating (as in anorexia nervosa) or other forms of food restriction and disordered eating. For this reason, people with eating disorders such as anorexia can be of all genders, all ages, and a wide variety of weights. 

The stereotype that anorexia only affects affluent people can also be common. However, eating disorders do not discriminate based on socioeconomic status and can impact the lives of people who aren’t wealthy. The issue is usually not one of money or privilege but is often a sense of being out of control—control that an eating disorder like anorexia may falsely seem to give back. 

The harmful effects of stereotypes

Stereotypes can also be harmful to mental health work. Although mental health professionals are trained to avoid interacting based upon stereotypes, stereotypes can still work their way into one’s understanding of different mental health disorders, leading to inaccurate diagnoses or a lack of diagnosis altogether. Both scenarios can be harmful.

Stereotypes can be particularly problematic when eating disorders are involved, as people who do not fit the standard physical expectations of an eating disorder are often overlooked, ignored, or misdiagnosed, allowing disordered eating to continue. According to the National Eating Disorders Association (NEDA) risk factors in eating disorders range from biological, psychological, and social. Without treatment, eating disorders can be dangerous and may be fatal.

To avoid stereotypes, try to see people as individuals. You might focus on talking to and getting to know them before making assumptions. It can be helpful to ask questions without judgment and honor the different perspectives people bring to the table.

Anorexia isn’t characterized by a single body type

The myth of a single body type being associated with anorexia nervosa can be a pervasive one in both popular culture and the mental health field. Many people with eating disorders may go undiagnosed because they do not fit the narrow confines often given to the body types and weights associated with eating disorders. 

Perhaps due to its perceived prevalence among people with specific careers, anorexia nervosa and other eating disorders can often be downplayed while being frequently ascribed to lower-weight individuals. People with atypical anorexia also have an intense fear of gaining weight, but may not be particularly thin; they present in different body shapes and sizes and may be outwardly considered healthy. Although this view of eating disorders has long been viewed as problematic—and has long ignored the reality of the conditions and who they affect—it often persists.

The myth of a single body weight may not only be persistent, but it can also be actively harmful. Clinicians may be less prone to diagnose individuals who display symptoms of disordered eating—restricting food, over-exercising, fixating on dieting, and exercising—if those individuals are of a weight that is considered average or above average. 

Although an entirely separate diagnosis has been created for individuals with anorexia nervosa who do not fit the diagnostic criteria of low BMI and emaciation (called atypical anorexia), the myth of a single body type and body weight has primarily continued, potentially creating barriers for individuals to receive the correct diagnosis and subsequent treatment.

Moving away from size in diagnosing eating disorders

Historically, shape and size may have been valuable determinants when searching for evidence and symptoms of an eating disorder. However, appearance is no longer a core, reliable indicator of an eating disorder. As food has grown increasingly complex with the proliferation of highly processed foods and hyper-palatable foods, the relationship between weight and food has also grown increasingly complicated. 

Caloric deficits and nutrient deficiencies do not necessarily occur at the same rate, which can influence body weight and composition. Individuals who develop anorexia nervosa while at an elevated weight may not show the physical symptoms of the condition as quickly as those who are already at a lower weight.

Size can play a role in diagnosing anorexia nervosa—but it might not always be an indicator. Clinicians often look at more than body size when evaluating for eating disorders, considering all possible symptoms. Additionally, a greater understanding of eating disorders may be helpful for the general public, as the notion that eating disorders are unique to the young and slender could negatively impact older people living with an eating disorder, as well as their friends and family.

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