Anorexia nervosa (anorexia) = anorexia is an eating disorder whose focus is weight loss. This goal is often pursued by the patient with such consistency that it can even lead to life-threatening conditions.

The diagnosis is i.a. ensured by the fact that the patient's body weight is at least 15% below that of a "normal" comparison person, and that there is a noticeable change in the patient's hormone balance.

Symptoms of anorexia

Common physical complaints and symptoms of anorexia and bulimia nervosa:

  • Circulatory disorders with low blood pressure
  • Circulatory disorders with cold hands and feet
  • Slow pulse (Bradycardia)
  • Low body temperature (Hypothermia)
  • Gout (Hyperuricemia)
  • Water retention in the tissue (Edema)
  • Gastric dysfunction, bloating and digestive disorders (e.g. constipation = constipation)
  • heartburn
  • Menstrual disorders up to amenorrhea (absence of menstrual bleeding)
  • Other hormonal imbalances
  • osteoporosis
  • Caries
  • Dry skin and hair loss
  • Mineral and vitamin deficiencies
  • Enlarged salivary glands (Sialose)
  • depression

Read more about Osteoporosis in underweight. and These symptoms show you a magnesium deficiency

What are the signs of anorexia?

When a person does not want to eat, loved ones and friends become very worried. Parents of young girls in particular are afraid that refusal to eat could indicate anorexia. Or if an already slim person doesn't want to eat on a date, friends quickly think of an eating disorder.

Food abstinence per se is not anorexia, e.g. should only shed a few kilos and eating behavior quickly returns to normal.A pathological eating disorder therefore includes, in addition to reduced food intake, above all a psychological problem, above all the incorrect perception of one's own body, external pressure from the environment and society and any unresolved internal conflicts.

Signs for this are e.g. negative statements about one's own body or the idolization of underweight stars, excessive preoccupation with the topic of nutrition and weight loss, a significant increase in physical activity and sport for weight loss and many other typical behaviors.

In young women in particular, however, these signs also occur without anorexia when they deal with their own figure. It therefore only becomes particularly suspicious if the person maintains their harmful behavior over a longer period of time, if necessary wants to conceal it and begins to lie, or if the normal everyday life is neglected in favor of weight reduction.

Then there is a great risk that the eating disorder will determine life more and more and the person will become anorexic.

If you are interested in this topic, then read our next article under: Eating disorder

Hair loss from anorexia

Hair loss is a common symptom of severe anorexia and is due to a lack of essential nutrients such as vitamins and trace elements, often in combination with brittle nails and pale skin.

Hair loss often leads those affected to the doctor, as they do not necessarily recognize the connection with their eating behavior. If the patient is treated and supplied with the necessary nutrients, the hair grows back.

For more information on this topic, see: Hair loss in women

Missing periods due to anorexia

Long-term malnutrition leads to a reduction in hormone production in the female body and thus to the absence of ovulation and menstruation. Such a weakened body would not be able to carry a child to term, which is why infertility is, so to speak, a protective mechanism.

If the underweight persists over a longer period of time, the hormonal balance can remain impaired for longer and, in the worst case, lead to permanent infertility of the woman, even if she gains weight again.

The following topic could also be of interest to you: Menstrual disorders

Can you cure anorexia?

Anorexia is curable in terms of physical symptoms. However, since it is a mental illness that is not called “addiction” for nothing, certain psychological aspects of the illness remain anchored in the patient.

In the psychotherapy that is part of the treatment, the person learns to deal with his or her own psychological conflicts, to learn a realistic body perception and to understand the need for adequate food intake.

The patient must maintain these principles for life to avoid relapse as the genetic and psychological disposition to eating disorders remains. And even if the weight can be kept stable, the person is still sick if the thoughts of eating and the fear of gaining weight rule everyday life.

Only when the patient has internalized the principles of psychotherapy and, in addition to weight stabilization, there is no longer any impairment of the psyche, can one speak of a cure.

If you'd like to dig deeper into this topic, then read our next article at: Therapy for an eating disorder

When do I need professional help?

Eating behavior becomes problematic when it determines the everyday life of the person concerned and / or the body becomes critically undersupplied.

So if your thoughts only revolve around food and how you can hide the food restriction from your surroundings, you have a serious psychological impairment that requires professional help.

If there is also physical impairment due to malnutrition, a doctor is definitely necessary to avoid permanent damage.

What is the prognosis for anorexia?

Unfortunately, anorexia ends in up to 20% of (severe) Cases of death due to malnutrition or suicide with accompanying depression.

Unfavorable factors that make healing more difficult and worsen the prognosis are poor social integration and support, particularly low body weight, long-term anorexia, a late age of onset or any accompanying illnesses.

However, if the disease is treated in good time and the accompanying problems are not too serious, the patient's condition can be stabilized in most cases. Thus, everyday practice and a normal life can be made possible, even if psychological factors of the disease remain. It is therefore advisable to remain under psychotherapeutic treatment for several years after successful weight stabilization in order to prevent relapse.

Causes of Anorexia

Harmful eating behavior is usually triggered by the person's psyche. This is shaped by the environment and the experiences of the person affected, but genes also play an important role. People with a close relative who already suffers from anorexia are therefore at a particularly high risk.

Exactly which genes are important in this context is still unclear and a genetic disposition alone does not make a person anorexic, otherwise many more people in a family would become ill.

Only when other factors are added, such as Psychosocial problems or high pressure from the beauty ideals of our society, the risk of eating disorders increases, especially among girls and young women.

These can develop into real anorexia if the problems persist, the person's self-esteem is low and the initial positive changes of a food restriction set in. Because initially the nutrient deficiency leads to a downright drug-like reaction in the brain, which explains the concept of lean "addiction".

If the risk factors mentioned trigger an eating disorder, this is intensified by the biological processes in the body and brain and anorexia is self-sustaining as a result.

How is it diagnosed?

The diagnosis of anorexia can usually be made through medical history and specific questionnaires.

Disorder-specific instruments:

Eating Disorder Inventory (EDI, Garner et al., 1983)

The EDI comprises 8 scales that contain typical psychological characteristics of anorexia and bulimia patients:

  • Striving for slimness
  • bulimia
  • Body discontent
  • ineffectiveness
  • perfectionism
  • interpersonal mistrust
  • Interoception and fear of growing up.

The newer version EDI-2 was supplemented by the scales asceticism, impulse regulation and social insecurity.

Questionnaire on eating behavior (FEV, Pudel & Westenhöfer, 1989)

The FEV covers three basic psychol. Dimensions of eating behavior:

  • Cognitive control of eating behavior (restrained eating), rigid vs flexible control.
  • Disturbance and lability of eating behavior when disinhibited by situational factors
  • Hunger feelings and their behavioral correlates

This is based on the concept of "restrained eating" (Herman & Polivy, 1975), which can be a prerequisite for the disturbed eating behavior.

Structured interview for anorectic and bulimic eating disorders (SIAB, Fichter & Quadflieg, 1999)

The SIAB consists of a self-assessment sheet for the patient (SIAB-S) and an interview part for the examiner (SIAB-EX). It contains the diagnostic criteria of ICD-10 and DSM-IV and in addition to the typical anorectic and bulimic symptoms, other relevant symptom areas, such as B. Depression, anxiety and compulsions are taken into account.

Differential diagnosis of anorexia


Weight loss is a phenomenon that is very common in medicine. From a psychiatric point of view, depression should definitely be excluded. Patients who suffer from the symptoms of schizophrenia can occasionally show a pathologically altered eating behavior.

Many physical diseases can also lead to significant weight loss in their course (tumor diseases, inflammatory changes in the gastrointestinal tract, etc.). In the vast majority of cases, however, these diseases lack the fear of weight gain that is typical of anorexia.

Most patients take steps to prevent weight gain at all costs. These include vomiting, abuse of laxatives, excessive exercise, water (diuretics), enemas (enemas) and the use of medication.

In about half of all anorectic patients, cravings occur over time, which the patient with the above Measures to prevent seeks.

Anorexia And Bulimia - What's the Difference?

Anorexia and bulimia are very similar in psychological aspects, e.g. in terms of body awareness and self-esteem. However, the diseases differ in the underlying eating behavior.

In the case of anorexia, food restriction and / or massive sporting activity leads to weight loss; the disease therefore inevitably leads to underweight in the longer course, which is a diagnostic criterion for anorexia.

Patients with bulimia, on the other hand, suffer from downright binge eating, in which a multiple of the required calorie intake is taken. Those affected then take measures to avoid gaining weight, such as Vomiting or laxatives. Bulimia therefore does not necessarily lead to underweight, but for other reasons it has harmful consequences for the body and psyche of the patient.

It is not uncommon for anorexia and bulimia to merge, as the triggering factors are similar.

For more detailed information, see: Bulimia

What is classic anorexia?

The classic anorexia that Anorexia nervosa, is defined by the consciously induced weight reduction in the context of a mental body awareness disorder. This weight reduction can be brought about in a number of ways, resulting in different manifestations of anorexia.

Most often, food intake is simply reduced. Other patients vomit or use laxatives after eating. Excessive exercise also leads to weight loss. Many patients use several weight loss methods at the same time.


The precursor to the eating disorder, that restrained eating behavior, the regular performance of Diets or the regular use of laxatives to control weight are very common among the population. Almost 2/3 of all young women state that they frequently take weight-regulating measures or are almost constantly on a diet.

The full screen of a Anorexia nervosa (anorexia) but one sees much less often. With a ratio of 12: 1, women are much more likely to develop the disease than men.

In the age group of 15-30 years, the probability is due to one anorexia to get sick in about 1%.

The probable age for an initial illness is around 15-17 years.

Typical risk groups are dancers (especially ballet), photo models and competitive athletes (e.g. horse jockeys)

In 50% of cases, anorexia nervosa (anorexia) / anorexia is one Bulimia nervosa (bulimia) ahead.

What are the consequences of anorexia?

Anorexia causes great problems for the person concerned in the long run. The insufficient supply of nutrients not only leads to the dwindling of fat reserves, but also damages all of the patient's organs.

In addition to energy in the form of calories, essential vitamins and trace elements that are required for the maintenance of vital functions of the body are also missing. Thus e.g. the gastrointestinal tract, the bones and ultimately even the brain are affected if the undersupply persists for a long period of time.

In addition, the person's appearance suffers when hair falls out, nails become brittle and the skin appears pale and dry.

The psychological effects, however, cannot be seen from the outside. Anorexia is above all a mental illness that is sustained by the continuation of the eating disorder. Underlying psychological problems intensify and new ones arise.

Because while initially the cognitive performance increases, because the body mobilizes all reserves in view of the lack of nutrients, in the long run the ability to concentrate falls and mental illnesses such as depression often occur.

Are you interested in this topic? Then read our next article at: Consequences of anorexia

Complications in anorexia

The following serious complications can occur with anorexia and bulimia nervosa:

  • Cardiac arrhythmias
  • Anemia (Anemia)
  • Electrolyte disorders (e.g. Hypokalemia)
  • Renal dysfunction
  • Ulcers in the stomach or duodenum
  • Nerve damage (Polyneuropathy)
  • Lanugo hair (Downy hair)
  • Brain atrophy (Brain mass shrinkage)

How often does anorexia relapse?

If the occurrence of psychological symptoms of anorexia is counted as a relapse, almost all patients will sooner or later suffer one.

About 30% of those affected, i.e. one thirds, are underweight again after initially successful therapy and thus also physically relapse.

In about 25% of all sick people, i.e. a quarter, relapses occur again and again and anorexia becomes a long-term chronic problem.

Are there reliable tests for anorexia?

Anorexia is diagnosed on the basis of typical symptoms and a psychological or psychiatric examination. As with other mental disorders, there are no reliable tests in the form of laboratory tests or questionnaires that could prove the disease.

Such tests and the physical and psychological examinations therefore only result in the diagnosis of anorexia together and with the exclusion of other causes. Examinations of the body and a blood sample show, for example, a nutrient deficiency and a psychiatric assessment shows abnormalities in the person's self-perception.

Unfortunately, the investigations and the interpretation of the results are not always entirely clear. It therefore always needs an expert to look at those affected. Self-tests and questionnaires, such as those offered on the Internet, can therefore show a risk of developing an eating disorder, but never prove such a disease.

A reliable diagnosis must always be made after a careful examination by a doctor.