anorexic woman

What Is Anorexia?

Anorexia nervosa, commonly referred to as anorexia and anorexia athletica, are two different conditions that belong to a class of mental health problems known as eating disorders. Anorexia nervosa is officially recognized as an eating disorder by the American Psychiatric Association (APA). The diagnostic definition of anorexia was broadened by the APA in 2013 to emphasize its psychological components versus viewing it primarily as a weight disorder. “Feeding and eating disorders are characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.”1

People with anorexia athletica achieve an extremely low weight through compulsive, excessive exercise. Anorexia athletica is not recognized formally by standard mental health diagnostic manuals, including those published by the APA. However, the term is used in the mental health field to denote disordered behavior on the eating disorder spectrum characterized by excessive, obsessive exercise.

Underlying Causes

Anorexia nervosa typically appears in teenagers and young adults, although it can occur earlier or later in life. Like other eating disorders, the behaviors manifested in anorexia nervosa generally have very little to do with food. Instead, they occur when an individual has problems coping with ongoing sources of anxiety, depression, stress or other types of emotional difficulties. Underlying causes include a combination of genetic predisposition and factors such as cultural and social environments, specific personality traits and chemical imbalances within the brain and body.

Stats and Facts

  • At least 6% of adolescents suffer from eating disorders and more than 55% of teen girls and 30% of boys report some kind of “disordered eating” symptoms such as fasting, diet pills, vomiting or using laxatives.2
  • Eating disorders have the highest morality rate of any mental illness.3
  • An estimated 33% to 50% of anorexia patients have a comorbid mood disorder such as depression, and about 50% have comorbid anxiety disorders such as obsessive-compulsive disorder and social phobia.3
  • Of 52 professional ballet dancers ages 13 to 20, 5.8% were diagnosed with anorexia athletica and 1.9% with a clinical eating disorder.4
  • An estimated 90% to 95% of people with anorexia nervosa are female.5

Anorexia Nervosa Symptoms

People with this disorder develop an obsession with appearing thin and have an intense, irrational fear of gaining weight. They perceive themselves as fat regardless of weight, even when it is dangerously low and of concern to those around them. Their self-esteem is often overly associated with body image. Symptoms of anorexia include a range of behaviors and physical symptoms. In some cases, food-restricting behavior is the only method used to control body weight. Some people with anorexia exhibit similar behaviors as those with bulimia nervosa. This involves combining severe food restriction with bouts of binge eating, followed by purging behaviors such as vomiting or abuse of diuretic medications, enemas or laxatives. Others with anorexia combine food restriction with excessive exercise.

Outward Warning Signs of Anorexia Nervosa

  • Avoiding eating
  • Dramatic weight loss
  • Eating only small amounts of a variety of foods or specific “acceptable” foods
  • Development of food rituals (e.g. excessive chewing, rearranging food on a plate)
  • Strict counting of calories
  • Weighing food before eating
  • Frequent use of diuretics, laxatives or diet pills
  • Self-induced vomiting
  • Weighing oneself multiple times a day
  • Wearing baggy clothes to hide body
  • Talking incessantly about food or weight
  • Withdrawal from friends and activities
  • Exercising when ill or injured5

Anorexia Nervosa Physical Side Effects

Anorexia nervosa can lead to a variety of serious repercussions, including potentially fatal heart and kidney failure. Potential physical side effects include:

  • Anemia and other blood diseases
  • Low blood pressure
  • Muscle weakness
  • Osteoporosis-related bone fracture
  • Kidney stones
  • Memory problems
  • Delayed or impaired body development
  • Menstruation irregularities (e.g. amenorrhea)
  • Female infertility
  • Electrolyte imbalances
  • Dry hair and skin
  • Hair loss
  • Lanugo (a downy layer of hair growth on the body and face)5

What Is Anorexia Athletica?

Anorexia athletica is also known as compulsive exercise, hypergymnasia and sports anorexia. While it can occur in almost any teenager or adult, it most commonly affects serious athletes, especially those participating in sports that place an emphasis on lean, small body types. Instead of focusing primarily on their personal appearance, people with this disorder focus on their athletic performance. They measure their bodies and self-worth by comparing themselves to successful competitors in their respective fields. Exercise is normally a beneficial activity, which can make it difficult for doctors to separate healthy exercise patterns from unhealthy ones. However, people with anorexia athletica typically continue exercising even when these activities are clearly harmful. As with anorexia nervosa, the disorder commonly occurs in people with ongoing emotional difficulties, including depression, anxiety or low self-esteem.

Anorexia Athletica Symptoms

Potential signs of anorexia athletica include:

  • An ongoing daily preoccupation with exercise
  • Feelings of guilt or anxiety when normal exercise schedule is not followed
  • Exercising instead of working or attending school
  • Feelings of isolation while exercising
  • Loss of more than 5% of healthy body weight
  • Lying about the extent of exercise routine
  • Exercising when significantly ill or injured
  • Thinking about food only as it relates to exercise
  • Basing self-worth on the amount of exercise completed each day

Anorexia Athletica Side Effects

Even minor injuries can have long-term health consequences for those who exercise obsessively. Anorexia athletica can lead to short- and long-term problems.

  • Loss of muscle mass
  • Bone damage including stress fractures
  • Joint, cartilage, tendon and ligament damage
  • Osteoporosis
  • Menstruation irregularities (e.g. amenorrhea)
  • Potentially fatal heart irregularities (in co-occurring anorexia athletica and anorexia nervosa)

Anorexia Treatment

Anorexia nervosa is typically treated with a combination of psychotherapy and medications that combat underlying problems such as depression or anxiety. Therapeutic approaches include group therapy, family therapy and cognitive behavioral therapy. An estimated 50% of people with this disorder eventually recover. Treatment for anorexia athletica typically involves some form of psychotherapy, as well as appropriate use of medications. At The Ranch, our dedicated Eating Disorders Program helps clients begin to heal physically, while addressing underlying contributing factors. If you or a loved one is suffering from an eating disorder, call us today at 888-545-4849.

  1. DSM Library: Feeding and Eating Disorders American Psychiatric Association website. http://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425596.dsm10 Accessed October 20, 2016.
  2. Sim LA, Lebow J, Billings M. Eating Disorders in Adolescents with a History of Obesity. Pediatrics 2013 Oct, 132 (4) e1026-e1030; doi: 10.1542/peds.2012-3940.
  3. Eating Disorder Statistics. National Association of Anorexia Nervosa and Associated Disorders website. http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/ Accessed October 20, 2016.
  4. Herbrich L, Pfeiffer E, Lehmkuhl U, Schneider N. Anorexia athletica in pre-professional ballet dancers. J Sports Sci. 2011 Aug;29(11):1115-23. doi: 10.1080/02640414.2011.578147. Epub 2011 Jul 21.
  5. Anorexia Nervosa. National Eating Disorders Association website. https://www.nationaleatingdisorders.org/anorexia-nervosa Accessed October 20, 2016.