essay on anorexia nervosa

Anorexia Nervosa

Reviewed by Psychology Today Staff

Anorexia nervosa is an eating disorder that occurs when a person refuses to eat an adequate amount of food or is unable to maintain a minimally healthy weight for their height—a body mass index below 18.5. Individuals with anorexia often have a distorted body image . Those with anorexia view themselves as fat or bulky in certain areas and have an intense fear of gaining weight or becoming fat.

In service of their distorted belief, they typically engage in severely restricting food intake. What they consume, how much, and under what conditions becomes a preoccupation and is often obsessive in nature. They may avoid what they perceive as high-caloric food and meals, picking out a few foods and eating those in minuscule quantities, or they may carefully weigh and portion any food. People with anorexia may repeatedly check their body weight and engage in techniques to control their weight, such as intense and compulsive exercise or abuse of laxatives, enemas, and diuretics. Girls with anorexia often experience a delayed onset of their first menstrual period, and most women with anorexia experience amenorrhea, or absence of menstrual periods, as fertility is highly dependent on body weight in females.

Anorexia nervosa is one of the three major types of feeding and eating disorders; the others are bulimia nervosa and binge eating disorder. Eating disorders frequently co-occur with other psychiatric disorders, such as depression , substance abuse , anxiety disorders, and borderline personality disorder . In addition, people who suffer from eating disorders can experience a wide range of physical health complications, such as loss of bone mineral density, anemia, heart conditions, and kidney failure, which can, in some cases, lead to death. Anorexia nervosa is the most lethal mental health disorder.

The DSM-5 classifies symptoms of anorexia nervosa as follows:

• Refusal to maintain body weight at or above a minimally normal weight for one's age and height
• Intense fear of gaining weight or becoming fat, even though one is underweight
• Disturbance in the way in which one's body weight or shape is experienced
• Undue influence of body weight or shape on self-evaluation
• Denial of the seriousness of low body weight.

Anorexia nervosa involves starving the body; individuals with the condition tend to suffer the physical effects of malnutrition. While emaciation may be the most obvious sign, they may also experience cold intolerance, lethargy, abdominal pain, constipation, low heart rate, and low blood pressure, among other medical complications.

In the United States, an estimated 0.9 percent of females and 0.3 percent of males suffer from anorexia nervosa in their lifetime. The condition is most prevalent among 15- to 19-year-old girls.

There are two main types of anorexia nervosa:

Restricting Type Anorexia Nervosa occurs when the primary method of weight loss involves dieting, fasting, and excessive exercising—and not engaging in any bingeing or purging behaviors for at least a three-month period.

Binge Eating/Purging Type Anorexia Nervosa occurs when the individual has engaged in episodes of bingeing or purging behavior, such as self-induced vomiting, misuse of laxatives, diuretics, or enemas.

Yes, people can have atypical anorexia nervosa, which involves all of the same symptoms as classic anorexia except that the person’s body mass index doesn’t fall below 18.5 and they are not considered underweight or emaciated. They are still in danger of developing severe and even life-threatening health problems, however, and their eating disorder should be treated seriously and promptly.

Athletes are at a high risk of developing an eating disorder such as anorexia nervosa in order to be competitive in their sport. Parents, coaches, and other adults can be alert for warning signs , such as unusual or secretive eating habits, a preoccupation with being fat, evidence of purging (e.g., sores on the mouth or tongue caused by frequent vomiting), severe restriction of calories, food avoidance, irritability, and fatigue.

Anorexia nervosa and other eating disorders are commonly found in cultures and settings where thinness is seen as highly desirable. This is particularly the case in post-industrialized, high-income countries where fashion trends, sales campaigns, and media often present thinness as a desirable or typical trait. Some activities and professions, such as modeling and athletics, may promote a goal of unusual leanness (more than is required for health) in order to do well.

The onset of an eating disorder can also be associated with a stressful life event. For young adults, leaving home for college can be such an event. For older adults, other life transitions—returning to work after raising a family, finding a new job, separation or divorce —can precipitate symptoms of an eating disorder.

Temperamental factors, such as perfectionism and obsessional traits in childhood , are also associated with eating disorders.

Due to the increased prevalence of anorexia among first-degree relatives of those with the disorder, as well as in identical twins (relative to fraternal twins), biology and heredity seem to play an important role in risk of developing the disorder.

Appetite is, of course, a basic instrument of survival. It should come as no surprise that the basic biology of appetite is extraordinarily complex, regulated by many mechanisms affecting many body systems. Science is still plumbing all the effects of its alteration by prolonged overeating, on the one hand, and starvation, on the other. One hope is that such research will lead to new pharmacologic treatments for eating disorders. Scientists suspect that multiple genes may interact with environmental and other factors to influence the risk of developing these illnesses.

Anorexia nervosa is not all about food. Key risk factors for developing anorexia nervosa may include low self-esteem ; poor relationships with one’s parents; physical, verbal, or emotional abuse ; trauma ; substance abuse ; a perfectionistic or obsessive personality ; and genetics , among others.

Research suggests that people who use social media especially frequently are more likely than others to develop an eating disorder such as anorexia nervosa. The danger is particularly high for adolescents, both girls and boys. Parents who are aware of the connection between social media use and eating disorders can be alert to the risk,  recognize when it might be affecting their child, and get help as soon as possible.

If left untreated, anorexia may lead to osteoporosis, cardiac problems, infertility , depression , relationship difficulties, suicide , and even death from medical complications. Anorexia carries the highest death rate of any psychiatric condition.

Because of their complexity, eating disorders require a comprehensive treatment plan involving medical care and monitoring, psychosocial interventions, nutritional counseling, and, when appropriate, medication management . Counseling and therapy, coupled with medical attention to health and nutritional needs are important aspects of treatment. The sooner the disorder is identified and diagnosed, the better the chances for treatment and successful outcomes.

Treatment of anorexia involves three main goals :

• Restoring weight lost as a result of severe dieting and purging
• Treating psychological disturbances associated with body image distortions
• Achieving either long-term remission and rehabilitation or full recovery.

Find a Treatment Center here .

When deprived of the essential nutrients it needs, the human body can become malnourished no matter what the number on the scale says. As a result, when recovering from anorexia nervosa, patients need to embrace healthy nutrition and to gain weight, which can be an emotionally taxing process. Under the supervision of doctors and nutritionists, people in recovery from anorexia learn to consume enough calories to gain weight over the course of months or even years until they reach a healthy set point for their body. In the process, their blood pressure, heart rate, and temperature gradually return to normal levels. Importantly, females resume their menses (if applicable). In the course of recovery, mood of patients improves, they develop a healthier relationship with food, and they begin enjoying socializing and other activities.

Therapy is typically necessary to uncover factors underlying fears about eating and gaining weight as well to help individuals work through issues related to body image, self-esteem, control, and perfectionism. Cognitive Behavioral Therapy (CBT) is considered an effective form of therapy for eating disorders. It is time-limited and focused in nature, helping individuals to see the links between their thoughts, beliefs, and behaviors. CBT also involves building a tolerance for the discomfort and distress surrounding food that is common to anorexia patients. Such therapy helps to normalize eating patterns and encourage behaviors that support gaining healthy weight. CBT can shed light on dysfunctional thought patterns and negative attitudes and beliefs about food and eating that promote body shame and poor esteem. 

Family therapy is also considered to be an effective way to treat anorexia nervosa as well as other eating disorders. The "Maudsley Method" is a form of family therapy in which parents become active agents supporting their child’s recovery. Developed at the Maudsley Hospital in London in 1985, the approach emphasizes that parents be calm, supportive, and consistent in the feeding of the child or adolescent with eating disordered behavior.

The role of medications in treating eating disorders is limited. Antidepressants or other psychiatric medications may be warranted to treat co-existing disorders, such as depression or anxiety . When a person's eating disorder is severe enough to be life-threatening or causes severe psychological or behavioral problems, inpatient or residential treatment may be recommended.

Not yet. There are some drugs normally prescribed for other conditions—such as the antipsychotic agents olanzapine and aripiprazole  and the cannabinoid dronabinol, used to treat the nausea and vomiting associated with chemotherapy—that may be used off-label to promote weight gain. However, they frequently meet with resistance from patients, whose greatest fear is putting on weight and “being fat.” The drugs typically work by increasing hunger signals in the body and encouraging patients to eat more; however, they don’t always work with  anorexia patients, who are used to feeling and ignoring hunger signals.

When an individual starves their body, their metabolism slows down in response; it is an essential biological defense mechanism meant to conserve energy and preserve life. In most cases, as a person increases their caloric intake, a process called "refeeding," their metabolism starts to speed up in response. Recovering from anorexia is difficult but possible , particularly with the support of a trained therapist and nutritional counseling.

Individuals who develop anorexia nervosa tend to have high levels of harm-avoidance and are prone to worrying. Learning healthy ways to cope with stress can be valuable. Anorexia involves rigid control, so it can be helpful to encourage psychological flexibility and spontaneity during treatment. Greater self-directedness can help people examine the underlying causes of their eating disorder and take an active role in planning solutions. 

• Find a Therapist
• Find a Treatment Center
• Find a Psychiatrist
• Find a Support Group
• Find Online Therapy
• United States
• Brooklyn, NY
• Chicago, IL
• Houston, TX
• Los Angeles, CA
• New York, NY
• Portland, OR
• San Diego, CA
• San Francisco, CA
• Seattle, WA
• Washington, DC
• Asperger's
• Bipolar Disorder
• Chronic Pain
• Eating Disorders
• Passive Aggression
• Personality
• Goal Setting
• Positive Psychology
• Stopping Smoking
• Low Sexual Desire
• Relationships
• Child Development
• Self Tests NEW
• Therapy Center
• Diagnosis Dictionary
• Types of Therapy

At any moment, someone’s aggravating behavior or our own bad luck can set us off on an emotional spiral that threatens to derail our entire day. Here’s how we can face our triggers with less reactivity so that we can get on with our lives.

• Emotional Intelligence
• Gaslighting
• Affective Forecasting
• Neuroscience

• Patient Care & Health Information
• Diseases & Conditions
• Anorexia nervosa

Anorexia (an-o-REK-see-uh) nervosa — often simply called anorexia — is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives.

To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively. No matter how much weight is lost, the person continues to fear weight gain.

Anorexia isn't really about food. It's an extremely unhealthy and sometimes life-threatening way to try to cope with emotional problems. When you have anorexia, you often equate thinness with self-worth.

Anorexia, like other eating disorders, can take over your life and can be very difficult to overcome. But with treatment, you can gain a better sense of who you are, return to healthier eating habits and reverse some of anorexia's serious complications.

Products & Services

• A Book: Mayo Clinic Family Health Book, 5th Edition
• Newsletter: Mayo Clinic Health Letter — Digital Edition

The physical signs and symptoms of anorexia nervosa are related to starvation. Anorexia also includes emotional and behavioral issues involving an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat.

It may be difficult to notice signs and symptoms because what is considered a low body weight is different for each person, and some individuals may not appear extremely thin. Also, people with anorexia often disguise their thinness, eating habits or physical problems.

Physical symptoms

Physical signs and symptoms of anorexia may include:

• Extreme weight loss or not making expected developmental weight gains
• Thin appearance
• Abnormal blood counts
• Dizziness or fainting
• Bluish discoloration of the fingers
• Hair that thins, breaks or falls out
• Soft, downy hair covering the body
• Absence of menstruation
• Constipation and abdominal pain
• Dry or yellowish skin
• Intolerance of cold
• Irregular heart rhythms
• Low blood pressure
• Dehydration
• Swelling of arms or legs
• Eroded teeth and calluses on the knuckles from induced vomiting

Some people who have anorexia binge and purge, similar to individuals who have bulimia. But people with anorexia generally struggle with an abnormally low body weight, while individuals with bulimia typically are normal to above normal weight.

Emotional and behavioral symptoms

Behavioral symptoms of anorexia may include attempts to lose weight by:

• Severely restricting food intake through dieting or fasting
• Exercising excessively
• Bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products

Emotional and behavioral signs and symptoms may include:

• Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them
• Frequently skipping meals or refusing to eat
• Denial of hunger or making excuses for not eating
• Eating only a few certain "safe" foods, usually those low in fat and calories
• Adopting rigid meal or eating rituals, such as spitting food out after chewing
• Not wanting to eat in public
• Lying about how much food has been eaten
• Fear of gaining weight that may include repeated weighing or measuring the body
• Frequent checking in the mirror for perceived flaws
• Complaining about being fat or having parts of the body that are fat
• Covering up in layers of clothing
• Flat mood (lack of emotion)
• Social withdrawal
• Irritability
• Reduced interest in sex

When to see a doctor

Unfortunately, many people with anorexia don't want treatment, at least initially. Their desire to remain thin overrides concerns about their health. If you have a loved one you're worried about, urge her or him to talk to a doctor.

If you're experiencing any of the problems listed above, or if you think you may have an eating disorder, get help. If you're hiding your anorexia from loved ones, try to find a person you trust to talk to about what's going on.

The exact cause of anorexia is unknown. As with many diseases, it's probably a combination of biological, psychological and environmental factors.

• Biological. Although it's not yet clear which genes are involved, there may be genetic changes that make some people at higher risk of developing anorexia. Some people may have a genetic tendency toward perfectionism, sensitivity and perseverance — all traits associated with anorexia.
• Psychological. Some people with anorexia may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. They may have an extreme drive for perfectionism, which causes them to think they're never thin enough. And they may have high levels of anxiety and engage in restrictive eating to reduce it.
• Environmental. Modern Western culture emphasizes thinness. Success and worth are often equated with being thin. Peer pressure may help fuel the desire to be thin, particularly among young girls.

Risk factors

Anorexia is more common in girls and women. However, boys and men have increasingly developed eating disorders, possibly related to growing social pressures.

Anorexia is also more common among teenagers. Still, people of any age can develop this eating disorder, though it's rare in those over 40. Teens may be more at risk because of all the changes their bodies go through during puberty. They may also face increased peer pressure and be more sensitive to criticism or even casual comments about weight or body shape.

Certain factors increase the risk of anorexia, including:

• Genetics. Changes in specific genes may put certain people at higher risk of anorexia. Those with a first-degree relative — a parent, sibling or child — who had the disorder have a much higher risk of anorexia.
• Dieting and starvation. Dieting is a risk factor for developing an eating disorder. There is strong evidence that many of the symptoms of anorexia are actually symptoms of starvation. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.
• Transitions. Whether it's a new school, home or job; a relationship breakup; or the death or illness of a loved one, change can bring emotional stress and increase the risk of anorexia.

Complications

Anorexia can have numerous complications. At its most severe, it can be fatal. Death may occur suddenly — even when someone is not severely underweight. This may result from abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body.

Other complications of anorexia include:

• Heart problems, such as mitral valve prolapse, abnormal heart rhythms or heart failure
• Bone loss (osteoporosis), increasing the risk of fractures
• Loss of muscle
• In females, absence of a period
• In males, decreased testosterone
• Gastrointestinal problems, such as constipation, bloating or nausea
• Electrolyte abnormalities, such as low blood potassium, sodium and chloride
• Kidney problems

If a person with anorexia becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. This damage may not be fully reversible, even when the anorexia is under control.

In addition to the host of physical complications, people with anorexia also commonly have other mental health disorders as well. They may include:

• Depression, anxiety and other mood disorders
• Personality disorders
• Obsessive-compulsive disorders
• Alcohol and substance misuse
• Self-injury, suicidal thoughts or suicide attempts

There's no guaranteed way to prevent anorexia nervosa. Primary care physicians (pediatricians, family physicians and internists) may be in a good position to identify early indicators of anorexia and prevent the development of full-blown illness. For instance, they can ask questions about eating habits and satisfaction with appearance during routine medical appointments.

If you notice that a family member or friend has low self-esteem, severe dieting habits and dissatisfaction with appearance, consider talking to him or her about these issues. Although you may not be able to prevent an eating disorder from developing, you can talk about healthier behavior or treatment options.

• Sim LA (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 31, 2018.
• Anorexia nervosa. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed Nov. 13, 2017.
• Hales RE, et al. Anorexia nervosa. In: The American Psychiatric Publishing Textbook of Psychiatry. 6th ed. Washington, D.C.: American Psychiatric Publishing; 2014. http://psychiatryonline.org. Accessed Nov. 13, 2017.
• Klein D, et al. Anorexia nervosa in adults: Clinical features, course of illness, assessment, and diagnosis. https://www.uptodate.com/contents/search. Accessed Nov. 13, 2017.
• Mehler P. Anorexia nervosa in adults and adolescents: Medical complications and their management. https://www.uptodate.com/contents/search. Accessed Nov. 13, 2017.
• Mehler P. Anorexia nervosa in adults: Evaluation for medical complications and criteria for hospitalization to manage these complications. https://www.uptodate.com/contents/search. Accessed Nov. 13, 2017.
• Pike K. Anorexia nervosa in adults: Cognitive behavioral therapy (CBT). https://www.uptodate.com/contents/search. Accessed Nov. 13, 2017.
• Walsh BT. Anorexia nervosa in adults: Pharmacotherapy. https://www.uptodate.com/contents/search. Accessed Nov. 13, 2017.
• Anorexia nervosa. Merck Manual Professional Version. http://www.merckmanuals.com/professional/psychiatric-disorders/eating-disorders/anorexia-nervosa. Accessed Nov. 13, 2017.
• Harrington BC, et al. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. American Family Physician. 2015;91:46.
• Brockmeyer T, et al. Advances in the treatment of anorexia nervosa: A review of established and emerging interventions. Psychological Medicine. In press. Accessed Nov. 13, 2017.
• Davis H, et al. Pharmacotherapy of eating disorders. Current Opinion in Psychiatry. 2017;30:452.
• Herpertz-Dahlmann B. Treatment of eating disorders in child and adolescent psychiatry. Current Opinion in Psychiatry. 2017;30:438.
• Fogarty S, et al. The role of complementary and alternative medicine in the treatment of eating disorders: A systematic review. Eating Behaviors. 2016;21:179.
• Eating disorders. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-Conditions/Eating-Disorders/Overview. Accessed Nov. 13, 2017.
• Lebow J, et al. Is there clinical consensus in defining weight restoration for adolescents with anorexia nervosa? Eating Disorders. In press. Accessed Dec. 4, 2017.
• Lebow J, et al. The effect of atypical antipsychotic medications in individuals with anorexia nervosa: A systematic review and meta-analysis. International Journal of Eating Disorders. 2013;46:332.
• Five things to know about safety of dietary supplements for children and teens. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/tips/child-supplements. Accessed Feb. 9, 2018.

Associated Procedures

• Acupuncture
• Bone density test
• Complete blood count (CBC)
• Electrocardiogram (ECG or EKG)
• Liver function tests
• Psychotherapy

Mayo Clinic in Rochester, Minnesota, has been recognized as one of the top Psychiatry hospitals in the nation for 2023-2024 by U.S. News & World Report.

• Symptoms & causes
• Diagnosis & treatment
• Doctors & departments

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

• Opportunities

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .

• Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence
• The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book
• Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance
• FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment
• Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book

Your gift holds great power – donate today!

Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List

Recent advances in understanding anorexia nervosa

Guido k.w. frank.

1 Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA

2 Neuroscience Program, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA

Megan E. Shott

Marisa c. deguzman.

Anorexia nervosa is a complex psychiatric illness associated with food restriction and high mortality. Recent brain research in adolescents and adults with anorexia nervosa has used larger sample sizes compared with earlier studies and tasks that test specific brain circuits. Those studies have produced more robust results and advanced our knowledge of underlying biological mechanisms that may contribute to the development and maintenance of anorexia nervosa. It is now recognized that malnutrition and dehydration lead to dynamic changes in brain structure across the brain, which normalize with weight restoration. Some structural alterations could be trait factors but require replication. Functional brain imaging and behavioral studies have implicated learning-related brain circuits that may contribute to food restriction in anorexia nervosa. Most notably, those circuits involve striatal, insular, and frontal cortical regions that drive learning from reward and punishment, as well as habit learning. Disturbances in those circuits may lead to a vicious cycle that hampers recovery. Other studies have started to explore the neurobiology of interoception or social interaction and whether the connectivity between brain regions is altered in anorexia nervosa. All together, these studies build upon earlier research that indicated neurotransmitter abnormalities in anorexia nervosa and help us develop models of a distinct neurobiology that underlies anorexia nervosa.

Anorexia nervosa (AN) is characterized by a persistent restriction of energy intake and leads to a body weight that is significantly lower than what is expected for height and age 1 . There is either an intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain (even though at significantly low weight). Individuals with AN experience a disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight. A restricting type has been distinguished from a binge eating/purging type; individuals in the latter group may intermittently have binge eating episodes or may use self-induced vomiting to avoid weight gain. AN shows a complex interplay between neurobiological, psychological, and environmental factors 2 and is a chronic disorder with frequent relapse, high treatment costs, and severe disease burden 3 , 4 . AN has a mortality rate 12 times higher than the death rate for all causes of death for females 15 to 24 years old 5 – 7 . Treatment success is modest, and no medication has been approved for AN treatment 8 .

Various psychological or psychodynamic theories have been developed in the past to explain the causes of AN but their underlying theories have been difficult to test 9 . On the contrary, neurobiological research using techniques such as human brain imaging leads to more directly testable hypotheses and holds promise to help us tease apart mechanisms that contribute to the onset of the illness, maintenance of AN behavior, and recovery from AN. This article will review recent advances in our understanding of the neurobiology of AN. Neurobiology is a branch of the life sciences, which deals with the anatomy, physiology, and pathology of the nervous system 10 . Neurobiology is closely associated with the field of neuroscience, a branch of biology, which tries to understand brain function, from gross anatomy to neural circuits and cells that comprise them 11 . The goal of neurobiological research in AN is to develop a medical model perspective to reduce stigma and help develop better treatments 12 . At the earlier stages of brain research in AN, study samples tended to be quite small, which made replication difficult 13 . Most frequently, altered serotonin function was associated with AN and anxiety in the disorder 14 . More recent brain research has built upon those studies and increased sample sizes in structural studies and introduced studying brain function in relation to specific tasks that are thought be related to food restriction, anxiety, and body image distortion. Most studies have been carried out in adults, although there is a growing body of literature that investigated youth with AN.

The most frequently applied brain imaging study design in the past studied brain volume in AN, and more recent research now allows cortical thickness of the brain to be investigated. For a long time, there was the notion that gray matter volume and cortical thickness are lower in patients with AN (when ill and after recovery) than in controls. This research was pioneered by Katzman et al . in adolescents with AN 15 , 16 . However, recent research by Bernardoni et al . 17 and King et al . 18 in adolescents and young adults indicated that such abnormalities are rather short-lived and that both lower volume and cortical thickness normalize with weight recovery. Animal studies suggest that those changes may be due to the effects of malnutrition and dehydration on astrocytes within the brain connective tissue 19 . Two studies from our group have found larger orbitofrontal cortex and insula volume in adults and adolescents with AN after 1 to 2 weeks of normalization of food intake or in individuals after recovery, and orbitofrontal cortex volume was related to taste pleasantness 20 , 21 . Those results were intriguing as they implicated taste perception in relation to brain volume but they need replication. New data from our group in healthy first-degree relatives of patients with AN also show larger orbitofrontal cortex volume, supporting a trait abnormality (unpublished data). Studies by Bernardoni et al . in young adults have found abnormalities in gray matter gyrification in AN, and nutritional rehabilitation seems to normalize altered cortical folding 22 . A valuable lesson from those studies is that food intake can have dramatic effects on brain structure. Whether lower or higher brain volume in AN has implications on illness behavior or is instead an effect of malnutrition without effects on behavior is still unclear and needs further research 23 , 24 .

Functional brain imaging provides the opportunity to tie behavior to brain activation and thus to distinct brain neurobiology, which could become a treatment target. Several aspects of behavior in AN stand out. One is the ability to restrict food intake to the point of emaciation while the typical mechanisms to maintain a healthy body weight are inefficient. Another is how the body can maintain this behavior even when AN patients in therapy are trying to break that behavior pattern.

Relevant to food avoidance behavior is the brain reward system, which processes the motivation to eat and hedonic experience after food intake, and also calculates and updates how valuable a specific food is to us 25 . This circuitry includes the insula, which contains the primary taste cortex, the ventral striatum that comprises dopamine terminals to drive food approach, and the orbitofrontal cortex that calculates a value, while the hypothalamus integrates body signals on hunger and satiety for higher-order decision making and food approach. Many studies have used visual food cues but it has been difficult to draw conclusions on the pathophysiology of AN from those studies 26 .

Several studies from our group using sugar taste stimuli have found that brain activation in adolescent and adult AN was elevated compared with controls in response to unexpected receipt or omission of sweet taste in the insula and striatum 27 , 28 . This so-called “prediction error” response has been associated with brain dopamine circuitry and serves as a learning signal to drive approach or avoidance of salient stimuli in the environment in the future. In addition, orbitofrontal cortex prediction error response correlated positively with anxiety measures in AN 28 , 29 . We found a similar pattern of elevated brain activation in AN to unexpected receipt or omission of monetary stimuli, suggesting a food-independent alteration of brain dopamine circuitry. Importantly, those studies have also shown that brain response was predictive of weight gain during treatment and that brain dopamine function could have an important role in weight recovery in AN. This was supported by a retrospective chart review in adolescents with AN that suggested that the dopamine D 2 receptor partial agonist aripiprazole was associated with higher weight gain in a structured treatment program in comparison with patients not on that medication 30 . Mechanistically, it was hypothesized that dopamine D 2 receptor stimulation might be desensitizing those receptors and normalize behavior response. This, however, is speculative and controlled studies are lacking.

Other lines of research on the pathophysiology of AN are directed toward feedback learning, and several studies have found that AN is associated with alterations, behaviorally or in brain response. A study by Foerde and Steinglass, who investigated learning using a picture association task in patients with AN before and after weight restoration, indicated deficits in feedback learning and generalization of learned information in comparison with controls 31 . Such alterations could translate directly into difficulties in behavior modification toward recovery. Studies from Ehrlich’s group found normal feedback learning in ill, but reduced performance on reversal learning in recovered AN, which made the impact of learning in ill AN less clear 32 , 33 . Furthermore, Bernardoni et al ., using a different study design, found that individuals with AN had an increased learning rate and elevated medial frontal cortex response following punishment 34 . That result supports previous findings of elevated sensitivity to punishment in AN as a possible biological trait 35 . Another very interesting study by Foerde et al . tested brain response to food choice presenting images of food and that research implicated the dorsal striatum in this process in AN 36 . The authors also found that the strength of connectivity between striatum and frontal cortex activation correlated inversely with actual caloric food intake in a test meal after the brain scan. The authors interpreted the findings to mean that this frontostriatal involvement in AN could contribute to habit formation of food restriction behavior. Behavioral research has provided evidence that habit formation or habit strength could be necessary for the perpetuation of AN behaviors and this concept is important to study further 37 – 39 .

The self-perception of being fat despite being underweight is another aspect of AN that the field continues to struggle with in finding its underlying pathophysiology. Some studies have found a specific brain response related to altered processing of visual information or tasks that tested interoception. For instance, Kerr et al . 40 found elevated insula activation during an abdomen perception task, and Xu et al . 41 found that a frontal and cingulate cortex response during a social evaluation task correlated with body shape concerns. A study by Hagman et al ., however, indicated a strong cognitive and emotional influence on body image distortion, and the intersection between altered perception and fear-driven self-perception needs further study 42 . Social interaction and its brain biology constitute another area that was hypothesized to be related to AN behaviors and some research is emerging on this topic. For instance, a study by McAdams et al . showed that the quality of the social relationship or social reciprocity tested in a trust game showed lower occipito-parietal brain response in patients with AN in comparison with a control group 43 . This research suggests altered reward experience from interpersonal contact in AN, which could impact emotional well-being and interfere with recovery. Oxytocin, a peptide hormone related to social behavior, could play a role but this requires more detailed research 44 .

Studies on brain connectivity can test either what brain regions work in concert during a specific task (functional connectivity) or what the hierarchical organization is between areas in the brain (that is, what region drives another) (effective connectivity). Several studies in the past have shown that resting-state functional connectivity is altered in patients with AN compared with control groups. Those studies repeatedly found altered connectivity that involved the insula, a region associated with taste perception, prediction error processing, and integration of body perception, as reviewed by Gaudio et al . 45 . More recent studies found higher or lower resting-state activation in AN across various networks and during rest or task conditions 39 , 46 – 49 . Longitudinal studies will need to test what might be the best resting-state network to focus on to predict, for instance, illness outcome or whether functional connectivity during specific tasks such as taste processing could be more informative. One study by Boehm et al . found normalization of functional connectivity in the default mode but continued abnormal frontoparietal network connectivity in recovered AN 50 . It remains to be seen whether functional connectivity will normalize with recovery or can identify long-lasting or maybe trait alterations.

Effective connectivity studies indicated that while viewing fearful faces, a group with AN had deficits of brain connectivity between prefrontal cortex and the amygdala, which correlated with measures for anxiety and eating behaviors in a study by Rangaprakash et al . 51 . Studies from our group that assessed effective connectivity during the tasting of sucrose solution found that, whereas in controls the hypothalamus drove ventral striatum response, in patients with AN, effective connectivity was directed from the ventral striatum to the hypothalamus 28 , 52 . Previously, a dopamine-dependent pathway from the ventral striatum to the hypothalamus that mediates fear was described and we hypothesized that this circuitry might be activated in AN to override appetitive hypothalamic signals 53 .

In summary, brain research has started to make inroads into the pathophysiology of AN. We have learned that malnutrition has significant effects on brain structure, changes that can recover with weight restoration, but whether those alterations have an impact on illness behavior remains unclear 23 . Research into the function of brain circuits has implicated reward pathways and malnutrition-driven alterations of dopamine responsiveness together with neuroendocrine changes, and high anxiety may interfere with normal mechanisms that drive eating behavior 54 . Habit learning and associated striatal-frontal brain connectivity could provide another mechanism of how brain function and interaction of cortical and sub-cortical regions may perpetuate illness behavior that is difficult to overcome. Those advances are promising to establish that AN is associated with a distinct brain pathophysiology. This will help researchers develop effective biological treatments that improve recovery and help prevent relapse. A significant challenge to overcome will be to integrate the differing brain research studies and develop a unified model 13 . Critical in this effort will be well-powered and comparable study designs across research groups, which take into account confounding factors such as comorbidity and medication use and which use rigorous standards for data analysis.

[version 1; peer review: 2 approved]

Funding Statement

This work was supported by National Institute of Mental Health grants MH096777 and MH103436 (both to GKWF) and by T32HD041697 (University of Colorado Neuroscience Program) and National Institutes of Health/National Center for Advancing Translational Sciences Colorado Clinical and Translational Science Awards grant TL1 TR001081 (both to MCD).

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Editorial Note on the Review Process

F1000 Faculty Reviews are commissioned from members of the prestigious F1000 Faculty and are edited as a service to readers. In order to make these reviews as comprehensive and accessible as possible, the referees provide input before publication and only the final, revised version is published. The referees who approved the final version are listed with their names and affiliations but without their reports on earlier versions (any comments will already have been addressed in the published version).

The referees who approved this article are:

• Carrie J McAdams , Department of Psychiatry, University of Texas at Southwestern Medical Center, Dallas, TX, USA No competing interests were disclosed.
• Janet Treasure , Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK No competing interests were disclosed.

• Open access
• Published: 11 December 2023

What kind of illness is anorexia nervosa? Revisited: some preliminary thoughts to finding a cure

• S. Touyz 1 ,
• E. Bryant 1 ,
• K. M. Dann 1 ,
• J. Polivy 2 ,
• D. Le Grange 3 ,
• P. Hay 4 , 5 ,
• H. Lacey 6 ,
• P. Aouad 1 ,
• S. Barakat 1 ,
• J. Miskovic-Wheatley 1 ,
• K. Griffiths 1 ,
• B. Carroll 1 ,
• S. Calvert 7 , 8 &
• S. Maguire 1  

Journal of Eating Disorders volume  11 , Article number:  221 ( 2023 ) Cite this article

3661 Accesses

6 Citations

28 Altmetric

Metrics details

Two decades have elapsed since our publication of ‘What kind of illness is anorexia nervosa?’. The question remains whether our understanding of anorexia nervosa and its treatment thereof has evolved over this time. The verdict is disappointing at best. Our current gold standard treatments remain over-valued and clinical outcomes are modest at best. Those in our field are haunted by the constant reminder that anorexia nervosa carries the highest mortality rate of any psychiatric disorder. This cannot continue and demands immediate action. In this essay, we tackle the myths that bedevil our field and explore a deeper phenotyping of anorexia nervosa. We argue that we can no longer declare agnostic views of the disorder or conceive treatments that are “brainless”: it is incumbent upon us to challenge the prevailing zeitgeist and reconceptualise anorexia nervosa. Here we provide a roadmap for the future.

In our essay over two decades ago, we described anorexia nervosa as follows:

“ Anorexia nervosa is a mental and physical disease that was recognised in France in the 19 th century, usurped for England by Queen Victoria’s physician, and subsequently adopted by many thousands of Americans. According to the prevailing grand narratives embodied in DSM-IV and ICD 10, it is merely a part of the spectrum of eating disorders. This categorisation not only distorts our view of the illness, but also trivialises its seriousness (Beumont and Touyz [ 1 ] ) .”

It is not difficult to be disillusioned with our current concepts of anorexia nervosa (AN). Little has changed over the past 20 years since the publication of “ What kind of illness is anorexia nervosa? ”[ 1 ]. One incontrovertible fact about AN remains—it takes time to recover [ 2 ]. Despite decades of research into psychological interventions, and to a lesser extent pharmacotherapy, AN continues to have the sad distinction of having the highest mortality rate of all of the psychiatric disorders [ 3 ]. Researchers working in illnesses such as diabetes can point to their innovation in developing GLP1 agonists [ 4 ], and those in surgery to the advances in key-hole interventions [ 5 ] to manage, and in many cases even cure, people of their condition. Contrastingly, researchers and clinicians in the field of AN must accept that only 30 percent of those who survive the illness at ten years are fully recovered [ 6 ]. Schmidt and Campbell lamented that “ AN in adulthood remains markedly persistent and difficult to treat, with the holy grail of an effective, replicable outpatient treatment remaining highly elusive ” [ 7 , 8 ]. It is fair to say this picture is somewhat more optimistic for patients who are rapidly treated in adolescence, providing this treatment is in the outpatient domain where families are actively engaged in support of the young person’s recovery. Moreover, such family-based approaches can significantly reduce the need for inpatient treatment, the latter often associated with high rates of relapse and readmission to inpatient settings [ 9 , 10 ]. A precise explication for why treatment outcome in adolescence might be more favourable than in adulthood is complex. One hypothesis to consider here is that AN presenting in early adolescence is a ‘different’ syndrome than when presenting in adulthood in that the relational processes in adolescent AN are less compromised, which in turn makes recovery more likely [ 11 ]. Schmidt and Campbell [ 6 , 7 ] also drew attention to the lack of innovation in psychosocial treatments to date and felt it to be unlikely that any future breakthroughs in treating AN would emanate out of the talking therapies alone [ 8 ]. Kaye and colleagues (2015) have rubbed further salt into the wound by declaring that the field has fallen behind other psychiatric disorders in terms of the understanding of responsible brain circuitry and pathophysiology and agree that the treatment of AN can no longer remain “brainless” [ 8 , 12 ]. Bulik has further exposed this unpalatable truth by declaring that we have ‘…. not been paddling as hard as we can’ [ 13 ]. She later went on to say that the science of eating disorders has been held back by decades of “misunderstanding and misconceptions” and that there has been an ongoing promulgation of myths pertaining not only to the aetiology of AN, but as to the clinical effectiveness of treatment, as well as the prospects for recovery/cure [ 14 ].

There has been a proliferation of eating disorders in succeeding editions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). It has grown from one diagnostic group to eight, and each warrants our attention [ 15 ], all contributing significantly to the burden of disease in eating disorders. But the profound suffering of those with severe and enduring anorexia nervosa (SE-AN) as well as the heavy financial load that it places on their carers continues unabated [ 16 ].

It is perhaps tempting to focus our energy on repairing over-burdened mental healthcare systems post COVID-19; however, the more vexing challenge is perhaps addressing the deeper malady at play which lies at the root of the problem: what exactly is AN? Is it a misperception of body image as Bruch alluded to [ 17 ], or a psychotic illness? [ 18 ]. Is it a phobia of normal body weight as Crisp described? [ 19 ]. Garner and Bemis [ 20 ] drew similarities between the severe psychological and physiological symptoms of malnutrition observed in the Minnesota Starvation Study [ 21 ] with those of the emaciated patient with AN, yet refeeding to the expected body weight rarely in itself guarantees full recovery from the illness [ 22 ]. Is it a learned habit as proposed by Strober, Walsh and Steinberg, and are such habits prone to consolidation during episodes of under-nutrition? [ 7 , 23 ]. The origins of this concept can be traced back to Montaigne who summarised this phenomenon better than most:

For in truth habit is a violent and treacherous schoolmistress. She establishes in us, little by little, stealthily, the foothold of her authority; but having by this mild and humble beginning settled and planted it with the help of time, she soon uncovers to us a furious and tyrannical face against which we no longer have the liberty of even raising our eyes (Montaigne (1580), in Graybiel [ 24 ] ) .

If neurobiological mechanisms are the root cause, will newer interventions such as temperament-focussed treatments be the answer? [ 12 ]. Are there data to refute some of these early propositions which might at least open the door ever-so-slightly for a reconceptualisation of AN? [ 25 ]. The room for growing our understanding of AN is boundless, but a shift in thinking is needed.

As early as 1985, Touyz et al. showed that those with AN did not misperceive or inaccurately distort their body image, but their persistent distress regarding their body shape was an affective over-evaluation rather than a factual distortion or visual misperception [ 26 ]. Yet this over-valuation of shape and weight has become the hallmark of AN and “such enduring wrong assumptions” are now being challenged [ 27 ]. Those with lived experience have been equal in their disdain regarding the social contagion of “body image” being at the core of this devastating illness. Such simplification of the complexity of AN becomes minimising, ultimately breeds stigma and misdirects the focus of research and clinical advancement. Bryant (2021), in her Lancet Psychiatry essay, has summarised this well when she asserts that “anorexia is an illness that blurs culture and pathology, and modern medicine still does not understand it” and that “the idea that something this powerful is merely a gesture of vanity is not only laughable, it is insulting” [ 28 ].

It is important to remember here that the earliest descriptions of AN by Moreton [ 22 ], Gull [ 29 ], and Lasegue [ 30 ] did not refer to any concerns about shape or weight, and it would therefore seem that that such a depiction of this illness is perhaps a more recent development in the history of AN [ 31 ]. Consequently, it has led to speculation that there could in fact be fat or weight phobic and non-fat phobic cases of AN [ 32 , 33 ]. Moreover, in a recent published study by our group, 5 of 21 AN patients admitted to hospital had beliefs of delusional intensity rather than merely having an over-valued idea [ 34 ]. To these arguments, one must add the important contribution of the Anorexia Nervosa Genetics Initiative (ANGI) study [ 35 ], which delineated many of what might be considered core symptoms of AN, but also came to the conclusion, albeit preliminary, that it was not only a psychiatric disorder but a metabolic one as well [ 36 ].

Is weight recovery from AN equivalent to actual recovery? Our group contrasted those who had gained significant weight (and can be considered weight recovered) to those who had in fact more fully recovered on several measures (including Eating Disorders Examination score and psychosocial adjustment) [ 37 ]. There were subtle differences between these two groups, suggesting the deeper more damaging psychological roots characteristic of AN had not diminished despite significant weight gain. There is an abundance of clinical confirmation as to the veracity of this contention, in that patients often allude to profound and life-disrupting distress caused by their persistent illness whilst at exactly the same time, their caregivers and families report their relief at the weight gain [ 38 ]. Caregivers and families, together with the therapeutic team appear unable to understand the overwhelming anxiety and phobic distress at the core of their loved one’s suffering has either remained constant, or at times even become exacerbated despite significant gains in weight. In many cases, they go on to lose weight again to alleviate and communicate that distress [ 38 , 39 ]. This is not to negate that weight gain is essential for recovery in the emaciated patient with AN, but unfortunately for many, weight recovery alone is not the silver lining as the “monster within” continues unabated.

We have also referred to a biological candidate marker for AN. In her ground-breaking ERP studies, Hatch et al. [ 40 ] was able to show that emotionally elicited ERPs pertaining to facial expression did not change throughout weight gain and remained depressed relative to controls. In not too dissimilar a vein, the over-active Default Mode Network (DMN) is now being targeted in innovative studies using psilocybin assisted psychotherapy [ 41 ]. Koning and Brietzke [ 41 ] in their narrative review on the potential role of Psilocybin Assisted Psychotherapy (PAP) in eating disorders, describe a 1959 French clinical case study of a patient with treatment resistant AN who received two doses of psilocybin. This resulted in her gaining insights into the root causes of her disorder with an almost immediate improvement in mood, and longer-term weight gain. They go on to provide a cogent argument that a disturbed neurotransmitter signalling may lie at the heart of the aetiology of this disorder. There is now emerging evidence to implicate both neurostructural changes in AN as well as abnormalities in reward and somatosensory processing networks [ 42 , 43 ]. Koning and Brietzke postulate that PAP may target many of the core aspects of AN including (a) serotonergic function, (b) abnormal eating behaviours, (c) depressive symptoms, (d) cognitive flexibility, (e) anxiety, (f) distress and avoidance of feared foods, as well as (g) acceptance of weight gain [ 41 ]. Much enthusiasm abounds with regards to psychedelics in the treatment of psychiatric disorders [ 44 ], however the clinical efficacy of these treatments remains to be determined and it is unlikely to be a panacea for “all that ails”.

The outcome data of such studies are eagerly awaited as they may identify critical differences in brain function in AN. As Kaplan points out “AN hijacks the neuronal system of the brain and pathologises it” (personal communication). Williams has started to map the brain circuitry in depression which could ultimately change the clinical landscape for that illness. For example, she refers to a large biomarker prediction study that indicates amygdala hyperactivation consistent with a negative bias biotype might help to delineate those patients who are less likely to respond to alternative types of antidepressants such as a dual-action serotonin–noradrenaline reuptake inhibitor [ 45 ]. Could the brain circuitry of AN be mapped in a similar way to that of depression? Both genetic and clinical research point to an almost hatred /disavowal of self, neophobia, unimaginable anxiety, intrapersonal and interpersonal distress, perseveration and rigidity, fear of failure, maturity fears, a disconnect between perception of illness severity and even impending death and a feeling of not deserving to eat, which are stoically defended despite evidence to the contrary [ 2 ]. As stated previously, at times these reach delusional intensity.

Our current treatments either focus disproportionally on overvaluation of shape and weight or on refeeding [ 22 , 46 , 47 ]. We accept both are essential for ultimate recovery. There are many clinical examples of AN patients who attain a normal weight who show a rapid and somewhat remarkable recovery after re-engaging with life as it was prior to weight loss. However, others struggle, despite having received evidence-based interventions and go on to progress to a severe and often enduring form of this disorder. What separates out the 30 percent who recover within 10 years from the 30 percent who require 10–20 years to achieve the exact same outcome, and the 40 percent who appear to never recover or die an often-tragic early death after years of suffering, for both patient and their carers? [ 6 ]. It does not seem implausible that the lengthy delay to full recovery after more than a decade of illness may indicate the brain healing itself, but only if an optimum weight is maintained whilst at the same time challenging the debilitating symptoms of the disorder. Such brain plasticity is now well known [ 48 ]. The time may have come to embark on a harm minimisation strategy [ 49 ] using universally accepted rehabilitation concepts (e.g., supported accommodation, recreational and vocational opportunities) as has been established for schizophrenia [ 50 ]. It may well be that those with SE-AN who appear to show a remarkable recovery after years of illness are in fact those who were able to realign their disrupted neuronal system by maintaining a more optimum weight and at the same time dealing with the core psychopathological characteristics of the disorder.

With recent developments in the study of genetics and epigenetics, metabolism, neural networks and personalised medicine [ 51 ], we are at the cusp of a paradigm shift which augers well for the future. For more than a century we have created a straw house, just like the three little pigs in the well-known children’s fable. This has served its purpose until now as clinicians have an imperative to treat and individuals with AN deserve nothing less than to be offered, at least initially, an evidence-based treatment. But these treatments continue to have modest recovery rates [ 6 ] and are wearing thin despite attempts to boost their clinical efficacy. How long will it take for the big bad wolf to come along and ‘huff-and-puff and blow the house down’? Only time will tell!

What will the future look like in the brave new world of eating disorders and how will we get there? The world recently witnessed the break-neck speed with which research related to COVID-19 was translated into practice [ 5 ]. With the will and appropriate funding, change can happen swiftly. The eating disorders field needs to build on the scientific foundations laid, and in many countries there are now ground-breaking research initiatives such as government-funded centres for excellence to enable this. This will ensure a sophisticated research infrastructure and workforce at the ready for the next exciting chapter in our understanding of what eating disorders are and how they can be best treated [ 52 , 53 ].

When it comes to the oldest eating disorder in the DSM [ 15 ], anorexia nervosa, it is “groundhog day”. We need to start again. However painful this may be, it must surely be done. This is not to throw the proverbial baby out with the bathwater – much has been achieved over the past decades including important theory developments and research demonstrating the safety of rapid refeeding without the over-arching nemesis of refeeding syndrome [ 54 ], or undertaking refeeding in the home environment [ 55 ]. But the well-worn assumption that AN is essentially a phobia about body image and that refeeding to a healthy weight constitutes full recovery should be reconsidered. AN is a complex psychiatric/metabolic disorder with roots firmly entrenched in early childhood characterised by a heightened degree of anxiety, lack of reward sensitivity, the avoidance of novelty seeking and a fragile self-esteem with a desperate need for sameness [ 56 , 57 , 58 , 59 ]. A marked fear of failure, and early indications of reluctance to engage in interpersonal relationships is at times confused by the suggestion that AN is somehow implicated in Autism Spectrum Disorder (ASD)—although this is not to say that some with AN may in fact have a dual diagnosis in this regard [ 60 ].

Although the Eating Disorder Examination (EDE) [ 61 ] has become the “gold standard” in the assessment of eating disorders and has enabled a high level of comparison between published studies, it has an unfortunate bias in that it conceptualises AN as a disorder with overvaluation of weight and shape at its core. The time has arrived to better delineate the phenomenology of AN [ 58 ], and then construct targeted treatments in the true spirit of precision psychiatry. To do so, a new multiaxial assessment instrument is needed that provides a comprehensive profile of each and every patient diagnosed with AN so that the complexities inherent in each case can be better evaluated and then targeted in intervention [ 62 ].

What would such a multiaxial assessment look like? What is needed is a scale that includes a comprehensive psychological profile of the core characteristics of AN, thus eliminating the need for the commonly used psychometric instruments such as the DASS, Beck Depression or Anxiety inventories, WSAS [ 63 , 64 , 65 , 66 ], self -esteem measures, perfectionism inventories, quality of life measures, to name just a few. We began this work developing the first co-designed (before the concept was fashioned) deep multi-axial assessment purely designed to measure the core psychological features of anorexia nervosa and assess their manifestation along severity axes providing a deeper understanding of the phenotype (the CASIAN; [ 67 , 68 ]. This work needs to be extended and broadened to include other parameters, although the second axis could measure the stage of illness as the illness changes with regards to severity over time [ 69 ]. The third axis may include the laboratory investigations routinely administered such as bloods, biochemistry, liver function, ECG and bone densitometry scans. A fourth axis could include brain circuitry based upon EEG and fMRI analyses. A biological candidate marker for AN already exists [ 40 ], and as this rapidly evolving phase of discovery gains momentum, this axis will come into its own. A further axis should provide a comprehensive neuropsychological profile based upon well-established research criteria developed by Tchanturia et al. and others [ 70 , 71 ]. Lastly, an additional axis devoted to functional outcomes is warranted. Improvements in everyday functioning are meaningful treatment outcomes for patients [ 72 ], and despite current illness, AN patients have enduring functional strengths which could be integrated into treatment [ 73 ]. What is so remarkable about AN is the oft-observed degree of resilience when it comes to academic achievement, or the ability to outperform others in a scholastic or work environment. This phenomenon has been noted in the genetic studies undertaken thus far [ 36 ], and although perfectionistic and maladaptive because of its extremes, does offer a strength to be better utilised in therapy.

Finally, the subtyping of restrictive versus binge/purge AN, which has been integral to each and every DSM iteration, may have reached its used-by-date. Although somewhat diligently recorded in almost every published study, and if not provided then without doubt would be requested during the review process, this distinction adds little to overall clinical care. Pierre Beumont was not only one of the founding fathers in the field of eating disorders, but a visionary scientist as well. While he was the first to point to the heterogeneity of AN and the need to subtype the disorder [ 74 ], a new subtyping is proposed here similar to an early model of depression [ 75 ]. A novel subtyping of reactive versus endogenous AN needs scientific exploration (Polivy, 2023 personal communication). It is proposed that in those patients with AN, where a clear precipitant is able to be identified (Reactive AN), existing evidenced-based treatments may be clinically effective; but, perhaps less so for those who have a more endogenous onset without an obvious precipitating factor or event (Endogenous AN). Patients with more complex presentations also appear less likely to respond to talk therapies, and may need a different, possibly more biological, approach. It is the latter group to whom the term “treatment resistant” is likely to be applied, with blame often attributed to the person with the illness. It is, however, the therapist who might be inadequate here, as the existing (psychological) treatments may not have the clinical power to effect change in this seriously ill and distressed cohort.

We cannot deny the indisputable fact that patients with AN continue to suffer (many for years and even decades) and die from this serious disorder. Patients in continental Europe have been approved for euthanasia and reports on “palliative care” are increasing. The desperate need to avoid further suffering is often openly expressed by those with a lived experience and their carers alike. However, others have expressed caution— asserting that in the absence of a clinically effective evidence-based treatment, it is unwise to talk about someone being treatment resistant, and further, that many patients with AN either receive no treatment at all − or at best inadequate treatment. Are these the advances we desperately wanted in our field in 2023? We suspect not. The time for complacency has ended and the need to find a cure for AN has arrived. We have brilliant minds at work, but rather than working in silos we need to work together with colleagues not just from inside our field, but also from outside our immediate field to finally put the conundrum of AN to rest. Bulik has likened the field of eating disorders to an island, suggesting we have not been “gregarious enough in engaging external scientists in our work” [ 14 ]. We also need to find ways to overcome the issue of under-funding in eating disorder research that contribute to the maintenance of the status quo [ 76 , 77 ]. It is now almost a century and a half since Gull [ 29 ] described AN, and those enduring the illness and their carers cannot wait any longer. We owe it to them.

So, what might the treatment of AN look like in a decade’s time? Kan and colleagues have given us a glimpse into the futuristic world of AN treatment and a possible roadmap to get there [ 51 ]. They provide a cogent argument that the time has now arrived to focus our research initiatives on developing new interventions that reduce the translational gap between emerging findings in neuroscience and the clinic. The days of agnostic assumptions in this regard are numbered.

Thus, we may need to tailor treatment and supplement intervention by targeting specific elements of risk and resilience. This would require a deeper phenotyping to examine facets of the core psychopathology including social and interpersonal function, reward reinforcement, anxiety sensitivity, cognitive styles and other biomarkers [ 51 ].

We encourage others to build upon this model or to provide alternative ones. Fernandez-Aranda and colleagues have already reminded us that “necessity is the mother of invention” and the aftermath of COVID 19 will no doubt lead to changes in our therapeutic models with the introduction of “more efficient and effective mixed methods of connection and a more personalized treatment palette as to what and how might work best for whom” [ 78 ].

So, what might the smorgasbord of innovative treatment modalities look like in the AN clinic of the future? Both Treasure et al. and Stengel and Giel have already begun to explore “emerging therapeutic targets” that could provide the armamentarium for treatment delivery in the next decade [ 79 , 80 ]. These will not only include the eating disorder phenotype such as cognitive, social and emotional difficulties, but also compounds other than olanzapine and antidepressants. The list grows longer day by day with further interest in lithium, ketamine, psilocybin, opioids, endocannabinoids as well as hormones such as oestrogen, histamine, oxytocin, leptin, growth hormone, ghrelin and nesfatin-1 [ 81 ]. These could be supported by innovations that better target eating behaviour habits and underlying processes that focus particular attention on implementation interventions, exposure-based therapies, inhibition training as well as disruptions to food cravings. Furthermore, neuromodulatory treatments that include non-invasive brain stimulation (NIBS) and deep brain stimulation (DBS) are being actively explored, however, caution should be exercised before we rush into interventions based on preliminary hypotheses or limited evidence. Further systematic research will be needed to determine the ultimate clinical success of these novel treatments, which must also be balanced by the risk of doing harm and making sure to adhere to the first rule in medicine “primum non nocere”.

Co-design is the new mantra of the day but rarely is it implemented in the manner that it was advocated and unfortunately tokenism abounds. Stengel and Giel so aptly point out that if our desired aim is to increase the acceptability and eventual adoption of novel therapeutics then “… it will be an important next step to increase integration of lived experience by patients and carers into the whole clinical research process” [ 80 ]. The status quo can no longer prevail. Science does not take kindly to attempts to change the existing zeitgeist but there now appears to be an unstoppable groundswell and determination to do exactly that in both our understanding and delivery of efficacious treatment(s) in AN. Existing clinical guidelines will become increasingly challenged and much careful thought and deliberation will need to be given to future iterations of DSM and ICD as the avalanche of new and exciting research findings come into play.

It is not expected that those who read this commentary will agree with all the propositions enunciated above, but it is hoped that it may spur others to action as it is likely to be a collective enterprise that ultimately bears the fruit of success. [ 16 ]. Opportunities for increasing research spending and providing opportunities for cross-collaborative research will go some way to enhancing translational research in the eating disorder field. However, any such enterprise must embrace the views of those with lived experience and their carers. They know better than most as to what this “monster within” does to often brilliant minds. We should refrain from our well-worn mantra of improving clinical effectiveness to the much loftier aspiration of finding a cure for AN. It is now within our grasp and time is of the essence. This journey has already commenced and the quotation from Noam Chomsky below should provide further impetus to realise this lofty aim.

“Optimism is a strategy for making a better future. Because unless you believe that the future can be better, it's unlikely you will step up and take responsibility for making it so. If you assume that there's no hope, you guarantee that there will be no hope.”—Noam Chomsky

Availability of data and materials

Not applicable.

Beumont PJV, Touyz SW. What kind of illness is anorexia nervosa? Eur Child Adolesc Psychiatry. 2003;12(1):i20–4.

PubMed   Google Scholar  

Touyz S, Strober M. Managing the patient with severe and enduring anorexia nervosa. Managing Severe and Enduring Anorexia Nervosa: Routledge; 2016. p. 115–31.

Book   Google Scholar  

Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Arch Gen Psychiatry. 2011;68(7):724–31.

Article   PubMed   Google Scholar  

Baynes KC. The evolving world of GLP-1 agonist therapies for type 2 diabetes. Ther Adv Endocrinol Metab. 2010;1(2):61–7.

Article   PubMed   PubMed Central   Google Scholar  

Touyz S, Lacey H, Hay P. Eating disorders in the time of COVID-19. J Eat Disord. 2020;8(1):19.

Eddy KT, Tabri N, Thomas JJ, Murray HB, Keshaviah A, Hastings E, et al. Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. J Clin Psychiatry. 2017;78(2):184–9.

Walsh BT. The enigmatic persistence of anorexia nervosa. Am J Psychiatry. 2013;170(5):477–84.

Schmidt U, Campbell IC. Treatment of eating disorders can not remain ‘brainless’: the case for brain-directed treatments. Eur Eat Disord Rev. 2013;21(6):425–7.

Eisler I, Simic M, Fonagy P, Bryant-Waugh R. Implementing service transformation for children and adolescents with eating disorders across England: the theory, politics, and pragmatics of large-scale service reform. J Eat Disord. 2022;10(1):146.

Bentz M, Pedersen SH, Moslet U. An evaluation of family-based treatment for restrictive-type eating disorders, delivered as standard care in a public mental health service. J Eat Disord. 2021;9(1):141.

le Grange D, Eisler I. Family interventions in adolescent anorexia nervosa. Child Adolesc Psychiatr Clin N Am. 2009;18(1):159–73.

Kaye WH, Wierenga CE, Knatz S, Liang J, Boutelle K, Hill L, et al. Temperament-based treatment for anorexia nervosa. Eur Eat Disord Rev. 2015;23(1):12–8.

Bulik CM. Are we really paddling as fast as we can? reflections on why eating disorders treatment and research always seem to be one step behind: commentary on hay, mitchell, and stice & becker: prevention and treatment. Int J Eat Disord. 2013;46(5):489–91.

Bulik CM. Towards a science of eating disorders: Replacing myths with realities: the fourth Birgit Olsson lecture. Nord J Psychiatry. 2016;70(3):224–30.

American psychiatric association. Feeding and eating disorders. Diagnostic and statistical manual of mental disorders. 5th Ed, Text Revision 2022.

Pépin G, King R. Collaborative care skills training workshops: helping carers cope with eating disorders from the UK to Australia. Soc Psychiatry Psychiatr Epidemiol. 2013;48(5):805–12.

Bruch H. Perceptual and conceptual disturbances in anorexia nervosa. Psychosom Med. 1962;24(2):187.

Rodgers E, Marwaha S, Humpston C. Co-occurring psychotic and eating disorders in England: findings from the 2014 adult psychiatric morbidity survey. J Eat Disord. 2022;10(1):150.

Crisp AH. Premorbid factors in adult disorders of weight, with particular reference to primary anorexia nervosa (weight phobia). A literature review. J Psychosom Res. 1970;14(1):1–22.

Garner DM, Bemis KM. A cognitive-behavioral approach to anorexia nervosa. Cogn Ther Res. 1982;6(2):123–50.

Article   Google Scholar  

Keys A, Brožek J, Henschel A, Mickelsen O, Taylor HL. The biology of human starvation. (2 vols). 1950.

Phillipou A, Rossell SL, Castle DJ. Anorexia nervosa or starvation? Eur J Neurosci. 2018;48(11):3317–8.

Steinglass J, Walsh BT. Habit learning and anorexia nervosa: a cognitive neuroscience hypothesis. Int J Eat Disord. 2006;39(4):267–75.

Graybiel AM. Habits, rituals, and the evaluative brain. Annu Rev Neurosci. 2008;31:359–87.

Touyz S, Hay P. Severe and enduring anorexia nervosa (SE-AN): in search of a new paradigm. J Eat Disord. 2015;3(1):26.

Touyz SW, Beumont PJV, Collins JK, Cowie I. Body shape perception in bulimia and anorexia nervosa. Int J Eat Disord. 1985;4(3):259–65.

Gutiérrez E, Carrera O. Severe and Enduring anorexia nervosa: enduring wrong assumptions? Front Psychiatry. 2021;11:52889.

Bryant E. Anorexia: the great taboo. Lancet Psychiatry. 2021;8(10):866–7.

Gull WW. Anorexia nervosa (apepsia hysterica. anorexia hysterica). Trans Clin Soc. 1874;7:22–8.

Google Scholar  

Lasègue E-C. De l’anorexie hystérique Arch gén méd. 1873;21:385–403.

Russell GF. Anorexia nervosa: its identity as an illness and its treatment. Modern Trends Psychol Med. 1970;2(1):56–62.

Lee S, Ho TP, Hsu LG. Fat phobic and non-fat phobic anorexia nervosa: a comparative study of 70 Chinese patients in Hong Kong. Psychol Med. 1993;23(4):999–1017.

Korn J, Vocks S, Rollins LH, Thomas JJ, Hartmann AS (2020) Fat-Phobic and Non-Fat-Phobic Anorexia Nervosa: A Conjoint Analysis on the Importance of Shape and Weight. Front Psychol 11: 90.

Barton R, Aouad P, Hay P, Buckett G, Russell J, Sheridan M, et al. Distinguishing delusional beliefs from overvalued ideas in anorexia nervosa: an exploratory pilot study. J Eat Disord. 2022;10(1):85.

Thornton LM, Munn-Chernoff MA, Baker JH, Juréus A, Parker R, Henders AK, et al. The anorexia nervosa genetics initiative (ANGI): overview and methods. Contemp Clin Trials. 2018;74:61–9.

Duncan L, Yilmaz Z, Gaspar H, Walters R, Goldstein J, Anttila V, Bulik-Sullivan B, Ripke S. Eating disorders working group of the psychiatric genomics consortium, Thornton L, Hinney. A significant locus and metabolic genetic correlations revealed in genome-wide association study of anorexia nervosa. Am J Psychiatry. 2017;174(9):850–8.

Windauer U, Beumont PJV, Lennerts W, Talbot P, Touyz SW. How well are ‘cured’ anorexia nervosa patients?: an investigation of 16 weight-recovered anorexic patients. Br J Psychiatry. 1993;163(2):195–200.

Barko EB, Moorman SM. Weighing in: qualitative explorations of weight restoration as recovery in anorexia nervosa. J Eat Disord. 2023;11(1):14.

Eiring K, Wiig Hage T, Reas DL. Exploring the experience of being viewed as “not sick enough”: a qualitative study of women recovered from anorexia nervosa or atypical anorexia nervosa. J Eat Disord. 2021;9(1):142.

Hatch A, Madden S, Kohn MR, Clarke S, Touyz S, Gordon E, et al. Emotion brain alterations in anorexia nervosa: a candidate biological marker and implications for treatment. J Psychiatry Neurosci. 2010;35(4):267–74.

Koning E, Brietzke E. Psilocybin-assisted psychotherapy as a potential treatment for eating disorders: a narrative review of preliminary evidence. Trends Psychiatry Psychother. 2023. May 1 (Ahead Of Print).

Su T, Gong J, Tang G, Qiu S, Chen P, Chen G, et al. Structural and functional brain alterations in anorexia nervosa: a multimodal meta-analysis of neuroimaging studies. Hum Brain Mapp. 2021;42(15):5154–69.

Russell H, Aouad P, Le A, Marks P, Maloney D, Touyz S, Maguire S. Psychotherapies for eating disorders: findings from a rapid review. J Eat Disord. 2023;11(1):175.

Peck SK, Shao S, Gruen T, Yang K, Babakanian A, Trim J, et al. Psilocybin therapy for females with anorexia nervosa: a phase 1, open-label feasibility study. Nat Med. 2023;29(8):1947–53.

Williams LM. Precision psychiatry: a neural circuit taxonomy for depression and anxiety. Lancet Psychiatry. 2016;3(5):472–80.

Phillipou A, Castle DJ, Rossell SL. Anorexia nervosa: eating disorder or body image disorder? Aust N Z J Psychiatry. 2018;52(1):13–4.

Glashouwer KA, van der Veer RML, Adipatria F, de Jong PJ, Vocks S. The role of body image disturbance in the onset, maintenance, and relapse of anorexia nervosa: a systematic review. Clin Psychol Rev. 2019;74:101771.

Doidge N. The brain that changes itself: stories of personal triumph from the frontiers of brain science: Penguin; 2007.

Dawson L, Rhodes P, Touyz S. The recovery model and anorexia nervosa. Aust N Z J Psychiatry. 2014;48(11):1009–16.

Paul R. Severe and Enduring Eating Disorders: Concepts and Management. In: Hubertus H, Ignacio Jáuregui L, editors. Anorexia and bulimia nervosa. Rijeka: IntechOpen; 2019. p. Ch. 10.

Kan C, Cardi V, Stahl D, Treasure J. Precision psychiatry—what it means for eating disorders? Eur Eat Disord Rev. 2019;27(1):3–7.

Wonderlich S. Plenary: Developments in the training of the next generation of clinical researchers. Eat Disord Res Conf (EDRS). 2022.

InsideOut institute for eating disorders. Australian eating disorders research and translation strategy 2021–2031. Sydney. 2021.

Kohn MR, Madden S, Clarke SD. Refeeding in anorexia nervosa: increased safety and efficiency through understanding the pathophysiology of protein calorie malnutrition. Curr Opin Pediatr. 2011;23(4):390–4.

Hambleton A, Aouad P, Miskovic-Wheatley J, Le Grange D, Touyz S, Maguire S. The efficacy of family treatments for adolescent anorexia nervosa in specialist versus non-specialist settings: protocol for a systematic review and meta-analysis. J Eat Disord. 2022;10(1):120.

Bulik CM, Flatt R, Abbaspour A, Carroll I. Reconceptualizing anorexia nervosa. Psychiatry Clin Neurosci. 2019;73(9):518–25.

Zipfel S, Giel KE, Bulik CM, Hay P, Schmidt U. Anorexia nervosa: aetiology, assessment, and treatment. Lancet Psychiatry. 2015;2(12):1099–111.

Bryant E, Aouad P, Hambleton A, Touyz S, Maguire S. ‘In an otherwise limitless world, I was sure of my limit.’† experiencing anorexia nervosa: a phenomenological metasynthesis. Front Psychiatry 2022; 13.

Wierenga CE, Ely A, Bischoff-Grethe A, Bailer UF, Simmons AN, Kaye WH. Are extremes of consumption in eating disorders related to an altered balance between reward and inhibition? Front Behav Neurosci. 2014;8:410.

Westwood H, Tchanturia K. Autism spectrum disorder in anorexia nervosa: an updated literature review. Curr Psychiatry Rep. 2017;19:1–10.

Fairburn CG, Cooper Z, O’Connor M. The eating disorder examination. Int J Eat Disord. 1993;6:1–8.

Schauenburg H, Friederich H-C, Wild B, Zipfel S, Herzog W. Focal psychodynamic psychotherapy of anorexia nervosa: a treatment manual. Psychotherapeut. 2009;54:270–80.

Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Therapy. 1995;33(3):335–43. https://doi.org/10.1016/0005-7967(94)00075-U .

Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arc General Psychiatry. 1961;4(6):561–71. https://doi.org/10.1001/archpsyc.1961.01710120031004 .

Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988;56(6):893–7. https://doi.org/10.1037/0022-006X.56.6.893 .

Mundt JC, Marks IM, Shear MK, Greist JM. The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British J Psychiatry. 2002;180(5):461–4. https://doi.org/10.1192/bjp.180.5.461 .

Maguire S, Touyz S, Surgenor L, Crosby RD, Engel SG, Lacey H, et al. The clinician administered staging instrument for anorexia nervosa: development and psychometric properties. Int J Eat Disord. 2012;45(3):390–9.

Maguire S, Surgenor LJ, Le Grange D, Lacey H, Crosby RD, Engel SG, et al. Examining a staging model for anorexia nervosa: empirical exploration of a four stage model of severity. J Eat Disord. 2017;5(1):41.

Maguire S, Le Grange D, Surgenor L, Marks P, Lacey H, Touyz S. Staging anorexia nervosa: conceptualizing illness severity. Early Interv Psychiatry. 2008;2(1):3–10.

Tchanturia K, Campbell IC, Morris R, Treasure J. Neuropsychological studies in anorexia nervosa. Int J Eat Disord. 2005;37(S1):S72–6.

Stedal K, Frampton I, Landrø NI, Lask B. An examination of the ravello profile—a neuropsychological test battery for anorexia nervosa. Eur Eat Disord Rev. 2012;20(3):175–81.

Mitchison D, Morin A, Mond J, Slewa-Younan S, Hay P. The bidirectional relationship between quality of life and eating disorder symptoms: a 9-year community-based study of Australian women. PLoS ONE. 2015;10(3):e0120591.

Dann KM, Hay P, Touyz S. Everyday flexibility and functional milestones in anorexia nervosa: survey results from a mixed community sample. Eat Weight Disord Stud Anorexia, Bulimia Obes. 2022;27(5):1641–50.

Beaumont P, George C, Smart D. “Dieters” and "vomiters and purgers” in anorexia nervosa. Psychol Med. 1976;6:617–22.

Lewis A. States of depression. BMJ. 1938;2(4060):875–8.

Marzola E, Panero M, Longo P, Martini M, Fernàndez-Aranda F, Kaye WH, et al. Research in eating disorders: the misunderstanding of supposing serious mental illnesses as a niche specialty. Eat Weight Disord Stud Anorexia, Bulimia Obes. 2022;27(8):3005–16.

Bryant E, Koemel N, Martenstyn JA, Marks P, Hickie I, Maguire S. Mortality and mental health funding; do the dollars add up? Eating disorder research funding in Australia from 2009 to 2021: a portfolio analysis. Lancet Reg Health Western Pacific.

Fernández-Aranda F, Casas M, Claes L, Bryan DC, Favaro A, Granero R, et al. COVID-19 and implications for eating disorders. Eur Eat Disord Rev. 2020;28(3):239–45.

Treasure J, Cardi V, Leppanen J, Turton R. New treatment approaches for severe and enduring eating disorders. Physiol Behav. 2015;152:456–65.

Stengel A, Giel K. Emerging therapeutic targets for anorexia nervosa. Expert Opin Ther Targets. 2023; 1–12.

Keeler JL, Treasure J, Himmerich H, Brendle M, Moore C, Robison R. Case report: intramuscular ketamine or intranasal esketamine as a treatment in four patients with major depressive disorder and comorbid anorexia nervosa. Front Psychiatry. 2023;14:1181447.

Download references

Acknowledgements

We would like to thank all those with lived experience who have shaped our understanding of this often-devastating illness. S.T. would like to acknowledge the important role that the late Pierre Beumont played in developing an understanding of AN. He was my mentor, colleague and friend and is sorely missed. We would also like to thank the anonymous reviewers for contributing their improvements to the manuscript.

Author information

Authors and affiliations.

InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, Australia

S. Touyz, E. Bryant, K. M. Dann, P. Aouad, S. Barakat, J. Miskovic-Wheatley, K. Griffiths, B. Carroll & S. Maguire

Department of Psychology, University of Toronto, Toronto, Canada

Department of Psychiatry and Behavioral Sciences, University of California, Parnassus Heights, San Francisco, USA

D. Le Grange

Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia

Mental Health Services SWSLHD, Campbelltown, Australia

Population Health Research Institute, St George’s, University of London, London, UK

Australian Eating Disorder Research and Translation Centre, The University of Sydney, Sydney, Australia

Healing Conversations, Perth, WA, Australia

You can also search for this author in PubMed   Google Scholar

Contributions

ST: conceptualization, writing—original draft. EB and KD: writing—original draft, writing—review and editing and project administration. JP, DLG, PH, HL, PA, SB, JMW, KG, BC, SC: writing—review and editing. SM: writing—review and editing, and supervision. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to E. Bryant .

Ethics declarations

Ethical approval and consent to participate, competing interests.

P.H. has received sessional fees and lecture fees from the Australian Medical Council, Therapeutic Guidelines publication, and New South Wales Institute of Psychiatry and royalties from Hogrefe and Huber, McGraw Hill Education, and Blackwell Scientific Publications, and she has received research grants from the NHMRC and ARC. She is Chair of the National Eating Disorders Collaboration in Australia (2019–) and an Editor in Chief of this journal. In July 2017, she provided a commissioned report for Takeda (formerly Shire) Pharmaceuticals on lisdexamfetamine and binge eating disorder, is a consultant to Takeda, and in 2018–2020 received honoraria for education of Psychiatrists. S.T. receives royalties from Taylor and Francis, Hogrefe and Huber and McGraw Hill for published book chapters. He has received honoraria from Shire/ Takeda Group of Companies for chairing the Australian Clinical Advisory Board for Binge Eating Disorder, public speaking engagements, commissioned reports as well as investigator- initiated research grants. He is an Editor in Chief of this journal, an inaugural committee member of the National Eating Disorders Collaboration, a Member of the Technical Advisory Group (TAG) on Eating Disorders (Commonwealth of Australia) and a member of the governing council of the Australian Eating Disorders Research and Translation Centre. DLG receives royalties from Guilford Press and Routledge, is Co-Director of the Training Institute for Child and Adolescent Eating Disorders, LLC, and is a member of Equip Health Clinical Advisory Board. The other authors have no conflicts of interest to disclose.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Touyz, S., Bryant, E., Dann, K.M. et al. What kind of illness is anorexia nervosa? Revisited: some preliminary thoughts to finding a cure. J Eat Disord 11 , 221 (2023). https://doi.org/10.1186/s40337-023-00944-3

Download citation

Received : 19 July 2023

Accepted : 01 December 2023

Published : 11 December 2023

DOI : https://doi.org/10.1186/s40337-023-00944-3

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Journal of Eating Disorders

ISSN: 2050-2974

• General enquiries: [email protected]

• Dissertation
• PowerPoint Presentation
• Book Report/Review
• Research Proposal
• Math Problems
• Proofreading
• Movie Review
• Cover Letter Writing
• Personal Statement
• Nursing Paper
• Argumentative Essay
• Research Paper
• Discussion Board Post

Anorexia Essay: How to Work with a Scary Topic and Do It Right

Table of Contents

When you study at the Nutrition department or prepare to become a medical specialist, you’re sure to get an eating disorder essay assignment one day. This problem has become quite commonplace, with a complex of eating problems awaiting people who are too obsessed with slim body images on social media and want to lose weight at all costs.

Because of the popularity of slim body images and young people’s obsession with the sporty body, the problem of anorexia is getting acuter day by day. So, when you get an anorexia essay assignment, be ready to do some thorough research, develop strong arguments, and compose a paper in line with academic writing rules.

If you’re confused about this task, here are some working tips to get the process going.

What Is Anorexia and How to Talk About It

Problems with eating surface not that quickly. At first, individuals may limit their portion sizes and refuse some products that they believe are dangerous for their weight. Next, they refrain from several meals a day, leaving only 1-2 food intakes to stay slim and not to overeat. As a result of such severe limitations in eating, some people develop anorexia nervosa.

This disease goes far beyond a permanent loss of appetite and manifests itself in various neurological and gastrointestinal problems. Its common symptoms are:

• Extreme, uncontrollable weight loss
• Unhealthy thinness
• Fatigue experienced during a significant part of the day
• Unexpected attacks of dizziness and frequent fainting
• Thinning hair and breaking nails
• Intolerance to cold
• Hypertension
• The inability of the gastrointestinal tract to process the consumed food – nausea and vomiting after food intakes

Given such an abundance of symptoms and clinical manifestations of this condition, you can approach the subject from several angles. Some students discuss the psychological causes of the disorder in their anorexia essay papers. Others focus on the biological mechanisms of anorexia development. Another interesting approach is to consider clinical evidence of therapeutic methods to treat anorexic people and help them regain a healthy weight.

How to Write an Eating Disorder Thesis Statement

The first task that you should complete in crafting your anorexia essay is developing a solid, clear thesis statement. It is a crucial element of your assignment that will guide the readers from the introduction to the concluding part, giving them a firm grasp of your logic and argument flow.

Thus, to build a robust and believable thesis, you need to follow these guidelines:

• Choose a sub-topic within the subject of eating disorders. Formulate for yourself what you think about this topic first.
• Try to express your central idea in one sentence, showing your primary arguments and focus.
• Mention the arguments supporting your central claim briefly in this statement, without going into too much detail.
• Place the thesis statement correctly at the end of your introductory section to ensure that the readers and supervisor will locate it.

Anorexia Essay Outline

Now let’s consider a sample outline for an anorexia essay, which can serve as your guidance in future work on such papers.

INTRODUCTION

Introduce the broad context. Give some stats and facts. Delineate a concrete problem and its significance. Formulate a thesis statement.

Diet – a personal choice or a disorder? Global population (2.9 mln) affected by anorexia. No apparent cause identified yet (genetic, neurological factors). A variety of treatment modalities available today and their varying effectiveness. 

Paragraphs #1-3

Present a topic sentence with one central idea per paragraph. Add some credible evidence from external sources to support the points. Interpret the information you’ve provided.

Paragraph #1 – the process of anorexia development, extreme dieting, forced vomiting after eating to control body weight, obsession with slim body images. The result – clinical anorexia symptoms.

Paragraph #2 – the inability of anorexic individuals to reverse the process (return to healthy eating after achieving the weight loss goal). Clinical complications of anorexia (osteoporosis, infertility, heart damage). Forced feeding of anorexic individuals to prevent terminal organ failure.

Paragraph #3 – Treatment modalities – psychotherapy, healthy weight gain, and addressing the problematic behaviors (forced vomiting, food refusal). Effectiveness of CBT and family therapy. Pharmacological treatments.

Make a summary of what’s been said and reinforce the readers’ impression by referencing the broader context (public health, teen health, the devastating impact of social media, etc.).

Anorexia is not a strict diet. It is a neurological disorder that can cause morbidity and mortality among patients. Because of the absence of a clear understanding of its underlying causes, anorexia needs to be treated on a case-by-case basis by giving each patient an individual treatment plan in line with their health state and anorexia triggers. 

Eating Disorders: Conclusion That’ll Earn You A+ Grade

A conclusion of your anorexia essay should summarize all the evidence you provided in the body of your paper and return to the problem’s significance in the broader context of public health. Depending on your essay’s topic, you can draw some recommendations on helping young people avoid anorexia or some workable methods for managing this condition more efficiently.

Sample Essay on How We Should Treat People with Anorexia

Our writing experts have crafted a short essay sample based on the outline presented in the section above. Use it as a reference when preparing your following paper on this subject.

For many people, choosing what to eat and when to do it is a voluntary act. For those with anorexia nervosa, eating has become an impossible challenge, an act that they cannot commit voluntarily, even for the sake of their survival. At present, over 2.9 million people are affected by anorexia worldwide, suffering extreme weight loss, multiple organ problems, osteoporosis, heart damage, and a complex of other devastating consequences of strict dieting and food refusal. Thus, what starts as a diet for the sake of healthy weight loss and body slimming often ends with a clinical disorder with no cure. Still, the issue is grave for people affected by this condition as they need efficient, professional treatment to start eating normally again and avoid lethal malnourishment. This paper discusses the causes, manifestations, and treatment modalities for anorexia nervosa known today in an effort to find workable solutions for the affected patients.

No single cause of anorexia development has yet been identified, with a mixture of genetic, environmental, and psychological factors coming into play. Jameson (2009) discovered that anorexic patients often view themselves as overweight (even if they are thin) and deny any weight loss or nutrition problems. As a result of the distorted body image and an obsession with slimness, anorexic people force themselves to vomit, refuse many food types, engage in excessive exercise and use laxatives to prevent excessive body fat accumulation (Mary, 2007).

As a result, the process of body weight loss becomes irreversible and cannot be dropped even after the clinical problem is clear. Individuals with anorexia often develop osteoporosis, suffer from irreversible organ failure, and lose fertility (especially females). Anorexic patients refuse therapeutic interventions, vomit secretly, and avoid treatment in all ways. Thus, such severe manifestations of anorexia are commonly treated by forced feeding via nasogastric tubes upon a competent psychiatrist’s diagnosis of the patient’s psychological incompetence.

Other treatment methods include psychotherapy and family therapy to identify the underlying psychological causes for food refusal and change the false perceptions and prejudices of patients. Kale (2020) found CBP to be effective with young female anorexics, with 78% of the surveyed sample reporting significant improvements in body image perceptions and weight regain. Thus, psychotherapeutic methods are popular in anorexia treatment as they allow dealing with underlying psychological problems of patients and correct their beliefs about body image in the long run.

As the provided evidence suggests, anorexia nervosa is a severe clinical problem that millions of patients face worldwide. With no clear causes and specific clinical guidelines for its treatment, anorexia remains a pressing challenge for medical professionals and patients. Case-by-case management of anorexia cases is suggested, while a combination of pharmacological and psychotherapeutic treatments suggests the greatest efficiency thus far.

More Helpful Tips & Tricks

Tasked with an anorexia essay? Here are some valuable tips to follow to get an outstanding grade for this assignment:

• The underlying causes of this disorder are still unclear. So, you can surprise your tutor by presenting an in-depth analysis of the existing theories about the origin of anorexia.
• Treatments for anorexia differ, ranging from CBT to pharmacological care. You can compose in-depth research about the clinical evidence of each treatment modality’s effectiveness for various population groups.
• The psychological component of anorexia is powerful. An excellent paper can result from research on the psychological triggers and accompanying psychological disorders among anorexic individuals.

Here’s How a Professional Writer Can Help You

Still unsure how to compose an anorexia essay that will win you a high grade? Having little time to think over the subject thoroughly and develop workable arguments? Lacking a couple of free hours to attend the library and find the relevant, credible evidence to support your points? No problem, as our experts can do it for you.

Contact us today to get a perfectly written and well-proofread paper about eating disorders. We’ll surely impress your supervisor with original ideas and credible evidence. In this way, you’re sure to save crucial time for other academic priorities and avoid getting an F for a failed deadline.

100 Good Research Topics

Compare and contrast essay outline example, how to write movie titles in essays.

Anorexia Nervosa Eating Disorder

How it works

Anorexia nervosa is an eating disorder, characterized by the refusal of an emaciated individual to maintain a normal body weight (CITATION ENCYCLOPEDIA). More specifically, its diagnosis is based on three distinct criteria presented by the American Psychiatric Association (APA) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): First, consistent restriction of energy consumption resulting in a relatively low body weight must occur. Second, there is an irrational fear of weight gain. Finally, there is a disturbance in the way one’s body or shape is experienced or a lack of recognition for the seriousness of their low body weight (American Psychiatric Association [APA], 2013).

Transition sentence.

Eating disorder diagnoses are typically made during ages 12-19 with the peak onset age of anorexia being 12-14 years old (Diamond-Raab & Orrell-Valente, 2002). These diagnoses are unfortunately common, and according to Romero (1984), anorexia affects as many as 1 in every 250 girls between the ages of 12 and 18. While the onset age of anorexia focuses on upper middle school and high school, the development of anorexia is during middle school (Romero, 1984). Additionally, there have been cases of children as young as six with disordered eating (Tanofsky-Kraff et. al., 2004), suggesting that the development of anorexia can start even earlier. Often, by the time a diagnosis is made in older adolescents, there are deeply ingrained psychological effects, long-term health complications, and a low recovery rate (Romero, 1984, p.17). These complications make it imperative to educate on the disease during middle school and early adolescence for prevention and early intervention.

While it is acknowledged that there isn’t a single origin for anorexia nervosa, there are a multitude of impacting factors that can be broken down into psychological, biological, and environmental categories (CITATION Mayo Clinic). These impacting factors are important to understand in order to recognize at-risk children. General summary of external factors.

Psychologically, there are high rates of affective disorders, depression, anxiety disorders, obsessive-compulsive disorders, personality disorders, and substance use in adolescent girls with eating disorders (Emans, date). More specifically, middle school girls who are psychologically vulnerable to anorexia development (Romero, 1984) are perfectionists, praise-seeking, and overachievers. This type of girl often seeks praise due to an underlying lack of self-esteem (Romero, 1984). These traits coincide with anorexia development because, generally, individuals who have low self-esteem or view their bodies in a negative light are more likely to develop an eating disorder (citation Creative Wellness).

Insecurity and low self-esteem can result in eagerness to receive praise from outward sources and can also result in control-oriented and perfectionist tendencies (Emans, date). These tendencies can be observed in anorexia patients, as many view anorexia as a form of control in their lives. People with anorexia often have obsessive personality traits (Mayo Clinic). This trait is recognized in a patient’s intense, all-consuming focus on food and strict control over their energy consumption. In fact, a study conducted by Thornton and Russell (date) discovered additional OCD diagnoses for 37% of patients with anorexia nervosa. This high comorbidity rate raised awareness for the role of control in anorexia nervosa development and the significant impact of psychological factors.

Beyond perfectionism and controlling tendencies, anxiety is also linked to anorexia nervosa. Often, girls with anorexia nervosa are anxious and use food restriction as a means to cope with their anxiety. The element of control that comes with food restriction is an attempt to combat anxiety (Mayo Clinic citation).

Many of these psychological risk traits can be traced back to the biology of patients. Biologically, while there is no definite distinction of which genes cause a heightened risk for anorexia development, it is known that a person’s genetic makeup can influence the development of controlling, perfectionist, and anxious tendencies (Mayo Clinic). There is supporting evidence for the genetic component of anorexia, although further research needs to be conducted. A study on twins conducted between St George’s and the Maudsley Hospitals found 56.25% of the monozygotic (MZ) pairs and 7% of the dizygotic (DZ) pairs concordant for anorexia nervosa, providing further evidence for the genetic and familial component of anorexia nervosa. (Holland, et.al). Additionally, the risk of developing anorexia increases 11-fold in people with anorexic family members (sciencemag), and having a first-degree relative with anorexia also increases one’s likelihood of developing anorexia (Mayo). While it can be argued that this increased likelihood is due to environmental influences, researchers at the University of Pittsburgh believe otherwise (sciencemag). Psychiatrist Walter Kay found a link between defective proteins in appetite systems and a varied region of chromosome 1 in anorexia patients (sciencemag). More research needs to be conducted on this link, but its discovery has inspired further curiosity about the genetic component of anorexia nervosa and an excitement for future genetically focused treatments (science mag).

While part of the familial component of anorexia can be attributed to genetics, there are many familial and environmental influences on the development of anorexia. In adolescents, parents have a significant influence on their children’s behavior. Since children learn from direct observation, parental habits, and thoughts surrounding food can be adopted (citation). Additionally, parental opinions and comments on appearance can influence children’s self-perception. Further exploration is necessary on how parental attitudes and opinions influence their children’s behavior. Parental attitude and opinion hold great weight in shaping children’s attitudes towards foods (White 2000).

Focusing broadly on eating disorders, Emans (date) reported a high frequency of eating disorders among children with family histories of “eating disorders, depression, alcoholism, substance abuse, and other mental illnesses”. For example, daughters of mothers with eating disorders have a higher risk of developing an eating disorder than children without an immediate connection to the disease (book). Emans (date) also claims that these families often have high expectations, unstable marriages, and a lack of communication skills. Also, irrespective of individual factors, students have a higher chance of developing an eating disorder if their parents are highly educated (Bould). More specifically, these trends have been identified in patients with anorexia nervosa.

Romero (1984) depicts the families of anorexia patients as those with managerial or professional positions and high expectations. These parents emphasize physical appearances and academic achievement (Romero, 1984). Transition sentence.

Family culture may be associated with anorexia development. It was once argued that anorexia was most common in upper-middle-class white girls due to Western culture’s emphasis on thinness (Romero, 1984). However, this belief has been challenged, on the grounds that those suffering in a White upper-middle-class culture have the financial ability to receive treatment and report their eating disorder cases, whereas other minority anorexia patients may not be as fortunate and thus are underrepresented (GET CITATION). There have been numerous studies revealing the prevalence of eating disorders in minority populations. In a study of 545 Hispanic, Native American, and White high school students, it was discovered that both Native Americans and Hispanics had higher percentages of disturbed eating than non-Hispanic Whites (Smith & Krejci, 1991). The outcomes of this study contradict the belief that anorexia is primarily experienced by white communities. Moreover, a study conducted by Shaw, Ramirez, Trost, Randall, & Stice (2004), investigated the perceived differences in eating disorders between minority groups and Whites. Their findings showed “little support for the hypothesized ethnic differences in eating disturbances and suggested “that ethnic minority groups have achieved parity with Whites in this domain” (Shaw et. al, 2004). These studies raise awareness of the prevalence of eating disorders in groups once presumed to be less affected.

While these studies were not anorexia-specific and focused more generally on all eating disorders, they provide evidence that eating disorders do not discriminate their victims. Educators should bear this in mind and eliminate cultural biases when identifying eating disorder cases in their classrooms. Further research on anorexia-specific cultural trends should be conducted to identify correlations between culture and anorexia nervosa. However, from an educational and professional perspective, it is better to remove assumptions and consider that all students could be at risk to avoid overlooking cases (book).

Anorexia nervosa should be examined in an educational context because adolescent development places middle school students at risk for anorexia nervosa development. The onset age of anorexia corresponds to when students are in middle school (Romero, 1984). Many of the physical and social developments taking place during middle school can become risk factors for anorexia or cause side-effects that are risk factors for anorexia nervosa development (citation).

To start, there are heightened environmental transitions entering and exiting middle school. Many students transition into a new school for middle school and will transition into a new school for high school. These transitions come with new friends, classes, and unfamiliar environments. According to the Mayo Clinic (date), transitions are risk factors in the development of anorexia because of the emotional stress they cause. Those who experience emotional turmoil from transitions may use anorexia nervosa as a coping mechanism (Mayo Clinic, date). The physical environment transitions that often occur at the beginning and end of middle school, therefore, place students at risk for anorexia development.

Beyond the environmental transition to a new school, there are additional physical developmental changes that place middle schoolers at risk for anorexia nervosa. Puberty occurs during early adolescence and causes weight gain and increased fat distributions. These bodily changes can make middle school girls more conscious and insecure about their bodies (Romero, 1984). These insecurities can develop into body dysmorphia, delusional thoughts, and anorexia nervosa. If not treated, the lack of energy consumption from anorexia nervosa can stunt physical maturation, force amenorrhea, cause patients to lose up to 50% of their original body weight, and eventually die of starvation (Romero, 1984). Adolescents with anorexia nervosa have a 12 times higher mortality rate than those who do not have the disease (NEDA), making the intervention and prevention of anorexia nervosa imperative in middle schools.

During this time, adolescents are also emotionally developing an identity and cognitively developing their values. Physical development affects identity development since physical appearance is the number one factor that influences global self-esteem (book).

The recent development of identity and cognitive development among adolescents has made them more prone to fall under the weight of peer pressure. Social acceptance is prioritized over healthy choices (book). Peer influence is accentuated because during early adolescence, preoccupation with how their peers see them can become all-consuming (book).

• 1.1 Classroom intervention
• 1.2 Intervention:

INTERVENTION:

Its prevalence and 20% mortality rate (Romero, 1984, p.16) make it an important illness to examine in schools nationwide.

No programs were effective in improving body image in boys and girls with 12-18 year olds BUT effective programs were conducted with 1213 year olds. https://www.sciencedirect.com/science/article/abs/pii/S1740144513000405

What are current or possible responses at the classroom level? At the school or system level?

“The development of values, beliefs, and assumptions is transmitted through the school’s curriculum, the teachers’ attitudes, and peer interactions.” (Ricciardelli & McCabe, 2001).

“Wellness groups in schools, along with the education of parents and teachers, are crucial in identifying and preventing eating disorders in children and adolescents.” (Smolak, Harris, Levine, & Shisslak 2001; Russell-Mayhew, et al., 2008).

Classroom intervention

I. Counselor

II. Peer education on a topic

III. In health class

IV. Regular teachers

V. The effectiveness of these methods

VI. Dependence on School Environment:

Rates of eating disorders (ED) vary between schools, and this is not explained by individual characteristics. (Bould)

“Girls at schools with a high proportion of female students, and students with highly educated parents, have higher odds of ED regardless of individual risk factors.” On average, a young woman, regardless of her own background, is more likely to develop an ED if she attends a school with a higher proportion of girls or a higher proportion of children of highly educated parents. (Bould)

Schools are not entirely to blame for this, but this issue is crucial to examine from an educational perspective because of its prevalence and high mortality rate. School teachers see kids more often and during meals, and can pick up on abnormal behaviors.

Interventions that have statistically worked:

Intervention:

To date, it appears that the important elements of school-based programs include media skills, appreciation of body shapes and sizes, healthy eating at home and school, physical activity and exercise, outreach to parents and communities, and referrals for services. (Emans)

Conclusion: Going forward, more research is needed and there are flaws with the information we currently have.

Cite this page

Anorexia Nervosa Eating Disorder. (2019, Jul 31). Retrieved from https://papersowl.com/examples/anorexia-nervosa-eating-disorder/

"Anorexia Nervosa Eating Disorder." PapersOwl.com , 31 Jul 2019, https://papersowl.com/examples/anorexia-nervosa-eating-disorder/

PapersOwl.com. (2019). Anorexia Nervosa Eating Disorder . [Online]. Available at: https://papersowl.com/examples/anorexia-nervosa-eating-disorder/ [Accessed: 3 Jun. 2024]

"Anorexia Nervosa Eating Disorder." PapersOwl.com, Jul 31, 2019. Accessed June 3, 2024. https://papersowl.com/examples/anorexia-nervosa-eating-disorder/

"Anorexia Nervosa Eating Disorder," PapersOwl.com , 31-Jul-2019. [Online]. Available: https://papersowl.com/examples/anorexia-nervosa-eating-disorder/. [Accessed: 3-Jun-2024]

PapersOwl.com. (2019). Anorexia Nervosa Eating Disorder . [Online]. Available at: https://papersowl.com/examples/anorexia-nervosa-eating-disorder/ [Accessed: 3-Jun-2024]

Don't let plagiarism ruin your grade

Hire a writer to get a unique paper crafted to your needs.

Our writers will help you fix any mistakes and get an A+!

Please check your inbox.

You can order an original essay written according to your instructions.

Trusted by over 1 million students worldwide

1. Tell Us Your Requirements

2. Pick your perfect writer

3. Get Your Paper and Pay

Hi! I'm Amy, your personal assistant!

Don't know where to start? Give me your paper requirements and I connect you to an academic expert.

short deadlines

100% Plagiarism-Free

Certified writers

Anorexia Nervosa: Medical Issues Essay

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

Introduction

There are different afflictions which affect millions of individuals throughout the country. Many of these afflictions are debilitating and cause problems not only for the patients but also for the significant persons near him or her. However, of these many conditions, some pose not only serious mental conditions but also grave physical problems as well.

One of these is anorexia nervosa. With regard to this, I have confronted with the question of what exactly is anorexia and how does it affect an individual, who should know about it. Moreover, what are the causes of anorexia and how it can be prevented from developing? In response to this, the writer wishes to state that the purpose of this paper is to present a brief outline of anorexia and its causes to the millions of Americans out there without knowledge about it.

To understand the cause of anorexia, the reader must understand what anorexia is. Anorexia is a eating disorder characterized by severely low body weight and distortion of body image. Despite the fact that their appearances may be severely malnourished and skeletal, anorexic clients tend to believe that they are still fat. Moreover, anorexic patients are extremely afraid of gaining weight. To avoid this, they engage themselves upon weight-losing activities such as exercise, going insofar as to purge, vomit, drink slimming pills and diuretics, and self-starve which can lead to death. It primarily affects women though ten percent are known to be men. It is very complex as to involve psychological, sociological, physiological, and neurobiological aspects of living (Lask & Bryant-Waugh, 2000).

There is no single cause of anorexia and more commonly, it is the result of numerous factors in life. One of the presumed causes is on genetics. According to recent studies, genetics play a significant role in the inheritance of genes which may contribute to the development of eating disorders among individuals (Klump et al, 2001 p. 218). In addition to this, nutritional factors are also blamed for anorexia. According to nutritionists, a deficiency in Zinc may lead to the loss of appetite in people which eventually develops into anorexia nervosa.

However, despite the findings involving genetics and nutrition, psychosocial factors are still considered as the most contributing factor to the progress of anorexia in a client. Findings suggest that people with anorexia tend to have low self-esteems and believe that they are not attractive. Moreover, the society’s notion that fat people are not beautiful is also regarded as a contributing factor to the rise in number of anorexic clients. Anorexics are commonly high-achieving people and characterizes by perfectionism and an ability to resist temptation.

As stated, societal notions of the ideal body for a woman also affect anorexics. Since researchers believe that obsessive-compulsive disorder and depression is comorbid with anorexia, the continuous pressure to gain the ideal body prompts women to become obsessed with weight loss, especially among the high achievers. Furthermore, females from well-to-do white families are the ones at high risk of developing the disorder. Aside from this, women working on jobs demanding ideal bodies such as modeling and advertising are at risk of having anorexia due to popular demands for thin models.

In conclusion, anorexia nervosa, as well as other eating disorders, is an alarming condition in people which needs intense attention and treatment. Since no prevention can be used to delay or stop the disorder, early detection should be the priority. Moreover, social norms regarding the definition of beauty should never be emphasized. Instead, healthy lifestyle should be encouraged without regard of the trends in society which, more often than not, cause low self-esteem in many, especially in children and adolescents who are at the age of rapid assimilation of ideas and notions. Eating disorders such as anorexia nervosa affect each and every one of us. Therefore, it is best to promote health in lieu of clichéd and often wrong beliefs regarding the ideals of beauty among men and women.

Lask, B., & Bryant-Waugh, R. (2000). Anorexia Nervosa and Related Eating Disorders in Childhood and Adolescence .Psychology Press.

Klump, K.L., Kaye, W.H., & Strober, M. (2001). The Evolving Genetic Foundations of Eating Disorders. Psychiatric Clinics of North America . Vol. 24, No. 2 , pp. 215-225.

• The Eating Disorder - Anorexia Nervosa
• Anorexia Nervosa: Signs, Effects and Therapies
• Anorexia Nervosa in Psychological Point of View
• Psychopathology. The United States National Mental Health
• The Methods to Reduce Preoperational Anxiety
• “Psychopathy and Antisocial Personality Disorder" by Robert D. Hare
• The Problem of Somnambulism
• Obsessive-Compulsive Disorder: Effective Treatment
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2021, September 27). Anorexia Nervosa: Medical Issues. https://ivypanda.com/essays/anorexia-nervosa-medical-issues/

"Anorexia Nervosa: Medical Issues." IvyPanda , 27 Sept. 2021, ivypanda.com/essays/anorexia-nervosa-medical-issues/.

IvyPanda . (2021) 'Anorexia Nervosa: Medical Issues'. 27 September.

IvyPanda . 2021. "Anorexia Nervosa: Medical Issues." September 27, 2021. https://ivypanda.com/essays/anorexia-nervosa-medical-issues/.

1. IvyPanda . "Anorexia Nervosa: Medical Issues." September 27, 2021. https://ivypanda.com/essays/anorexia-nervosa-medical-issues/.

Bibliography

IvyPanda . "Anorexia Nervosa: Medical Issues." September 27, 2021. https://ivypanda.com/essays/anorexia-nervosa-medical-issues/.

Header menu - Mobile | United Kingdom

Header menu - drawer | united kingdom, james' story: my experience with anorexia and eating disorders.

This content mentions eating disorders, body image or generally discusses weight, which some people may find triggering.

It’s ‘Eating Disorder Awareness Week (EDAW)’ from 27 February 2023, and this year’s focus is on eating disorder awareness in men . Yes, that’s us strong, tough men who hide our feelings. Oh, hang on a minute, that’s not actually true, is it?

It’s a myth that it’s only women and girls who suffer with ‘eating disorders’.

The National Association for Males with Eating Disorders estimates that 25% to 40% of people with eating disorders are men and boys.

The big blocker to getting help is stigma , together with a lack of understanding about the size and presentation of eating disorders in the male population can mean that eating disorders are not identified or treated early enough.

Of course, it is possible that men and boys are particularly resistant to early intervention. One of the main reasons for this could be a reduced likelihood of family, friends or medical professionals suspecting an eating disorder as early as they would in a female with the same symptoms.

So, this is my story about how I fell victim to the deadly disease ‘ Anorexia Nervosa ’. Thankfully and luckily, I live to tell the tale and turn my wounds into wisdom. I hope that this will help people who are affected to understand the importance of getting help, no matter what type of eating disorder they may have.

Malnourished to Manpower!

For two years in my early twenties I lived with anorexia but convinced myself that I was fine. Only when my weight dropped, did I finally agree to get the help that I needed. I now raise awareness of the illness to help others.

I was a relatively chubby child, and, as I’m sure you know, kids can be mean. I was bullied at school for the way I looked and, at one point, was even given the nickname ‘Bacon Boy.’

But looking back, it didn’t make me desperately unhappy. Not at the time. It wasn’t like those unkind words made me want to change myself or fit in or triggered an eating disorder. Although, I suppose, in some way, that’s what did happen. It just crept up, surprising me years later when I was 22.

After leaving school, I was happy. I was living at home in Milton Keynes, I studied horticulture and then ended up working for a local company. Everything felt pretty stable. As I got older, I did want to look good and feel better in my skin, so I signed up to the local gym and found that I actually really enjoyed it.

I fell into a good routine; making my own lunch in the morning, going to work and then the gym after that. I lost weight, felt good, and my life as an 18-year-old seemed very normal. Until I got offered a secondment in London which meant being away from home and the familiarity of that entire routine. That’s when things began to change and over those few months away from home, I got used to the feeling of being empty and hungry, and what’s more, I liked it.

What also happened, as I began eating all of my meals alone and doing nothing but work and going to the gym, I began to isolate myself from other people.

I didn’t feel comfortable being around anyone else, having people watch what I was (or wasn’t) eating, so I cut myself off. My work colleagues didn’t really know me, so they didn’t notice much difference, but when I went home after my secondment ended, my family saw that my behaviour had changed.

I kept telling them I was fine. I thought I was. I just wanted to be left alone, and the more they told me to eat, the less I wanted to. But I guess that deep, deep down, I knew things weren’t fine. I remember at the same time thinking that I just wanted to fade away, to not exist, to be gone by the time my sister had her baby, six months later.

However, I pushed those thoughts and feelings down and carried on. There were moments during those months, before my diagnosis, where I was feeling a lot of tension. When you’re malnourished, it plays havoc with your emotions.

I was angry, snappy and volatile. My parents didn’t understand what was happening to me or how to help, how could they when I didn’t know what was happening myself?

When I finally spoke to a GP , they told me that I was severely underweight. You might think that at this point, things would start to look up. But for me, this is where my mental health actually hit rock bottom.

The first thing that happened was that I was signed off work for eight weeks and had to declare my licence to the DVLA as I was considered a risk on the roads. It felt like I was being punished. In fact, worse, it felt like people had taken away my control and were trying to control me.

I was told that I was entitled to 30 weeks of Cognitive Behavioural Therapy . Something that I really didn’t want. It’s hard to explain, but with anorexia you can only start to accept help and get better when you hold your hands up and say, “I need help”. But I still couldn’t do that. I was in complete denial.

My aim then was just to be healthy and for it all to be over - to be left alone. So, I went from being extremely anorexic to binge eating .

I now show myself compassion, and I can give myself a ‘talking to’ when I have thoughts that might not be healthy. Of course, I’ve had setbacks, but over the last eight years I’ve really managed to get myself back on track.

I’m still very aware of what I eat. There’s no doubt about that, but I don’t restrict myself anymore. And on the days that I do indulge, it doesn’t hurt as much as it used to. They helped me see things differently, admit that I ‘did’ need help and recognise that I never want to be back in that painful place again.

People started saying that I looked good and how much ‘healthier’ I must be now that I was gaining weight. What they couldn’t see was the way I was crumbling inside. Even though it’s hard to explain or pinpoint when, why or how the therapy started to help. It just did.

I think when you start to feed yourself physically with food, and mentally with therapy, you get a better perspective and understanding. I learned to recognise the voice in my head - the one telling me that my weight needed to be as low as possible for me to be happy - and change it.

When the therapy ended, the hard work on myself really began, but the treatment had given me the tools to do that, and what’s more, I wanted to.

It’s why I’m now extremely passionate about raising awareness of male eating disorders and talking about how to recognise it in friends and colleagues - and in yourself. Luckily, Cognitive Behavioural Therapy (CBT) helped me, and I’ve turned things around. But I’m very aware that so many people are convincing their friends, family - and themselves - that they’re fine. I hope that by talking about my experience, it will help them.

Things are changing for the better!

Eating disorders continue to have the highest mortality rates of ALL mental illnesses. Yes, all mental illnesses - shocking, I know. There has been much improved training for healthcare professionals over the past year. But we need to see more accurate awareness of the early signs, symptoms and risks of eating disorders, and we need to see more prioritisation of early detection and treatment, especially in men and boys and before medical treatment become necessary.

As someone with lived experience, I strongly believe any related deaths are preventable if people get the right care early enough. Recovery from eating disorders is possible, but getting the right treatment early is key for the sufferer and the increasing strain on our health care system. Eating disorders are a severe mental illness and shouldn’t be underestimated.

And if you could take anything away from my story, it would be the following: “All the advice in the world won’t help, until you are willing to help yourself”. You can and will get better!

If you feel affected by the content you have read, please see our get help page for support.

Related content

A-z topic: eating disorders, a-z topic: anorexia nervosa.

Read stories about people like you

Read the stories you've shared about your lived experiences of mental health.

Help us to help you

Our Personal Experience Network (OPEN) is a diverse community whose personal experiences and stories guide everything we do, helping us to help you.

Make a donation

Was this content useful.

Reframing Anorexia Nervosa: A Phenomenological Exploration of the Self-Other Relationship with Husserl’s Intersubjective Theory

• Article contents
• Figures & tables
• Supplementary Data
• Peer Review
• Get Permissions
• Cite Icon Cite
• Search Site

Junguo Zhang; Reframing Anorexia Nervosa: A Phenomenological Exploration of the Self-Other Relationship with Husserl’s Intersubjective Theory. Psychopathology 3 June 2024; 57 (3): 229–235. https://doi.org/10.1159/000533989

Download citation file:

• Ris (Zotero)
• Reference Manager

This paper explores the overlooked contributions of Husserl’s Phenomenology of intersubjectivity in understanding anorexia nervosa. It highlights the intricate relationship between the self and others, emphasizing their mutual constitution while acknowledging inherent differences. The distorted body image approach often overlooks this perspective, leading to psychopathological issues in individuals with anorexia nervosa. By integrating subjective experience and external observation, a more balanced and equal intersubjective relationship can be established. Utilizing this philosophical framework allows for a deeper understanding of the disorder’s dynamics and sheds new light on the subjective experiences of individuals with anorexia nervosa in relation to others.

Individual Login

Institutional login.

• Access via Shibboleth and OpenAthens
• Access via username and password

Digital Version

Email alerts, citing articles via, suggested reading.

• Online ISSN 1423-033X
• Print ISSN 0254-4962

INFORMATION

• Contact & Support
• Information & Downloads
• Rights & Permissions
• Terms & Conditions
• Catalogue & Pricing
• Policies & Information
• People & Organization
• Stay Up-to-Date
• Regional Offices
• Community Voice

SERVICES FOR

• Researchers
• Healthcare Professionals
• Patients & Supporters
• Health Sciences Industry
• Medical Societies
• Agents & Booksellers

Karger International

• S. Karger AG
• P.O Box, CH-4009 Basel (Switzerland)
• Allschwilerstrasse 10, CH-4055 Basel
• Tel: +41 61 306 11 11
• Fax: +41 61 306 12 34
• Contact: Front Office
• Experience Blog
• Privacy Policy
• Terms of Use

This Feature Is Available To Subscribers Only

Sign In or Create an Account

Essay on Anorexia Nervosa

Adolescence is a physically and mentally challenging phase of development that can result in negative body image and body-related dissatisfaction. The adolescence period is characterized by the appearance of secondary sexual characteristics due to increased body hormones leading to body dissatisfaction. The body changes are associated with feelings of decreased social acceptance and a false feeling of insufficiency that can be the starting point for psychological problems (Magrini et al., 2022). The psychological disorder that happens in the context of poor body image following increased body weight is anorexia nervosa. The majority of people take their ability to eat for granted. However, anorexia is a serious psychological disease among young people’s most common chronic illnesses and is usually related to significant personal, familial, and social consequences. Compared to other significant adolescent illnesses like asthma, type I diabetes, and any other mental disease, the mortality of anorexia nervosa is higher.

Causes of Anorexia Nervosa

The relevance of anorexia nervosa to psychology is that its pathogenesis has been based on the cognitive behavioral model. The cognitive-behavioral model focuses on maintaining factors such as judging self-worth based on weight and shape, the need to control eating, and dietary restraint (Jansingh et al., 2020). The first symptoms associated with anorexia nervosa include high body dissatisfaction and a distorted body image. The basis of causes of anorexia nervosa is based on deficits of the self. Deficits in an individual form the foundation of this condition’s psychopathology. For people with anorexia nervosa, their ability to integrate cognitive, conative, and affective functions experiences a challenge. They function with a false self that makes them unable to discriminate between their own and other peoples’ expectations.

The first psychological development during childhood that relates to anorexia nervosa is associated with self-identification during childhood. Among children who have been found to have anorexia nervosa, most of them have been found to have particular conflation with body esteem and self-esteem (Gizzi et al., 2022). They tend to use their bodies as a proxy for building a self-concept about themselves due to a deficit in self- definition during development. Negative self-shames and a negative body image can be understood psychologically as an expression of internalized self–aspects that may be set for the development of anorexia nervosa. Deficits in development caused by problems with body self-definition represent a core factor in the development of anorexia nervosa during childhood.

During early development, the ability to develop psychological attachment is highly dependent on early attachament bonds with primary caregivers’. This attachment to caregivers continues to be an important aspect even during adolescence. Attachment to caregivers plays the role of encouraging individuals to look for protection, intimacy, and dependence (Achermann et al., 2022). During early adolescence and late childhood, however, peer relationships gradually begin to take a more central role in the developing of self-esteem and self-concept.

Adolescence is associated with increased sensitivity to social approval and a heightened need to integrate new thoughts, behaviors, and experiences in relation to self (Gilsbach et al., 2022). Adolescence is a period that is also associated with body changes that are related to structural changes associated with the maturation of sex hormones. The change in adolescence comes with an increased need to seek approval from other people in accordance with looks. As a result, a cohesive attachment that comes with this stage promotes the active mastery and exploration of the environment. Failure for one to be socially appreciated during adolescence produces a specific vulnerability to eating habits. Most individuals, during this stage, are thus more likely to starve themselves in search of weight loss or as a way of seeking approval.

How to Get Help and Who Gets Anorexia Nervosa

Anorexia nervosa applies psychological interventions such as Maudsley’s anorexia nervosa treatment for adults (MANTRA) in treatment (Jansingh et al., 2020). MANTRA is an evidence-based cognitive, interpersonal approach that incorporates neuropsychological and personality traits in treating anorexia nervosa. It includes interpersonal and intra maintain factors in proposing treatment strategies for anorexia nervosa. Therapists and patients work together to describe the perpetuating aspects in anorexia nervosa. The patient is given an active role in their plan of management where they describe their goals in a personal workbook structure. The patients then meet with the psychologist once a week for about fifty minutes to discuss the progress in management. The psychologist together with the patient pays attention to weight gain and working towards achieving normal eating patterns. Attention is specifically paid to motivating patients towards change and maintaining of eating habits that are important to the patient.

Psychology through cognitive behavior therapy is also applied in managing patients with anorexia nervosa. The goal of cognitive behavior therapy is to use psychology in identifying the processes that operate in a given patient and use them to make a treatment plan that fits the specific patient (Stojilikovic-Drobnjak et al., 2022). It is based on the principle of “people learn by doing,” and thus, it focuses on only a few aspects in changing behavior by concentrating on changing the most perpetuating behaviors.

Psychologists apply strategies such as dietary rules, dietary restrain and changes in eating patterns that are coherent with the patient’s mood. Specialist supportive clinics have also been applied psychologists to manage anorexia nervosa. It combines supportive psychotherapy and clinical management in creating sessions that seek to normalize eating habits and restore normal weight. Specialist psycho-education focuses on other symptoms that are associated with anorexia nervosa, such as over exercising and vomiting. Special attention is given to offering patients with psycho education about food and eating disorders. The psychologist seeks to identify the cause of the eating disorder from the patient and their motivation to change such behavior.

Can One Beat Anorexia Nervosa?

The relevance of anorexia nervosa to nursing is that nurses have a role in establishing trusting relationships and emotional alliances with patients. These relationships between patients and nurses are essential to help accomplish changes that direct patients towards recovery. Often, nurses are usually the first point of entry to care for most patients, including those with eating disorders. As the first point of care, nurses carry the important responsibility of identifying patients with anorexia nervosa and help them establish the foundation for recovery, especially for those patients who do not realize they have a problem by themselves (Gizzi et al., 2022). Nurses should possess the skill of identifying patients with eating disorders by being able to break down myths associated with eating disorders. Even after identifying patients with eating disorders, most of them are not convinced that they need any form of treatment or they are ashamed to seek help from health care professionals.

Given that nurses are familiar with psychological, clinical and behavioral symptoms, they can better recruit newly diagnosed patients into treatment. This knowledge can also help nurses to work closely with physicians during mental and physical assessments of patients. Nurses have the responsibility of addressing the motivations that are expressed by patients at the early stages of treatment to help maintain positive attitudes towards change. Nurses ensure that during the management of patients with anorexia nervosa they gather knowledge that seeks to identify the factors that promote relationships that promote patients health. These relationships promote patients health by reducing the length of care and increase treatment results, reduce suffering during care and reduce the length of care (Magrini et al., 2022). Nurses hold the best position among health care workers in which they can impact the quality of care given to patients with anorexia nervosa, given their ability to manage complex relationships with their patients.

The nursing role in managing patients with anorexia nervosa is to have knowledge that will enable them to monitor the patients’ food intake. Nurses should be able to remember that most patients with anorexia nervosa may also be receiving treatment for other psychological conditions and thus the management they institute should consider all the other disorders. Nurses ensure that they observe patients nutritional status and ensure they maintain adequate nutrition with electrolyte balance (Achermann et al., 2022). They also play the role of supervision of patients after every meal to prevent the common practice of vomiting after eating. They help patients set realistic goals for time limits for every meal time and ensure patients are in a relaxed environment that that helps reduce anxiety and stress. Nurses also act as educators to patients and their relatives about the disorder. They encourage the patient’s family to participate in providing care and support to the patient.

Nurses ensure equality and participation between psychologists and patients in ensuring that everyone is involved in patient management. Equality and participation relationships are important as they ensure that patients are free to express their feelings as well as the health care providers are able to express their expectations from the patients (Stojiljkovic-Drobnjak et al., 2021). Lack of patient involvement especially in anorexia nervosa works to hamper recovery or even worsen the illness given the false self believe among most patients. Nurses are mandated to show commitment in their work to ensure that their patients feel the meaning of care given to them. Patients with anorexia nervosa have a lot of psychological issues within them and failure to show commitment in managing them creates a sense of us versus them. Commitment can be achieved through patient centered conversations that seek to take the patient through the entire health process.

Anorexia nervosa is an eating disorder that affects many people across the globe, most of who have not been diagnosed. For those patients who have been diagnosed, recovery is an extremely complex process that requires the cooperation of multiple stake holders. In order to achieve long standing recovery for patients with anorexia nervosa, psychological, physical and social well- being of the patient must all be put into consideration.

Achermann, M., Günther, J., Goth, K., Schmeck, K., Munsch, S., & Wöckel, L. (2022). Body-Related Attitudes, Personality, and Identity in Female Adolescents with Anorexia Nervosa or Other Mental Disorders.  International Journal of Environmental Research and Public Health ,  19 (7), 4316. 10.3390/ijerph19074316

Gilsbach, S., Plana, M. T., Castro-Fornieles, J., Gatta, M., Karlsson, G. P., Flamarique, I., … & Herpertz-Dahlmann, B. (2022). Increase in admission rates and symptom severity of childhood and adolescent anorexia nervosa in Europe during the COVID-19 pandemic: data from specialized eating disorder units in different European countries.  Child and Adolescent Psychiatry and Mental Health ,  16 (1), 1-7. https://doi.org/10.1186/s13034-022-00482-x

Gizzi, G., Cataldi, S., Mazzeschi, C., Delvecchio, E., Ceccarini, M. R., Codini, M., & Albi, E. (2022). Hypercholesterolemia in Cancer and in Anorexia Nervosa: A Hypothesis for a Crosstalk.  International Journal of Molecular Sciences ,  23 (13), 7466. 10.3390/ijms23137466

Magrini, M., Curzio, O., Tampucci, M., Donzelli, G., Cori, L., Imiotti, M. C., … & Moroni, D. (2022). Anorexia Nervosa, Body Image Perception and Virtual Reality Therapeutic Applications: State of the Art and Operational Proposal.  International Journal of Environmental Research and Public Health ,  19 (5), 2533. 10.3390/ijerph19052533

Jansingh, A., Danner, U. N., Hoek, H. W., & van Elburg, A. A. (2020). Developments in the psychological treatment of anorexia nervosa and their implications for daily practice.  Current Opinion in Psychiatry ,  33 (6), 534.  10.1097/YCO.0000000000000642

Stojiljkovic-Drobnjak, S., Fischer, S., Arnold, M., Langhans, W., Kuebler, U., & Ehlert, U. (2021). Dysfunctional eating behaviour and leptin in middle-aged women: role of menopause and a history of anorexia nervosa.  International Journal of Behavioral Medicine ,  28 (5), 641-646. 10.1007/s12529-021-09958-0

Cite This Work

To export a reference to this article please select a referencing style below:

Related Essays

Essay on vibration testing, energy sector cybersecurity challenges: using edge computing to improve security in virtual power plants, my policy brief on pock harm reduction in canada, medically assisted death in the context of mental health challenges, gi and gi measurements and their influence on cardio-metabolic risk, blood sugar level, popular essay topics.

• American Dream
• Artificial Intelligence
• Black Lives Matter
• Bullying Essay
• Career Goals Essay
• Causes of the Civil War
• Child Abusing
• Civil Rights Movement
• Community Service
• Cultural Identity
• Cyber Bullying
• Death Penalty
• Depression Essay
• Domestic Violence
• Freedom of Speech
• Global Warming
• Gun Control
• Human Trafficking
• I Believe Essay
• Immigration
• Importance of Education
• Israel and Palestine Conflict
• Leadership Essay
• Legalizing Marijuanas
• Mental Health
• National Honor Society
• Police Brutality
• Pollution Essay
• Racism Essay
• Romeo and Juliet
• Same Sex Marriages
• Social Media
• The Great Gatsby
• The Yellow Wallpaper
• Time Management
• To Kill a Mockingbird
• Violent Video Games
• What Makes You Unique
• Why I Want to Be a Nurse
• Send us an e-mail

• Share full article

Advertisement

Supported by

Doctor-Assisted Death Is Legal in 10 States. Could New York Be No. 11?

Activists have renewed attention on legislation related to the emotional issue of so-called medical aid in dying that has long languished in Albany.

By Erin Nolan and Grace Ashford

Reporting from the State Capitol in Albany, N.Y.

The sounds of protest came forcefully from the Assembly chamber gallery, the chants echoing the words emblazoned on handmade banners that were held aloft: “Stop the suffering, pass the bill!”

But as New York State troopers began to remove some of the protesters — some holding canes, others slowed by the effects of cancer treatment — it was clear that this demonstration held personal and immediate resonance to those participating.

The protest was the latest in an increasingly desperate series of demonstrations aimed at persuading state legislators to pass a bill that would legalize so-called medical aid in dying , allowing terminally ill people access to life-ending medication for the first time in the state.

New York is one of 19 states where lawmakers are considering bills that would legalize medical aid in dying, a practice that is legal in 10 states and Washington, D.C.

The bill in New York would allow mentally competent, terminally ill adults with no more than six months to live to request prescriptions from their doctors for life-ending medication. The patients would have to be able to ingest the medication on their own, and only the person seeking to die could request the prescription.

“I’m not someone who enjoys conflict or who has much experience in civil disobedience,” said Jules Netherland, a protester who was detained in the Capitol. “But I really believed this was the only way to get people’s attention.”

Roughly a decade has passed since the first medical aid in dying bill was introduced in Albany, and it has yet to reach the floor for a vote.

But the proposal has gained momentum this year, because of endorsements from groups like the Medical Society of the State of New York, a trade group of roughly 20,000 doctors, and the efforts of activists like Dr. Netherland, who has a Ph.D. in medical sociology and was diagnosed with Stage 4 breast cancer last year.

Opponents worry that some patients might choose to end their lives based on an inaccurate prognosis or after being pressured to do so. And while the current bill is restricted to terminally ill people, they worry that lawmakers could expand eligibility for medical aid in dying after any initial legislation is passed.

“Even if there is just one case of abuse or coercion, or even if there is just one mistake, that is a dead person,” said Colleen Barry, a nurse and board member of Euthanasia Prevention Coalition USA.

With roughly a week left in the 2024 legislative session, the bill faces an uphill climb in the Legislature, which Democrats control, especially without the official support of Gov. Kathy Hochul or the leaders of the Assembly and Senate.

Still, Assemblywoman Amy Paulin, the chairwoman of the body’s Health Committee, said that it had gradually garnered support since she first sponsored it in 2016.

“It’s an emotional vote,” not unlike those on abortion or marriage equality, said Ms. Paulin, who represents parts of Westchester County and is motivated by the memory of her sister, who could not get such aid when she was dying of ovarian cancer. “A lot of my colleagues have come to me with stories that drove them to change their minds. It’s about life, and it’s about choice. More members are feeling that and living that and understanding that.”

But it is precisely the emotional gravity of the issue that has some in leadership hesitating, according to numerous lawmakers.

“I just think that, as a culture, in terms of the country, there has not been a lot of conversation about dying,” the State Senate majority leader, Andrea Stewart-Cousins, said of the proposal earlier this year, adding that she was not opposed to having that conversation.

Opponents, including the Center for Disability Rights and the New York State Catholic Conference , warn that even this narrow application of aid in dying will invariably lead to broader use. They point to places, mostly outside the United States, where the practice is available not only to patients struggling with terminal physical illnesses, but also to those with mental illnesses as well.

The vast majority of people who have availed themselves of such laws in the United States were facing terminal physical illnesses — most commonly cancer. But rare exceptions, like a 36-year-old Colorado woman who was prescribed life-ending medication after a diagnosis of “terminal anorexia nervosa,” have sparked controversy and raised questions about suffering, autonomy and the role and responsibilities of physicians.

The American Medical Association is formally opposed to physician-assisted suicide, which it describes as “ ​​fundamentally incompatible with the physician’s role as healer. ” For many years, the Medical Society of the State of New York agreed.

But recent conversations around the legislation — which not only restricts the practice to terminally ill people but also allows individual providers to opt out based on their own convictions — caused the group to reverse course and endorse the measure .

Supporters of the practice say that legalizing medical aid in dying would help untold numbers of people avoid suffering and die peacefully. They point to polls like one commissioned earlier this year by YouGov that found 72 percent of New Yorkers supported “death with dignity.”

Between 1994, when Oregon became the first state to legalize the practice, and 2020, 8,451 people received prescriptions under medical aid in dying laws. Of those, 5,329 took the life-ending medication, according to a 2022 study published in the Journal of the American Geriatrics Society .

Barbara Thomas, 87, fought tears as she tried to imagine a reality where that would have been an option for her husband, Bob Thomas, who died 15 months after he was diagnosed with glioblastoma multiforme — a type of terminal brain cancer — in the fall of 2010.

“I think it would have been much more loving. We could have all gathered,” she said, pausing to blink back tears. “He would have, I’m sure, preferred to be able to have everyone around so he could speak to them all, give them his wishes for their lives and hear them say what they liked about him.”

Instead, Mr. Thomas, a proud outdoorsman who enjoyed fly fishing, hunting, camping and hiking, spent most of his final months in his bed at home in West Milton, N.Y., tired and frail, Ms. Thomas said.

“Sometimes we would just lay in the bed and cry about what an impossible situation we were in,” she recalled.

Twice, Mr. Thomas asked his wife to bring him his gun and help him kill himself, Ms. Thomas said. She never did it, but it pained her to see how miserable he was and to know there was nothing she could do to alleviate his suffering.

“He was the person I had lived with longer than any other person — longer than my parents, longer than any of my children,” Ms. Thomas said, adding that they had been married for 55 years. “We were still in love.”

To her, allowing people like her husband to choose when and how they die is “the compassionate, loving thing to do.”

Erin Nolan is a reporter covering New York City and the metropolitan region. She is a member of the 2023-24 Times Fellowship class. Email her at [email protected] . More about Erin Nolan

Grace Ashford covers New York government and politics for The Times. More about Grace Ashford

Politics in the New York Region

Doctor-Assisted Death: Legislation related to the emotional issue of so-called medical aid in dying has long languished in Albany. But a new push to legalize the practice has gained momentum .

Plastic Waste: As plastic continues to fill landfills and oceans, New York lawmakers are considering a proposal to limit single-use plastic products. Here’s what to know about the legislation .

A Quiet Suspension: A little-known New York State fund that paid the medical expenses of children who suffered neurological injuries as a result of medical malpractice during childbirth has been suspended .

Limiting Donations to Israel: Representative Alexandria Ocasio-Cortez, who rarely wades into state politics, publicly backed a bill  that could strip New York nonprofits of their tax-exempt status if their funds are used to support Israel’s military or settlements.

Transgender Student-Athlete Rules: A parent group in New York City asked for a review of rules that let students play on sports teams that align with their gender identity. Democratic officials responded angrily .