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Anorexia nervosa
Last reviewed: 12.07.2025
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Nervous anorexia (an - denial, orexis - desire, urge to eat) is a pathological eating behavior, expressed by a conscious refusal to eat in order to correct appearance, leading to severe endocrine and somatic disorders.
Anorexia is characterized by a persistent desire to be thin, a morbid fear of being overweight, a refusal to maintain a minimum normal body weight, and, in women, amenorrhea. The diagnosis of anorexia is based on clinical findings. Treatment consists of cognitive behavioral therapy; olanzapine may help with weight gain, and SSRIs, especially fluoxetine, may help prevent relapses.
Severe anorexia is uncommon, affecting less than 0.5% of the general population. On the other hand, most mild forms are usually undiagnosed. About 95% of patients with anorexia nervosa are women. Anorexia usually begins in adolescence.
Anorexia is most common in northern European countries. According to generalized statistics given in 1985, it was 4.06 cases per 100,000 population. However, this figure is significantly higher among young girls. It is up to 1% among girls aged 16-18. The age group of 15-19 accounts for 13%, 30-34 years - 14.1%, and 20-24 years and 25-29 years - 45 and 68.2%, respectively. It should be noted that anorexia is found mainly among females, students of ballet schools, and also among students of higher educational institutions.
The history of nervous anorexia is to some extent connected with the cult of fasting and ascetic education in the early Middle Ages. In the 16th-19th centuries, many people were fond of fasting and led an ascetic lifestyle. R. Morton (1697) was the first to describe the case of an 18-year-old girl who first had a depressed mood, then lost her appetite, then began to vomit, stopped taking care of herself, which led to her extreme exhaustion and death.
In 1914-1916, Simmonds studied cases of cachexia in which there was atrophy of the anterior pituitary gland. Anorexia began to be associated with endocrine disorders and was interpreted as "pituitary emaciation", "Simmonds' disease in miniature". However, clinical studies, as well as the absence of morphological changes in the adenohypophysis during pathological examination, made it possible to subsequently abandon the idea of nervous anorexia as a variant of Simmonds' disease.
After the 1930s, a new stage in the understanding of this disease began. The German term "magersucht", introduced at this time, reflects the essence of nervous anorexia as a passion for exhaustion.
The most significant growth of research on the problem of the disease was noted in the 1960-1980s. They showed changes in its nature. Firstly, the frequency of the disease increased, especially in men. Secondly, there was an increase in cases of bulimic nervous anorexia. And early works mentioned artificially induced vomiting and taking laxatives for nervous anorexia. Beginning in the 1970s, patients began to use these means more often after overeating. Such episodes were called "binge" - a syndrome of food "binge", "intoxication", "overeating". Since 1979, the term "nervous bulimia" began to spread. However, the legitimacy of its existence along with the term "nervous anorexia" is not completely clear.
Anorexia is a borderline mental disorder. Nervous anorexia is distinguished as an independent borderline mental disorder, in which most patients have a hereditary burden in the form of various personality anomalies and character accentuations in their parents.
Separately, prepubertal anorexia and atypical form of nervous anorexia, which is formed in the structure of an already existing hysterical neurosis, are distinguished. A syndrome of nervous anorexia within the framework of schizophrenia is also distinguished.
[ What causes anorexia nervosa?
What causes anorexia is still unknown. In addition to the gender factor (women), a number of other risk factors have been identified. In Western society, obesity is considered unattractive and unhealthy, so the desire to be slim is widespread even among children. More than 50% of prepubertal girls use diets or other methods of weight control.
What are the symptoms of anorexia?
Anorexia may be mild and transient or long-term and severe. Most patients are thin when they develop weight preoccupation and restrict food intake. Anxiety and worry about weight increase even as emaciation develops.
Anorexia is a misnomer, as appetite persists even when the patient has reached the level of cachexia. Patients are preoccupied with food: studying diets and counting calories, hoarding, hiding and throwing away food, collecting recipes, painstakingly preparing food for others.
What's bothering you?
How is anorexia recognized?
Denial is the main symptom of a disease such as anorexia, patients resist examination and treatment. They usually come to the doctor at the insistence of relatives or because of concomitant diseases. Anorexia, as a rule, manifests itself with noticeable characteristic symptoms and signs, first of all, a loss of 15% or more of body weight in a young girl experiencing a fear of obesity, with amenorrhea, denial of the disease, and otherwise looking well. Fat deposits on the body are practically absent.
How to examine?
How is anorexia treated?
If anorexia is left untreated, the mortality rate from the disease is about 10%, although undiagnosed mild disease rarely leads to death. With treatment, half of the patients regain all or almost all of the lost weight, and their endocrine and other functions are restored. About 1/2 of the patients have a satisfactory treatment result, and relapses may occur.
The remaining 1/2 of patients who have anorexia have unsatisfactory treatment results, exacerbations are observed, and mental and somatic complications persist.
What is the prognosis for anorexia?
The prognosis remains unsatisfactory. Data on the fluctuation of the number of fatal outcomes from 2-3% to 16-20% are cited in publications for 1970-1971. Among the causes of fatal outcomes are infections, sepsis, intestinal necrosis, and complications of therapy.
According to data from three British hospitals, over a period of 4 to 8-10 years (on average 5-6 years) among those examined, nervous anorexia or bulimia persisted in 56, 50, 38% of patients, respectively. Recovery occurred mainly between the 6th and 12th year after the onset of the disease.