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Understanding anorexia nervosa

By Dr Pooky Knightsmith


Anorexia is the most well-known eating disorder, with a high profile in the media. Anorexia sufferers believe they are grossly overweight, even if they’re dangerously thin. It is the most dangerous of all the eating disorders, with 10% of cases being fatal, either due to suicide or complications caused by low weight, like organ failure or heart attack. But anorexia is treatable and people do recover fully. In the UK, 1.6 million people are affected but it is actually the rarest eating disorder: only 10% of people with eating disorders have Anorexia Nervosa. Bulimia is the most prevalent eating disorder.


  • Weight loss A key indicator of anorexia is weight loss, either suddenly or steadily over time. The sufferer will be keenly aware of the minimum weight for their height and will make a determined effort to lose as much weight as possible to keep below that weight, either by a very restrictive diet or heavy exercising and often both.
  • Think they’re fat Even if they appear emaciated, many people with anorexia have a distorted view of their body and see themselves as fat or even obese. This drives weight loss, even when they’re already very thin.
  • Fear of eating and weight gain They will be terrified of gaining weight even if they understand their weight is abnormally low and is putting them in medical danger. This fear of eating can induce physical symptoms such as nausea and panic attacks, making it very difficult for anorexia sufferers to eat, even if they want to.
  • Self-evaluation based on weight They see thinness as good and being fat as bad and, although they’re often very slim, they think they’re overweight and so have very low self-esteem.
  • They weigh themselves often Their mood is directly affected by the numbers on the scales. Weight gain leads to low mood and anxiety and can often lead to other issues such as self-harm and substance abuse. Weight loss can make them feel happier but can also drive them to lose even more weight. They believe that everyone else judges them based on their weight. In some cases, when their emaciated frame attracts attention on the street, they believe this is due to being overweight, not because they’re severely underweight.
  • Loss of periods in female sufferers (amenorrhea). With extreme weight loss, periods become very irregular or stop altogether, which is very serious.
  • Calorie counting Anorexics will have an extensive knowledge of calorie content and nutritional breakdown of many different foods and will obsessively count calories over the course of a day and try to stick to an allotted (and usually very low) amount.
  • Hyperactivity They keep themselves constantly busy, fidget or exercise obsessively to make sure they are continually burning as many calories as possible. 

Warning signs

None of these warning signs on their own mean that someone is definitely developing anorexia. But, if they’re exhibiting several of these signs, you’re right to be concerned.

  • Restricted eating Eating very little or avoiding entire food groups, for example adopting a vegan or vegetarian diet.
  • Busy at lunch time in order to skip lunch.
  • Strange behaviour around food Anorexia sufferers often have complex rules about what they can/ can’t eat and how they do it (e.g. cutting all food into tiny pieces).  They may also show signs of panic or distress around food.
  • Wearing baggy clothes They often hide their wasting frame underneath oversized clothing, either because they feel ugly and fat or because they want to cover up their weight loss so no-one questions it.
  • Wrapping up warm As weight loss increases, they will constantly feel cold and will wear many layers to keep warm, even during mild weather.
  • Loss of friends As the disease takes grip, it’s difficult for the sufferer to focus on anything other than their internal battle with food. As such they tend to neglect their friendships and become isolated. This also decreases the chance of having to eat in a social situation, one of their biggest fears.
  • Wildly inaccurate views of their body and weight.
  • Avoiding PE or swimming because they’re ashamed of their body or are trying to hide the extent of their weight loss Conversely, some young people will over-exercise, taking every opportunity to burn extra calories both in and beyond scheduled sports lessons. 

If you're worried that your child might have anorexia nervosa, it's important to seek further help straight away by booking an appointment with your GP. First, though, it's a good idea to talk to them about it. To help you take these first steps, take a look at our articles on talking to your child about an eating disorder and seeking professional treatment

Further resources


Beat are the UK’s leading charity supporting anyone affected by eating disorders or difficulties with food, weight and shape. They provide a range of services and resources that can help and support you and your child:

·         Have a look at their Message Boards

·         Access support groups either in your local area or online

·         Contact their Helpline Services - call 0845 634 1414 or contact Beat on

·         Use HelpFinder, Beat’s online directory to search for services near you.

Anorexia Bulimia Care

Dr. Pooky Knightsmith’s free resources for schools and professionals