What anorexia is
Anorexia nervosa is an eating disorder characterized by the deliberate restriction of food intake, an intense fear of gaining weight and a distorted perception of one's own body image. Those affected develop a rigid control over their weight, even when it drops to a level so low that it becomes dangerous for their health. The disorder can have serious consequences for physical and mental health and is associated with an increased risk of medical complications and death.
Historically, anorexia was first described in the 17th century, but it was only in the 1970s that it was officially recognized as a distinct medical diagnosis. Today, in the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders), the diagnostic criteria include: restriction of food intake leading to a significantly low body weight, an intense fear of gaining weight or persistent behaviours that prevent weight gain, and a disturbance in the way the person perceives their weight or body shape.
Types of anorexia nervosa (according to the DSM-5):
Anorexia nervosa, restricting type
This type is characterized by severe restriction of food intake without recurrent episodes of binge eating or purging behaviours (self-induced vomiting, laxative abuse). The person limits the amount of food they eat, often counting calories obsessively, skipping meals and avoiding foods considered “dangerous” for their figure. It is the most common form and often develops gradually.
Anorexia nervosa, binge-eating/purging type
In this type, alongside the restriction of calorie intake, there are episodes in which the person eats a large amount of food in a short time, followed by compensatory behaviours such as self-induced vomiting, excessive use of laxatives or diuretics, or intense physical exercise. In the way it presents, this type comes close to bulimia nervosa, but it is diagnosed as anorexia when the weight remains significantly low.
Causes and risk factors for anorexia
1. Genetic and hereditary factors
Research suggests that anorexia may have an important genetic component. People who have first-degree relatives with eating disorders are at a significantly higher risk of developing this condition. Genes can influence not only the tendency towards a certain body build, but also traits such as perfectionism, anxiety or impulsivity, which contribute to triggering and maintaining anorexia.
2. Psychological factors
Certain personality traits increase the risk of anorexia: excessive perfectionism, the need for control, low self-esteem , anxiety and cognitive rigidity. People with these traits can develop a dysfunctional relationship with food, using dietary restriction as a way of regaining control over their lives or of obtaining external validation.
3. Social and cultural pressure
In societies where beauty standards promote very thin figures, the risk of anorexia is higher. The media, social networks and the fashion or entertainment industries can amplify the obsession with the idealized body, leading adolescents and young people in particular to adopt extreme restrictive behaviours in order to conform to these standards.
4. Biological and neurochemical factors
Imbalances in the neurotransmitters involved in regulating appetite, mood and reward (such as serotoninand dopamine) can contribute to the onset of anorexia. These imbalances can influence the perception of hunger, food-related anxiety and the ability to feel pleasure, all of which favour restricted eating.
5. Stressful or traumatic life events
Emotional trauma, abuse, significant losses and bullying related to weight or physical appearance can trigger eating disorders. In such cases, anorexia can become a way of managing suffering, of regaining a sense of control or of distracting oneself from emotional pain.
6. The influence of the family
The family environment plays a crucial role. Repeated criticism about weight, pressure to be perfect, unresolved conflicts or a lack of emotional support can contribute to the development of anorexia. Parents who are excessively preoccupied with dieting and body image can also indirectly pass the same anxieties on to their children.
7. Demographic factors
Anorexia is more common among women, especially during adolescence and early adulthood, periods in which social pressure about physical appearance is more intense. Nevertheless, cases among men are on the rise, and the risk exists at all ages and in all social settings.
8. The influence of the sporting or artistic environment
People involved in sports that place an emphasis on weight (gymnastics, ballet, figure skating, boxing, wrestling) or in fields such as modelling are exposed to additional pressure to maintain an “ideal” figure. This competitive environment can encourage calorie restriction and unhealthy eating behaviours.
9. Psychiatric comorbidities
Anxiety disorders, depression, obsessive-compulsive disorders and social phobias can all be risk factors. These conditions can favour the onset of anorexia through mechanisms such as social avoidance, rigid control of behaviour or obsessive thoughts about food.
10. Excessive access to contradictory information about nutrition
In the digital age, constant exposure to extreme diets, food trends with no scientific validation and “influencers” who promote dangerous restrictions can create confusion and unhealthy eating behaviours, increasing the risk of developing anorexia.
The symptoms of anorexia
Anorexia nervosa is a complex disorder that affects both the body and the mind. The symptoms are not only physical, but also emotional and behavioural, reflecting the profound impact of this condition on overall health. Identifying these signs early is essential in order to prevent severe complications and to begin the recovery process as effectively as possible.
1. Significant weight loss or the inability to reach a healthy weight
One of the most obvious signs is a marked drop in weight, sometimes down to dangerously low levels. In other cases, the person fails to reach the weight considered normal for their age and height, even if they are not visibly losing kilograms.
2. Extreme restriction of food intake
People with anorexia often follow very restrictive diets, drastically reducing their calorie intake and cutting out foods that are essential for health. This restriction is often accompanied by rigid rules about meal times and about which types of food are allowed.
3. An intense fear of gaining weight
Even when their weight is obviously low or underweight, people with anorexia show a persistent, irrational fear of putting on weight. This fear can lead to completely avoiding certain foods or to obsessive behaviours around weight control.
4. Distorted body image
A central symptom of anorexia is the false perception of one's own body. The person may see themselves as “fat” even when they are very thin, and they judge their personal worth almost exclusively in terms of weight and body shape.
5. Excessive preoccupation with food and weight
Paradoxically, although they eat less, people with anorexia think about food constantly: they read recipes, cook for others, count calories obsessively and weigh themselves frequently. This preoccupation can become the centre of their entire life.
6. Menstrual disturbances (amenorrhoea) or hormonal imbalances
In women, the absence of menstruation for at least three consecutive months is a common sign, while in both men and women there can be a drop in libido, brittle hair and nails or other symptoms of hormonal imbalance.
7. Chronic fatigueand reduced energy
Because of the insufficient intake of nutrients, the body enters an energy-conservation mode, which leads to weakness, dizziness, difficulty concentrating and intolerance to cold.
8. Compensatory behaviours or eating rituals
Some people develop rigid rituals, such as chewing food excessively, cutting it into very small pieces, avoiding meals in the company of others or even making themselves sick after eating.
9. Emotional and psychological changes
Anorexia is often accompanied by anxiety, depression, irritability, social withdrawal and difficulty managing emotions. Perfectionism and excessive self-criticism can make these manifestations worse.
10. Visible physical signs
In addition to weight loss, the following signs can appear: dry skin, hair loss, growth of fine body hair (lanugo), brittle nails, cold hands and feet, a slow heartbeat (bradycardia) and gastrointestinal problems.
Diagnosing anorexia
Diagnosing anorexia nervosa is a complex process that involves both a physical and a psychological assessment of the person. Because anorexia is a multifactorial disorder - affecting the body, the emotions and behaviour - there is no single test that can confirm the diagnosis. Instead, doctors and psychologists use a combination of methods and clinical criteria in order to obtain a complete picture of the patient's condition.
The first step in the diagnosis is usually a general medical consultation, in which the medical history, weight fluctuations, eating habits and any associated health problems are assessed. The doctor may request blood tests, ultrasound scans or other investigations in order to identify the nutritional imbalances and physical complications associated with anorexia, such as anaemia, hormonal disorders or electrolyte imbalances.
In parallel, there is the psychological assessment, an essential element of an accurate diagnosis. The psychologist or psychiatrist looks at the patient's relationship with their own body image, the fear of gaining weight, the presence of restrictive behaviours and their impact on everyday life. Standardized assessment tools and clinical interviews are used in order to determine whether the symptoms match the criteria set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
According to the DSM-5, for a diagnosis of anorexia to be confirmed there must be: (1) persistent restriction of energy intake leading to a significantly low body weight, (2) an intense fear of gaining weight or of becoming obese, even when the person is underweight, and (3) a distorted body image or a denial of the seriousness of the weight loss. The purpose of making the diagnosis is not to label the person, but to open the way towards personalized treatment and appropriate support, because anorexia is a disorder that can be life-threatening if it is not addressed in time.
Treatment options for anorexia
The optimal approach is multidisciplinary and personalized, combining medical, nutritional and psychotherapeutic interventions.
- Medical assessment, monitoring and stabilization
The first step is to establish medical safety: a full history, assessment of weight and nutritional status, blood tests (electrolytes, liver/kidney function, hormone profile), an ECG (risk of arrhythmias), monitoring of vital signs and of the risk of “refeeding syndrome”. When there is instability (severe bradycardia, low blood pressure, electrolyte imbalances, dehydration, suicidal thoughts), admission to hospital or programmes with a more intensive level of care (day-hospital, residential) is indicated.
- Nutritional rehabilitation guided by a dietitian
Eating is normalized gradually, with an individualized plan (a structure of meals and snacks, a step-by-step increase in calorie intake), addressing the “feared foods”, the temporary digestive symptoms and the fear of gaining weight. The goal is to restore a healthy weight, the hunger and satiety signals and a safer relationship with food, within a predictable and supportive framework.
- Individual psychotherapy (the core of treatment)
The evidence-based formats include CBT-E (Cognitive Behavioral Therapy - Enhanced) for eating disorders, schema-focused therapy / supportive psychodynamic therapy (working on perfectionism, self-criticism and control), ACT (acceptance and commitment therapy) for psychological flexibility and DBT (distress tolerance, emotion regulation). The objectives: reducing restriction, restructuring beliefs about the body and weight, graded exposure and increasing self-care behaviours.
- Family and couples therapy
With adolescents in particular, FBT/Maudsley involves the family in supporting eating and in changing maladaptive patterns. With adults, working with the family or the partner helps reduce criticism, increase support and strengthen healthy boundaries, which lowers the risk of relapse.
- Non-invasive interventions: neurofeedback, biofeedback
- Neurofeedback (guided by a neurofunctional assessment): it trains the self-regulation of the networks involved in anxiety, over-control and body image, supporting interoceptive attention and emotional tolerance. It can reduce reactivity to stress, improve sleep and support adherence to the nutritional plan.
- HRV biofeedback and diaphragmatic breathing: they increase heart-brain coherence and reduce the over-excitability of the autonomic nervous system.
- Medication (adjunctive, individualized)
Although it is not the primary treatment for anorexia, medication can help with comorbidities (anxiety, depression, insomnia, obsessions and compulsions) or with complications (bone health, digestive disorders). It is prescribed by a psychiatrist, with careful monitoring (including ECG and blood tests) and adapted to the person's weight and nutritional status. The aim is functional support, not a substitute for psychotherapy and nutritional rehabilitation.
- Management of medical complications
Addressing osteopenia and osteoporosis, amenorrhoea and hypogonadism, gastrointestinal problems (delayed emptying, constipation), cardiovascular damage or anaemia requires multidisciplinary coordination (endocrinology, cardiology, gynaecology, gastroenterology). The interventions aim both at reversing the complications and at long-term prevention.
- Levels of care and a crisis plan
Treatment is adjusted according to severity: outpatient, IOP (intensive outpatient), PHP/day-hospital, residential or inpatient care. A safety plan is drawn up (early warning signs, concrete steps, emergency contacts), with clear criteria for escalation when the person's medical or psychological status deteriorates.
- Trauma-focused interventions (at the right moment)
If there is a history of trauma or abuse, therapies such as EMDR or other trauma-focused interventions can be useful, once medical and nutritional stabilization has been achieved. Timing is essential: working on trauma too early can increase the risk of decompensation.
- Therapy groups and peer support
Skills groups (emotion regulation, food exposure, body image), support groups and carefully moderated communities reduce isolation, offer coping models and increase motivation, consolidating the changes achieved in therapy.
- Return to school or work and occupational therapy
Gradually planning the return to activities, structuring the daily routine, managing energy and expectations and developing interests unrelated to food (hobbies) all support functional recovery and an identity beyond the illness.
- Relapse prevention and long-term follow-up
Identifying personal triggers, early warning signs, a written response plan, regular medical and psychological check-ups and keeping up non-invasive practices (HRV biofeedback, mindfulness, maintenance neurofeedback) consolidate the results and lower the risk of relapse.
The benefits of neurofeedback in the treatment of anorexia
Neurofeedback is a non-invasive, personalized and passive method used to train the brain to regain its balance and to function in a more harmonious way. In anorexia, where mechanisms of excessive control, anxiety and a distorted body image play a central role, neurofeedback offers a complementary way of supporting recovery, without medication and without invasive interventions. Because brain activity is monitored and trained in real time, the patient does not have to make complicated conscious efforts: the process is largely automatic, and repeated training gradually leads to better regulation of the networks involved in the disorder.
A major benefit of neurofeedback in anorexia is the decrease in the compulsion linked to food control and restrictive behaviours. This is achieved by reducing over-activity in the brain areas involved in compulsive behaviour and excessive perfectionism, such as the anterior cingulate cortex and the fronto-striatal circuits. Through regular training, the brain learns to stabilize itself, which translates into better tolerance of exposure to food, a reduced need for rigid eating rituals and greater flexibility in making decisions about nutrition.
What is more, neurofeedback contributes to lowering anxiety and to emotional regulation, two elements that are often disrupted in anorexia. By optimizing the activity of the areas responsible for processing stress and fear (the amygdala, the salience networks), patients can feel a reduction in internal tension, which helps them accept a healthy nutritional plan more easily and cope with the challenges of the rehabilitation process. A greater state of mental calm also means a lower risk of relapse or of episodes of extreme avoidance.
Another beneficial effect is linked to self-esteem and body image. Neurofeedback helps rebalance the neural networks involved in self-evaluation and in processing one's self-image, such as the default mode network and the medial prefrontal cortex, supporting the development of a more realistic and gentler perception of oneself. This change makes it easier to accept progress and to build a healthier relationship with one's own body.
Neurofeedback therefore does not replace the classic interventions (psychotherapy, nutritional rehabilitation, medical support), but actively supports them by reducing the neurological barriers that keep the disorder going: intense anxiety, rigid control, compulsivity and negative self-evaluation. Being a gentle, personalized method with no significant side effects, it can become a valuable pillar of a complex recovery plan for anorexia.
Complications associated with anorexia
In the long run, nutritional imbalances and severe dietary restriction can lead to multiple complications that may be life-threatening. Below we present the main complications associated with anorexia, divided into physiological and psychological ones.
1. Cardiovascular complications
Nutritional restriction and severe weight loss can cause low blood pressure, bradycardia and arrhythmias, increasing the risk of severe cardiac complications. In extreme cases, heart failure or cardiac arrest can occur, the result of a combination of malnutrition and electrolyte imbalances.
2. Gastrointestinal complications
Malnutrition affects digestion and intestinal motility. People with anorexia can experience chronic constipation, bloating, abdominal pain and gastritis, which can impair the absorption of nutrients and worsen their general state of health.
3. Endocrine and metabolic disorders
Anorexia can lead to hormonal disturbances, including amenorrhoea in women, lower thyroid hormone levels and disruption of the adrenal axis. These changes affect the metabolism, body temperature and energy levels, contributing to frailty and to a drop in bone density.
4. Neurological and cognitive complications
Being deprived of essential nutrients affects brain function. Patients can have difficulty concentrating, memory problems, mental fatigue and even peripheral neuropathy, reflecting the impact of malnutrition on the central and peripheral nervous system.
5. Psychological complications
Anorexia is often accompanied by anxiety, depression, social isolation and obsessive-compulsive disorders. These effects not only make the disorder worse, but also reduce the patient's ability to follow an effective treatment plan, maintaining the vicious circle of malnutrition and excessive control.
6. Bone complications
Nutrient deficiency and hormonal disturbances lead to osteopenia and osteoporosis, increasing the long-term risk of fractures and skeletal deformities. This bone fragility can persist even after weight has been restored, requiring additional interventions.
7. Renal and electrolyte complications
Severe dietary restriction and any episodes of vomiting or abuse of diuretics can cause dangerous electrolyte imbalances and damage to kidney function, increasing the risk of acute renal failure.
Preventing anorexia
Preventing anorexia starts with creating a safe, supportive environment for the development of a healthy relationship with food and with the body. It is important that parents, teachers and the community promote balanced eating habits, encourage the expression of emotions and help build self-regulation skills. Education about a realistic body image, open communication about feelings and encouraging moderate, enjoyable physical activity are essential steps in reducing the risk of eating disorders.
Anorexia can be life-threatening, but recovery is possible with an integrated strategy. Non-invasive, personalized interventions such as neurofeedback therapy help regulate compulsions, improve self-esteem, reduce anxiety and support healthy eating behaviour, addressing several aspects of the disorder at the same time. If you would like to find out how neurofeedback can support the prevention or the treatment of anorexia, we invite you to fill in the contact form so that a specialist can call you and give you personalized recommendations.
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