Anorexia
An eating disorder with the highest mortality rate of any psychiatric diagnosis.
Anorexia nervosa, often shortened to anorexia, is an eating disorder marked by severe food restriction, a distorted view of one’s body, a dread of weight gain, and a strong drive to be thin. As a result, those affected frequently experience serious malnutrition. The condition carries the highest death rate of any mental illness: over a ten-year span, about 5% of individuals with anorexia die from related complications, with medical issues being the most common cause and suicide the second.
A key feature is the fear of putting on weight, even when a person is already underweight. The DSM-5 labels this perceptual symptom a “disturbance in the way in which one's body weight or shape is experienced.” Recent studies indicate this disturbance isn’t about visually overestimating body size—people with anorexia can accurately see how large they are—but stems from body dissatisfaction: they find extremely underweight bodies most appealing. Many also deny that their behaviors or symptoms signal an illness. To maintain tight control over their appearance, they may weigh themselves often, eat tiny portions, and restrict themselves to certain foods. Some also binge eat and purge, which can involve self-induced vomiting, excessive exercise, or laxative abuse.
Medical complications from anorexia include osteoporosis, infertility, heart damage, and the cessation of menstrual periods; in males, testosterone levels may drop. Death can occur. If a patient continually refuses significant food intake and weight-restoration efforts, a psychiatrist may declare them incapable of making decisions, leading to forced feeding via a nasogastric tube.
Anorexia typically emerges during adolescence or young adulthood. Its causes are complex and vary by person, involving genetic, societal, physiological, and environmental factors. A major life change or stressful event often triggers a worsening of the illness. Strong evidence points to a genetic component—identical twins are affected more often than fraternal twins—with many genetic risk factors at play, similar to other psychiatric disorders. Cultural factors are significant: societies that prize thinness see higher rates.
- Field
- Psychiatry / Eating Disorders
- Known for
- Eating disorder with highest mortality rate among psychiatric diagnoses
- Prevalence in women
- 0.3–4.3% in Western countries
- Prevalence in men
- 0.2–1% in Western countries
- Global deaths 2013
- about 600 deaths
Lore & Background
Anorexia nervosa often develops during adolescence or young adulthood. The causes are complex and vary across individuals, including genetic, societal, physiological, and environmental factors. There is strong evidence of a genetic component, with identical twins affected more often than fraternal twins. Cultural factors play a significant role, with societies that value thinness having higher rates of the disease. Anorexia also commonly occurs in athletes in sports where low bodyweight is thought advantageous, such as dance, gymnastics, and figure skating.
Reader's Guide
Anorexia nervosa is significant as the psychiatric disorder with the highest mortality rate, estimated to occur in 0.3–4.3% of women and 0.2–1% of men in Western countries. Its legacy includes ongoing debate about causes—genetic, cultural, and environmental—and treatment challenges. Treatment involves restoring healthy weight, addressing underlying psychological problems, and using therapies such as cognitive behavioral therapy or Maudsley family therapy. A daily low dose of olanzapine may increase appetite. In severe cases, nasogastric tube feeding may be used, though evidence for benefit is unclear. Relapse risk is highest within the first year post-discharge, with about 31% relapsing within two years. The disorder causes complications in every major organ system, including osteoporosis, infertility, heart damage, and death. An increase in diagnosis from the 20th century onward is observed, but it is unclear whether this reflects a true increase or improved diagnostic capabilities.
Did You Know?
- Anorexia nervosa has the highest mortality rate of any psychiatric diagnosis.
- About 5% of people with anorexia die from complications over a ten-year period.
- Individuals with anorexia can accurately visually identify their body size but find severely underweight bodies the most attractive.
- A daily low dose of olanzapine has been shown to increase appetite and assist with some weight gain in patients.
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