Anorexia nervosa: symptoms, causes and treatment

Key points

• Anorexia nervosa is a serious mental illness in which a person restricts what they eat and drink, alongside fear of weight gain and a distorted view of their own body [3][5].
• It occurs at every body size, age, gender and background, and a person does not need to look unwell to be seriously unwell [5][6].
• Atypical anorexia, where every feature is present but the weight criterion is not met, is just as serious [5][6].
• Anorexia carries the highest mortality of any eating disorder, from medical complications and from suicide [2].
• NICE recommends a talking therapy first at every age, and says single measures such as body mass index (BMI) must not decide whether treatment is offered [1].

What anorexia nervosa is

Anorexia nervosa is an eating disorder and a serious mental health condition in which a person limits what they eat and drink to keep their weight down, usually with a strong fear of gaining weight and a view of their own body that does not match how others see it [3]. It is an illness, not a diet and not a choice [5].

If you need help now. Samaritans: call 116 123, free, 24/7. Shout: text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger. Beat, the UK eating disorder charity, runs free helplines: 0808 801 0677 in England, 0808 801 0432 in Scotland, 0808 801 0433 in Wales, 0808 801 0434 in Northern Ireland, open 3pm to 8pm Monday to Friday. No diagnosis is needed [7].

Anorexia occurs at every body size, age, gender, ethnicity and background, and appearance does not measure how ill someone is [5][6]. NICE notes that community studies suggest as many as a quarter of people with an eating disorder are male [2]. NG69 quotes a Beat estimate, based on 2012 to 2013 hospital admissions, of more than 725,000 people in the UK with an eating disorder, about 15 per cent of them with anorexia [2]. Beat’s more recent estimate is at least 1.25 million [8].

Symptoms

Symptoms fall into three groups. Nobody has all of them.

Thoughts and feelings

• Fear of gaining weight, or dread attached to eating
• Judging oneself mainly by weight or body shape
• Thinking about food or the body for much of the day

Behaviour

• Restricting what is eaten or drunk, often following rigid personal rules
• Compensatory behaviours intended to undo eating
• Avoiding meals with others, or withdrawing socially

Physical

• Tiredness, dizziness, feeling cold, poor sleep, muscle weakness
• Digestive problems, and changes to hair, skin and nails
• Periods stopping, and in time effects on the heart, bones, teeth and kidneys [5]

It is often mistaken at first for dieting, fussy eating or a digestive condition. Depression, anxiety, obsessive compulsive disorder (OCD) and self-harm commonly occur alongside it [1].

Types

Anorexia nervosa has two recognised presentations, plus one closely related diagnosis that is often missed.

• Atypical anorexia. Every feature clinicians look for in anorexia is present, but the weight criterion is not met [6]. It sits within OSFED, other specified feeding or eating disorder, which is as serious as anorexia and accounts for the largest share of diagnoses [5][6]. People with it are often refused treatment for not being ill enough, which NICE’s recommendation on single measures rules out [1].
• Restricting presentation, written AN-R. Restriction of food and drink is the main feature, without regular binge eating [5].
• Binge-purge presentation, written AN-BP. Restriction continues alongside episodes of binge eating and compensatory behaviours [5]. People move between the two presentations, and the treatment is the same [1].

Causes and risk factors

No single cause is known. Anorexia develops from a mix of biological, psychological and social factors that differs between people [3][5].

• Biological. Family history of eating disorders or other mental health conditions, and inherited differences in appetite and anxiety.
• Psychological. Perfectionism, low self-esteem, difficulty coping with uncertainty, and existing anxiety, depression or OCD [1].
• Social. Bullying or comments about eating or appearance, bereavement, trauma, and settings where weight is closely watched.

The evidence does not support the ideas that the media alone causes it, that it is a failed diet, or that it is vanity or attention-seeking [5]. Families do not cause it [1].

How it is diagnosed

A GP is usually the first contact, and diagnosis is normally confirmed by a specialist eating disorder service [3]. The GP asks about eating, thoughts on food and body shape, mood and physical health, and usually checks the heart and takes blood tests [3].

If an eating disorder is suspected, NICE says the person should be referred immediately to a community-based, age-appropriate eating disorder service, and treatment should begin at the earliest opportunity [1]. Children and young people go to CAMHS or a community eating disorder service, adults to an adult service or mental health team.

NICE is explicit that single measures such as BMI or duration of illness must not decide whether treatment is offered [1]. The Royal College of Psychiatrists takes the same position on risk [9].

Waiting times are published only for children and young people in England, where 78.4 per cent of urgent and 81.7 per cent of routine referrals met the one and four week standards between September and November 2025 [10]. Adult figures are not published [10].

Treatment

NICE guideline NG69 recommends a talking therapy as the first treatment at every age, and says medication must not be the sole treatment [1]. For adults it recommends one of three [1]:

• Individual eating-disorder-focused cognitive behavioural therapy, CBT-ED. Looks at the thoughts and rules that keep the illness going, alongside eating, mood and relapse prevention [1].
• MANTRA, the Maudsley Anorexia Nervosa Treatment for Adults. Uses a workbook to examine what holds the illness in place and to build an identity separate from it [1].
• SSCM, specialist supportive clinical management. Combines supportive sessions with education about nutrition and regular review of physical health [1].

For children and young people, NICE recommends anorexia-nervosa-focused family therapy, FT-AN, first. It puts parents and carers at the centre of supporting eating and does not blame the family. If it does not help, individual CBT-ED or adolescent-focused psychotherapy, AFP-AN, are the alternatives [1].

Physical health monitoring runs alongside therapy, with dietary advice and supplements [1][4]. Medication is sometimes prescribed for a condition alongside anorexia, such as depression or anxiety, and is a matter for a GP or prescriber [4]. Most people are treated at home, with hospital admission when risk is high [4].

Anorexia carries the highest mortality of any eating disorder, from medical complications and from suicide [2]. Outcomes are better the earlier treatment starts [3].

Living with anorexia nervosa

Recovery is possible and rarely a straight line [5]. Progress shows in what you think, feel and do, not in how you look.

• Agree with one or two people what helpful support sounds like. Comments about eating, weight or appearance rarely help, even when kindly meant [5].
• Tell your GP about physical symptoms such as dizziness, fainting or dental problems, which are treatable [4].
• Beat runs free online support groups and a helpline for anyone affected, including carers [7].
• At work or university, anorexia can count as a disability under the Equality Act 2010, so adjustments can be requested without giving diagnosis details.

When to speak to a professional

Speak to your GP if food, eating, weight or body shape takes up much of your thinking, if you are restricting what you eat or drink, or if others have raised concerns. You do not need to be certain something is wrong first [3]. Ask for referral to your local eating disorder service [1].

Contact your GP or NHS 111 the same day if you feel faint or dizzy, have chest pain or an irregular heartbeat, or cannot keep fluids down [9].

Call 999 or go to A&E if you have collapsed, have had a seizure, or if anyone is in immediate danger.

If you are having thoughts of suicide or self-harm, call Samaritans on 116 123 or text SHOUT to 85258. Beat’s helplines are open on weekday afternoons and evenings [7].

Common questions

Can you have anorexia at a normal weight?

Yes. Atypical anorexia has every feature clinicians look for in anorexia without the weight criterion being met, and is just as serious [6]. NICE says single measures such as BMI must not decide whether treatment is offered [1].

Can a service refuse treatment because someone is not ill enough?

NICE says treatment should begin at the earliest opportunity, and that single measures must not decide whether it is offered [1]. Refusals still happen. Asking a GP to refer again, naming NG69, is a reasonable next step.

Is anorexia curable?

Full recovery is possible and more likely the earlier treatment starts [5]. It takes time and can include setbacks. The NICE-recommended therapies have the strongest evidence, though the adult trials are small [1].

Clinical review pending

References

1. National Institute for Health and Care Excellence. Eating disorders: recognition and treatment. NICE guideline NG69, published 23 May 2017, last updated 16 December 2020. https://www.nice.org.uk/guidance/ng69/resources/eating-disorders-recognition-and-treatment-pdf-1837582159813
2. National Institute for Health and Care Excellence. Eating disorders: recognition and treatment, Context. NICE guideline NG69. https://www.nice.org.uk/guidance/ng69/chapter/Context
3. NHS. Overview: Anorexia nervosa. NHS, accessed 2026. https://www.nhs.uk/mental-health/conditions/anorexia/overview/
4. NHS. Treatment: Anorexia nervosa. NHS, accessed 2026. https://www.nhs.uk/mental-health/conditions/anorexia/treatment/
5. Beat. Anorexia nervosa. Beat Eating Disorders, accessed 2026. https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/anorexia/
6. Beat. OSFED. Beat Eating Disorders, accessed 2026. https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/osfed/
7. Beat. I need support now: Helplines. Beat Eating Disorders, accessed 2026. https://www.beateatingdisorders.org.uk/get-information-and-support/get-help-for-myself/i-need-support-now/helplines/
8. Beat. Eating disorder statistics. Beat Eating Disorders, accessed 2026. https://www.beateatingdisorders.org.uk/media-centre/eating-disorder-statistics/
9. Royal College of Psychiatrists. Medical emergencies in eating disorders: guidance on recognition and management. College Report CR233, May 2022, updated December 2025. https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr233-medical-emergencies-in-eating-disorders-(meed)-guidance.pdf
10. House of Commons Library. Eating disorders. Research briefing CBP-10497, UK Parliament. https://researchbriefings.files.parliament.uk/documents/CBP-10497/CBP-10497.pdf