The self-esteem of individuals with this disorder is hyper-dependent on their body shape and weight. Even if they become extremely emaciated, an anorexic person's distorted body image convinces them they are "fat". Weight loss for them is viewed as an impressive self-achievement and an indication of extraordinary self-discipline, whereas weight gain is perceived as an unacceptable failure of self-control.

     A distorted self-image, however, may not be the primary factor in ever case of anorexia nervosa. Other physical and mental conditions need to be taken into account.

     The disorder usually begins around the time of puberty and the onset is often associated with a stressful life event such as leaving home for college, or their parents divorcing. However, some cases may occur in mid-life or later. The onset may be the result of later life stresses or crisis. A feeling of "lack of control", due to a divorce, layoff, or retirement may be a trigger in these later life occurrences.

     While more than 90% of the reported cases affect young women, this statistic may be misleading. The numbers of recognized cases of males and older adults with anorexia nervosa is increasing. Males can be at particular high risk for developing life-threatening medical problems as a direct result of this disorder, because they are too often diagnosed later than females.

     There are several explanations for the later diagnosis of males with anorexia. First, is the popular belief among the medical profession that this is a young girl disease? The doctors and psychologist are not on the "look-out" for this disease. Compounding this problem is that most rehabilitation and recovery facilities do not accept or treat male anorexics and most insurance carriers with not cover "male anorexia".

     Other factors affecting male diagnosis include drug and alcohol use by males. Excessive exercise by men (and women) may also mask the problem. Excessive running, jogging, cycling, swimming, they eat for performance and appearance, not nutrition. Outwardly, they may look healthy.

     In their concerted efforts to continually control and reduce their weight, anorexics reduce their food and calorie intake through such rigid strategies as excluding what they perceive to be high fat or high calorie foods. Limiting their food intake to just a few specific low calorie foods. Bingeing and purging; purging after even the smallest meals; refusing to eat in public, and/or going to great lengths to avoid eating with even close friends or family.

     Anorexics become obsessed with food—hoarding it, going to extra efforts to fix meals for others, carrying around stashes of candy—yet they will not allow themselves to eat any of it.

     Although some individuals with this disorder will acknowledge that they are thin, they typically deny the serious implications of their malnourished state. This denial, however, is no different from an alcoholic denying they have a drinking problem.

     Cardiac disease is the most common medical cause of death in people with severe anorexia; the heart can develop dangerously slow rhythms, known as bradycardia, or, in many cases, the heart muscles literally starve, losing size. Some individuals suffer nerve damage and experience seizures, disordered thinking, and/or chronic nerve problems in their hands and feet.

     Brain scans indicate that structural changes and abnormal activity occur in parts of the brain during anorexic states—while some of these changes can return to normal if weight is gained, there is evidence that some damage may be permanent.

     Individuals with anorexia nervosa can become victims to major depression which then sets in play a dangerous cycle of emotional and physical disturbances. Prolonged hunger leads to depression, which then seriously erodes self-esteem and self-confidence, which in turn increases, the need for hyper-vigilance over controlling their weight and an even firmer resolve to not eat.

     Some studies esteem that suicide is the cause of as many as half the deaths in anorexia nervosa. At this time, anorexia nervosa is not an illness that can be completely cured, however, if it is caught early and treated, many people do recover.

     There are two types of anorexia nervosa. Those who have the "restricting type" accomplish their weight loss primarily through dieting, fasting, or excessive exercise. Individuals who have the "binge-eating/purging type" regularly engage in binge eating. Eating abnormally large amounts of food during a very short period. Then purging—Self-induced vomiting, the misuse of laxatives, diuretics, or enemas to rid their bodies of the just-consumed food. This also referred to as Bulimia. The risk for early death is twice as high in anorexics that suffer from the binge-eating/purging type of the disorder.

There is no single cause. Anorexia nervosa is caused by a complex interplay of factors that can include emotional and personality disorders, family stress, and possible genetic or biologic susceptibilities, all of which c

     There is no single cause. Anorexia nervosa is caused by a complex interplay of factors that can include emotional and personality disorders, family stress, and possible genetic or biologic susceptibilities, all of which can be reinforced by a culture that equates healthiness with being thin.

     The first course of action should be to aggressively seek help from a physician to diagnose and immediately treat any physical problems. Hospitalization is sometimes necessary to prevent starvation. Because anorexia nervosa has biological, psychological, familial, and social cultural components, effective treatment should involve collaboration among health professionals, including physicians, therapists, and dieticians.

     Individuals with anorexia nervosa are often very resistant to getting help. Even when experiencing life-threatening problems, they remain convinced that their emaciated state is normal and even attractive. Their resistance is often reinforced by friends who envy thinness or by dance or athletic coaches who encourage extremely low body fat.

     Therapists are especially experienced at helping people who have this serious eating disorder. Therapy provides a safe, comforting, non-judgmental, and confidential setting. To receive the kind of concentrated help that can best determine and then treat underlying emotional and psychological causes for the self-destructive relationship with food and their distorted body perception.

     A twelve-step program, similar to Alcoholics Anonymous is also helpful. Overeaters' Anonymous is a program for people with compulsive eating disorders. Anorexic, Bulimic, and Exercise Addicts meet together or with Overeaters to share and discuss their common problems with eating. The term "abstinence" or "abstinence from eating disorders" is used synonymous with sober and sobriety as used in AA.

     The feelings of intense guilt and/or anxiety that family members' experience is similar to those produced by living with a loved one who is suicidal. Because of the this risk, because of the major role family members' attitudes can play in the anorexic's onset of the disorder, and because it's extremely important to have the heightened support of family members to better ensure their loved one's recovery. Family therapy is often encouraged and of significant benefit.

For a Self-Test please see Symptoms of Anorexia Nervosa & Bulimia