Anorexia nervosa is a serious and life-threatening eating disorder that is
characterized by a severe disturbance in an individual’s eating patterns and
the thoughts and feelings associated with such behaviors.
DSM-IV diagnostic criteria for anorexia nervosa is as follows10:
A. Refusal to maintain body weight at or above a minimally
normal weight for age and height (e.g., weight loss
leading to maintenance of body weight less than 85% of
that expected; or failure to make expected weight gain
during period of growth, leading to body weight less than
85% of that expected).
B. Intense fear of gaining weight or becoming fat, even
C. Disturbance in the way in which one’s body weight or
shape is experienced, undue influence of body weight or
shape on self-evaluation, or denial of the seriousness of
the current low body weight.
D. In postmenarcheal females, amenorrhea, i.e., the absence
of at least three consecutive menstrual cycles. (A woman
is considered to have amenorrhea if her periods occur
only following hormone, e.g., estrogen, administration.)
Most Common Warning Signs of Anorexia 1,2:
Refusal to maintain normal weight
Intense fear of becoming fat, even if underweight
Distorted body image
Amenorrhea (absence of menstruation)
Ritualistic and/or secretive eating patterns
Associating what is or is not eaten with self-worth
Wearing baggy clothes to hide appearance and weight
Irrational, black and white thinking
Exhibiting extremes in relationships (either very
superficial or very dependant)
Not expressing emotions, or not expressing them
Inability to concentrate/focus for extended periods of
Increased irritability, depression and/or mood swings
Which Adolescents Are at Risk for
Post-pubertal individuals (especially females)
Those that have family members with an eating disorder
Those that show extensive interest or obsession with
people in the media
Adolescents with other psychiatric disorders (i.e.,
depression, anxiety disorders, OCD, etc.)
Those with over-protective parents
Those that experience a traumatic life event (i.e., death of
a parent, abuse, etc.)
Adolescents that go on diets frequently
Individuals with a poor sense of self-identity
Those that are athletes, actors, models, TV personalities,
socialites or dancers
Most Common Medical Complications with
Decreased blood pressure and heart rate
Dehydration and therefore, constipation as well
Shortness of breath
Long Term Effects and Mortality Rate for
Approximately 6% of serious cases die
Reduced blood flow
Shrinking of the heart muscle
Higher cholesterol levels
Abnormal hormone levels (including low growth
hormones, thyroid hormones and reproductive hormones,
as well as high stress hormone levels)
Bloating and constipation
10 Ways to Promote Healthy Eating
Patterns and Self-Image Both In and Out of
Let students know the role that genetics plays in the
variation of shape and sizes and discourage prejudice
based on such topics
Lead by example
Avoid placing too much emphasis on body weight or
Promote healthy, balanced diet and exercise and discuss
the dangers of dieting
Listen to the concerns of your students, do not be
judgmental or oversimplify their concerns
Emphasize the importance of healthy self-esteem and
self-respect in all aspects of life, not just in regards to
Address the “roles” of men and women in society
Discuss positive, healthy coping mechanisms and
abilities to manage difficult feelings
Identify and acknowledge the student’s strengths and
abilities in areas not related to body shape or size (i.e.
academics, art, etc.)
Promote being assertive and establishing healthy
What to Do if You Suspect Anorexia9:
Speak with the student privately, not in front of a group
Re-iterate your care and concern for the student’s well-
State the data that you have observed
Provide the student with local resources to utilize
Listen to the student
Avoid an argument
Arrange for follow-up
For More Information on Anorexia
http://www.abbhh.org/programs/eating.html - This site is produced by
Alexian Brothers Behavioral Health Hospital in Hoffman Estates, IL. It
provides not only information about their eating disorder treatment program,
but a free screening that one could take if he/she is unsure if an eating
disorder is a possible problem.
http://www.anad.org/site/anadweb/section.php?id=2118 – Anorexia Nervosa
and Associated Disorders website. This site provides a contact phone
number as well as information about anorexia nervosa and other eating
disorders including definitions of various disorders, statistics, warning signs,
at risk groups, etiology, complications, treatment and recovery and much
http://www.anred.com – Anorexia Nervosa and Related Disorders, Inc.
website. This site provides similar information as that of the ANAD website.
nt.htm - This site is published by Healthguide©, is a project done by The
Rotary Club of Santa Monica and Center for Healthy Aging and provides
general information about anorexia nervosa.
http://www.nationaleatingdisorders.org/p.asp?WebPage_ID=290 – This link
takes you to the Information for Educators and Coaches section of the
National Eating Disorders Association (NEDA). There are links to different
articles on signs and symptoms, treatment, prevention and tips on how to
best interact with adolescents on the subject of weight and appearance.
Hard copy resources
First, Michael B., ed. Diagnostic and Statistical Manual of Mental Disorders.
4th ed. Washington DC: American Psychiatric Association, 2000.
Levenkron, Stephen. Anatomy of Anorexia. New York: Lion’s Crown,
Lucas, Alexander. Demystifying Anorexia Nervosa: An Optimistic Guide to
Understanding and Healing. Oxford: University Press, 2004.
Treasure, Janet. Anorexia Nervosa: A Survival Guide for Families, Friends
and Sufferers. East Sussex: Psychology Press, Ltd., 1997.
Resources cited on this page
“General Information”. Eating Disorder Info and Resources. 2000.
ANAD. 11 Mar. 2006.
Matthews, Dawn D., ed. Eating Disorders Sourcebook. 1st ed.
Detroit: Omnigraphics, 2001.
Schmidt, Ulrike. “Aetiology [sic] of Eating Disorders in the 21st
Century: New Answers to Old Questions”. European Child &
Adolescent Psychiatry; 2003. Vol. 12 Issue Supplement 1: 30.
EBSCOhost. Founders Memorial Library, DeKalb, IL. 11 Mar. 2006.
“Facts About Eating Disorders.” ANAD. 21 Mar. 2006.
Simon, Harvey. “How Serious is Anorexia Nervosa?”
2002.A.D.A.M. Inc. 21 Mar. 2006.
Lemberg, Raymond, ed. Eating Disorders: A Reference Sourcebook.
Phoenix: Oryx Press, 1999.
Levine, Michael and Margo Maine. “Eating Disorders Can Be
Prevented!”. 2005. National Eating Disorders Association. 13 Mar.
Garner, D.M. et al. “Cognitive-behavioral Therapy for Anorexia
Nervosa”. Handbook of Treatment for Eating Disorders. 2nd ed. Ed.
D.M. Garner and P.E. Garfinkel. New York: Guilford Press, 1997.
Levine, Michael and Margo Maine. “Educators: Understanding Your
Role”. 2005. National Eating Disorders Association. 13 Mar. 2006.
10 - First, Michael B., ed. Diagnostic and Statistical Manual of Mental
Disorders. 4th ed. Washington DC: American Psychiatric Association,
Created by: Carrie Frodin
Reviewed by: Carmen L. Crosser, LCSW, LMFT