If your doctor suspects that you have anorexia nervosa, he or she will typically run several tests and exams to help pinpoint a diagnosis, rule out medical causes for the weight loss, and check for any related complications.
These exams and tests generally include:
- Physical exam. This may include measuring your height and weight; checking your vital signs, such as heart rate, blood pressure and temperature; checking your skin and nails for problems; listening to your heart and lungs; and examining your abdomen.
- Lab tests. These may include a complete blood count (CBC) and more specialized blood tests to check electrolytes and protein as well as functioning of your liver, kidney and thyroid. A urinalysis also may be done.
- Psychological evaluation. A doctor or mental health provider will likely ask about your thoughts, feelings and eating habits. You may also be asked to complete psychological self-assessment questionnaires.
- Other studies. X-rays may be taken to check your bone density, check for stress fractures or broken bones, or check for pneumonia or heart problems. Electrocardiograms may be done to look for heart irregularities. Testing may also be done to determine how much energy your body uses, which can help in planning nutritional requirements.
Diagnostic criteria for anorexia
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
DSM-5 diagnostic criteria for anorexia include:
- Restricting food intake — eating less than needed to maintain a body weight that's at or above the minimum normal weight for your age and height
- Fear of gaining weight — intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, such as vomiting or using laxatives, even though you're underweight
- Problems with body image — denying the seriousness of having a low body weight, connecting your weight to your self-worth, or having a distorted image of your appearance or shape
When you have anorexia nervosa, you may need several types of treatment. Treatment is generally done using a team approach that includes medical providers, mental health providers and dietitians, all with experience in eating disorders. Ongoing therapy and nutrition education are highly important to continued recovery.
Here's a look at what's commonly involved in treating people with anorexia.
Hospitalization and other programs
If your life is in immediate danger, you may need treatment in a hospital emergency room for such issues as a heart rhythm disturbance, dehydration, electrolyte imbalances or psychiatric problems. Hospitalization may be required for medical complications, psychiatric emergencies, severe malnutrition or continued refusal to eat. Hospitalization may be on a medical or psychiatric ward.
Some clinics specialize in treating people with eating disorders. Some may offer day programs or residential programs rather than full hospitalization. Specialized eating disorder programs may offer more intensive treatment over longer periods of time.
Because of the host of complications anorexia causes, you may need frequent monitoring of vital signs, hydration level and electrolytes, as well as related physical conditions. In severe cases, people with anorexia may initially require feeding through a tube that's placed in their nose and goes to the stomach (nasogastric tube).
A primary care doctor may be the one who coordinates care with the other health care professionals involved. Sometimes, though, it's the mental health provider who coordinates care.
Restoring a healthy weight
The first goal of treatment is getting back to a healthy weight. You can't recover from an eating disorder without restoring an appropriate weight and learning proper nutrition.
A psychologist or other mental health professional can work with you to develop behavioral strategies to help you return to a healthy weight. A dietitian can offer guidance getting back to regular patterns of eating, including providing specific meal plans and calorie requirements that help you meet your weight goals. Your family will also likely be involved in helping you maintain normal eating habits.
These types of therapy may be beneficial:
- Family-based therapy. This is the only evidence-based treatment for teenagers with anorexia. Because the teenager with anorexia is unable to make good choices about eating and health while in the grips of this serious condition, this therapy mobilizes parents to help their child with re-feeding and weight restoration until the child can make good choices about health.
- Individual therapy. For adults, cognitive behavioral therapy — specifically enhanced cognitive behavioral therapy — has been shown to help. The main goal is to normalize eating patterns and behaviors to support weight gain. The second goal is to help change distorted beliefs and thoughts that maintain the restrictive eating. This type of therapy is generally done once a week or in a day treatment program, but in some cases, it may be part of treatment in a psychiatric hospital.
No medications are approved to treat anorexia because none has been found to work very well. However, antidepressants or other psychiatric medications can help treat other mental disorders you may also have, such as depression or anxiety.
Treatment challenges in anorexia
One of the biggest challenges in treating anorexia is that people may not want treatment. Barriers to treatment may include:
- Thinking you don't need treatment
- Fearing weight gain
- Not seeing anorexia as an illness but rather a lifestyle choice
People with eating disorders can recover. However, they're at increased risk of relapse during periods of high stress or during triggering situations. Ongoing therapy or periodic appointments during times of stress may help you stay healthy.
Lifestyle and home remedies
When you have anorexia nervosa, it can be difficult to take care of yourself properly. In addition to professional treatment, follow these steps:
- Stick to your treatment plan. Don't skip therapy sessions and try not to stray from meal plans, even if they make you uncomfortable.
- Talk to your doctor about appropriate vitamin and mineral supplements. If you're not eating well, chances are your body isn't getting all of the nutrients it needs.
- Don't isolate yourself from caring family members and friends who want to see you get healthy. Understand that they have your best interests at heart.
- Resist urges to weigh yourself or check yourself in the mirror frequently. These may do nothing but fuel your drive to maintain unhealthy habits.
Alternative medicine is the use of a nonconventional approach instead of conventional medicine. Complementary medicine is a nonconventional approach used along with conventional medicine.
Alternative medicine hasn't been well-studied as a treatment for people with eating disorders, but complementary treatments may help reduce anxiety. Such treatments may help people with eating disorders by increasing a sense of well-being and promoting relaxation.
Examples of anxiety-reducing complementary treatments include:
Talk with your doctor before trying any alternative medicine. Natural doesn't always mean safe. Your doctor can help you understand possible risks and benefits before you try a treatment.
Coping and support
You may find it difficult to cope with anorexia nervosa when you're hit with mixed messages by the media, culture, and perhaps your own family or friends. You may even have heard people joke that they wish they could have anorexia for a while so that they could lose weight.
Whether you have anorexia or your loved one has anorexia, ask your doctor or therapist for advice on coping strategies and emotional support. Learning effective coping strategies and getting the support you need from family and friends are vital to successful treatment.
Preparing for your appointment
Here's some information to help you get ready for your appointment and know what to expect from your doctor and other health providers.
What you can do
Before your appointment, make a list of:
- Any symptoms you're experiencing, including any that may seem unrelated to the reason for the appointment. Try to recall when your symptoms began.
- Key personal information, including any major stresses or recent life changes.
- All medications, vitamins and other supplements that you're taking and their doses.
- Questions to ask your doctor so that you'll remember to cover everything you wanted to.
Ask a family member or friend to go with you, if possible. Someone who accompanies you may remember something that you missed or forgot. A family member may also be able to give your doctor a fuller picture of your home life.
Some questions you might want to ask your doctor or other health care provider include:
- What kinds of tests do I need? Do these tests require any special preparation?
- Is this condition temporary or long lasting?
- What treatments are available, and which do you recommend?
- Is there a generic alternative to the medicine you're prescribing for me?
- Are there any brochures or other printed material that I can have? What websites do you recommend?
Don't hesitate to ask questions anytime you don't understand something.
What to expect from your doctor
Your doctor or other health care provider is likely to ask you a number of questions, such as:
- How long have you been worried about your weight?
- Do you exercise? How often?
- Have you found any other ways to lose weight?
- Are you having any physical symptoms?
- Have you ever vomited because you were uncomfortably full?
- Have others expressed concern that you're too thin?
- Do you think about food often?
- Do you ever eat in secret?
- Have any of your family members ever had symptoms of an eating disorder or been diagnosed with an eating disorder?