Anorexia nervosa

Diagnosis

If your healthcare professional thinks that you have anorexia nervosa, you may have several tests and exams to 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 exam includes measuring your height and weight and checking your vital signs. Vital signs include heart rate, blood pressure and temperature. Usually, the exam also includes checking skin and nails for problems, listening to the heart and lungs, and looking at the stomach area.
• Lab tests. These may include a complete blood count (CBC) and more-specialized blood tests to check electrolytes and protein, as well as the function of your liver, kidney and thyroid. A urine test also may be done.
• Mental health evaluation. Your healthcare professional likely will ask about your thoughts, feelings and eating habits. Your healthcare professional also may ask you to answer a series of questions about your health.
• 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. An electrocardiogram may be done to look for heart issues.

Treatment

It's best to treat anorexia nervosa using a team approach. The team includes doctors, mental health professionals and other healthcare professionals — all with experience in treating eating disorders.

Here's a look at what's commonly involved in treatment.

Hospital stays and other programs

If your life is in danger now, you may need to be treated in a hospital emergency department. This may be needed for issues such as a heart rhythm problem, dehydration, electrolyte imbalances or a mental health emergency. A hospital stay may be needed to treat medical complications, severe mental health problems, severe malnutrition or continued refusal to eat.

Some clinics specialize in treating eating disorders. They may offer day treatment programs or residential treatment programs rather than a hospital stay. Specialized eating disorder programs may offer more-intensive treatment over longer periods of time. The main goal is to make eating patterns more typical and promote behaviors to support weight gain. The second goal is to help change distorted beliefs and thoughts that maintain limited eating.

Medical care

You may need to be monitored often because of all the complications anorexia causes. This includes your vital signs, hydration level and electrolytes, as well as related physical conditions. In severe cases, you may at first require feeding through a tube that's placed in your nose and goes to the stomach. This is called a nasogastric tube.

Restoring a healthy weight

The first goal of treatment is to get to a healthy weight based on your personal growth history. You can't recover from anorexia without returning to a healthy weight and good eating habits. People involved in this process may include:

• Your healthcare professional, who can provide medical care and supervise your weight gain.
• A psychologist or another mental health professional trained to treat eating disorders, who can work with you on ways to change your behavior to help you return to a healthy weight.
• A dietitian, who is specially trained in eating disorders and can guide you on how to get back to regular patterns of eating. This includes giving you meal plans that meet your calorie needs and help you reach your weight goals.
• Your family, who will likely be involved in helping you keep good eating habits. This is especially true for children and teenagers with eating disorders.

Family-based treatment for teenagers

Family-based treatment, sometimes called FBT, is the only proven outpatient treatment for teenagers with anorexia. A person with anorexia can't make good choices about eating and health due to the impact of the disorder on the brain. So this therapy helps parents help their child eat right and get to a healthy weight until the child can make good choices about health.

Medicines

Unfortunately, no medicines have been found to help treat anorexia nervosa. For people who have anorexia, being underweight may interfere with the effectiveness of medicines they take for other conditions, including depression and anxiety. For people with anorexia, food is truly the medicine.

Some people may need supplements to reverse the effects of malnutrition, but most people should get the nutrients they need through food by getting back to regular eating habits and a healthy weight. Your healthcare professional may recommend taking supplements such as vitamin D, though it's important to talk to your healthcare professional to make sure you're taking the right things in the right way.

Treatment challenges in anorexia

One of the biggest challenges in treating anorexia is that you may not want to be treated. Barriers to treatment may include:

• Thinking that treatment isn't needed or that you're not sick enough to be treated.
• Fearing weight gain.
• Seeing anorexia as a lifestyle choice rather than an illness.

Recovery is possible with proven treatment that includes reaching a healthy weight. But you're at higher risk of anorexia returning during periods of high stress or triggering situations. Ongoing therapy or periodic appointments during times of stress may help you stay healthy.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

When you have anorexia nervosa, it can be hard to take care of yourself properly. In addition to professional treatment, follow these steps:

• Stay with 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 healthcare professional about proper vitamin and mineral supplements. Many people get their vitamins and minerals from food. But if you're not eating well, your body probably isn't getting all the nutrients it needs, such as vitamin D or iron.
• 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 outside of medical appointments or check yourself in the mirror frequently. These actions may do nothing but fuel your drive to keep unhealthy habits.

Alternative medicine

If you have anorexia nervosa, you may misuse dietary supplements, herbal products designed to make you lose weight or feel less hungry, stimulants or insulin. All these products and medicines can have serious side effects and not work well with other medicines. They also are very dangerous to those who are underweight and can increase your risk of dying from complications greatly.

Methods that help lower anxiety and help with anorexia treatment may raise your sense of well-being and help you relax. Examples of these methods include massage, yoga and meditation.

Coping and support

You may find it hard to cope with anorexia nervosa when media and culture — and maybe your own family or friends — give you mixed messages about what you should look like. Whether you have anorexia or your loved one has anorexia, ask your healthcare professional for advice on coping strategies and emotional support around diet culture and weight stigma that are so common. 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 healthcare professional.

You may want to ask a family member or friend to go with you. Someone who goes with you may remember something that you missed or forgot. A family member also may be able to give your healthcare professional a fuller picture of your home life.

What you can do

Before your appointment, make a list of:

• Any symptoms you're having, including any that don't seem to be related 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 medicines, vitamins, herbal products, medicines available without a prescription and other supplements you take, and their doses.
• Questions to ask your healthcare professional so that you'll remember to cover everything you wanted to.

For children, it's very helpful to take along a copy of their growth curve history so that the healthcare professional can see the changes.

Some questions you might want to ask your healthcare professional include:

• What kinds of tests do I need? Do I need to prepare for these tests?
• Is this condition temporary or long-lasting?
• What treatments do you recommend?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your healthcare professional likely will ask you several questions, including:

• How long have you been worried about your weight?
• How often do you exercise?
• What ways have you used to lose weight?
• Are you having any physical symptoms?
• Have you ever vomited because you were uncomfortably full?
• Do you think about food often?
• Do you ever eat in secret?
• Have others expressed concern that you're too thin?
• Have any of your family members ever had symptoms of an eating disorder or been diagnosed with an eating disorder?

Be ready to answer these questions to make sure there's time to go over any points you want to focus on.