Anorexia nervosa – When the desire for control becomes an illness

Anorexia nervosa, commonly referred to as anorexia, is more than “not wanting to eat.” It is a serious mental health disorder with profound physical and emotional consequences. Anorexia is shaped by a complex interplay of psychological, biological, and social factors – often with dramatic health outcomes.

In our overview article on eating disorders, we described how these disorders exist on a spectrum and can take many different forms. In this article, we focus specifically on anorexia nervosa – from diagnostic criteria and causes to treatment options.

Clinical Picture – What characterizes anorexia nervosa?

Severe restriction of food intake
Intense fear of gaining weight – even when underweight
Distorted body image – weight and body shape are misperceived
Often accompanied by social withdrawal, depressive symptoms, and compulsive behaviors
A dangerous aspect of the illness: it often begins subtly, as a seemingly “healthy” diet or lifestyle project. What follows is a progressive physical and emotional decline.

Diagnostic Criteria – ICD-10 vs. ICD-11

The International Statistical Classification of Diseases and Related Health Problems (ICD) is the globally recognized diagnostic system published by the World Health Organization (WHO).

ICD-10 (currently used in German-speaking countries until the ICD-11 translation becomes available):
- Body weight at least 15% below expected weight
- Self-induced weight loss through starvation, excessive exercise, vomiting, or laxatives
- Distorted body image
- Hormonal changes, e.g., absence of menstruation (amenorrhea)

ICD-11 – The modernized approach:
- No fixed weight threshold – focus is on functional impairment
- Psychological aspects (e.g., denial of the severity, body image distortion) are emphasized
- Amenorrhea is no longer required, making diagnosis more inclusive and less gender-biased

Causes – Why do people develop anorexia?

As outlined in our eating disorders overview, the bio-psycho-social model best explains the development of anorexia:

Biological: genetic predisposition, neurobiological abnormalities
Psychological: perfectionism, need for control, low self-esteem
Social: beauty ideals, family dynamics, stressful life events

One crucial point: the family is not to blame, but rather often part of the solution. Especially in adolescents, the family can be a vital resource – as detailed in our article on family-based early intervention.

Prevalence and Course

Onset: typically between ages 14 and 18, with increasing cases in children before puberty
Prevalence: around 1–2% of adolescents (more common in girls, but rising in boys)
Course: can be episodic or chronic – especially if treatment is delayed
Mortality: approximately 10% die from direct or indirect consequences – such as heart failure or suicide

Treatment – What helps?

Core Principles
Multidisciplinary: psychotherapy, nutritional counseling, medical supervision
Individually tailored: outpatient, intensive outpatient, or inpatient treatment
Goal-oriented: weight stabilization, normalization of eating behavior, and addressing psychological burdens

Family-Based Therapy
Especially for adolescents, family-based treatment (FBT) is considered the gold standard. In the first phase, parents take over responsibility for meals – not as control, but as support. The initial focus is not on exploring the causes, but on restoring physical health. Only later do psychotherapeutic themes like self-esteem, control, and emotional regulation take center stage.

Prognosis – Is there hope?

Yes – early intervention is key.

50–60% of those affected achieve full remission
20–30% develop a chronic course
Relapses are common – especially without long-term therapeutic support
The sooner and more consistently treatment begins, the better the chances for long-term recovery.

Conclusion – Taking anorexia seriously and acting early

Anorexia nervosa is not a trend or a matter of vanity, but a mental health disorder with a high burden of suffering. It affects not only eating behavior but also self-image, body perception, and often the entire social environment.

A holistic and respectful treatment approach – such as family-based therapy – can help intervene early and support the path back to a healthy, self-determined life.

Further resources:

Understanding eating disorders: Overview and causes
Family-based early intervention in anorexia: How early support can work