Dr. Ahmed Extreme Anorexia Nervosa, or severe anorexia nervosa, is a medical condition defined as a person with an eating disorder and a BMI of less than 15 kg/m².
Patients with anorexia nervosa perceive themselves as if they are overweight and fear the idea of gaining a slight weight.
Understanding Anorexia Nervosa
The term “anorexia nervosa” comes from two words:
- Anorexia means “without appetite.”
- Nervosa relates to “nervous” or psychological factors.
In simple words, anorexia nervosa (often called anorexia) is not just about refusing to eat—it’s a serious eating disorder. It is marked by:
- Very low body weight (or a steady drop in weight)
- An intense fear of gaining weight
- A distorted body image — people see themselves as “fat” even when they are dangerously thin
How Anorexia Affects People
People with anorexia are consumed by the idea of controlling their weight and body shape. They go to extreme lengths to lose weight, even when they are already underweight. This can include:
- Eating very little or skipping meals
- Forcing themselves to vomit after eating
- Misusing laxatives, diuretics, or other medicines to “cleanse” their body
- Exercising excessively, far beyond what is healthy
No matter how much weight they lose, they continue to fear weight gain.
Why Anorexia Is More Than Just About Food
Anorexia isn’t simply about dieting or wanting to be slim. It’s a mental health condition. Many people with anorexia tie their self-worth or confidence to how thin they are. In reality, the illness is often a way of coping with stress, anxiety, or emotional struggles.
Over time, anorexia can take over a person’s life, affecting their physical health, relationships, and mental wellbeing. Severe anorexia—where the body mass index (BMI) drops below 15—is extremely dangerous and can even be life-threatening.
Causes of Anorexia and Extreme Anorexia Nervosa:
We don’t know the exact cause of anorexia and extreme anorexia to date but it can be a combination of many factors, as many diseases are. The factors can be
- Environmental
- Hereditary
- Psychological
Causes and Risk Factors of Anorexia Nervosa
Anorexia nervosa doesn’t just appear out of nowhere. It often develops from a combination of psychological, social, and cultural pressures. Let’s break down some of the most common factors.
1. Pressure to Be Perfect
Modern society often celebrates thinness and the “perfect body.” Young people, in particular, may feel intense pressure to look a certain way. Instead of staying healthy, they may push themselves into extreme diets and excessive exercise. Over time, this can make them weak rather than fit.
The National Eating Disorders Association (NEDA) notes that many people with anorexia share a personality trait called rigidity — the need to always follow rules, stay in control, and do things “the right way.” This perfectionist mindset, combined with low self-esteem, increases the risk of developing an eating disorder.
2. Bullying and Harassment
Bullying is another powerful trigger. Children and teenagers who are shy, introverted, or struggle to express themselves are often easy targets. They may face:
- Hurtful comments about their body
- Name-calling or insults
- Social exclusion or constant teasing
Research shows that around 60% of people with eating disorders report harassment as a major factor in the development or worsening of their illness. The constant criticism about appearance can push someone to unhealthy eating habits, eventually leading to anorexia.
3. Challenges Faced by Minority Communities
People from racial or ethnic minority groups may face unique social pressures. They are often expected to fit into Western beauty standards, which may not reflect their natural body types. This can lead to feelings of not belonging or being “different.”
For example, a famous study in Fiji found that after the introduction of Western TV shows, women who had previously accepted their natural bodies started to feel dissatisfied. Within three years:
- 74% felt “too fat”
- 69% started strict dieting
- 11% practiced self-induced vomiting
- 29% were at risk of developing clinical eating disorders
This shows how cultural ideals can deeply affect body image and trigger anorexia.
4. Depression and Loneliness
Isolation is both a cause and a consequence of anorexia. Many people with anorexia describe having fewer friends, limited social activities, and little emotional support.
When eating becomes an obsession, they may avoid gatherings that involve food or hide their struggles out of shame. This withdrawal leads to loneliness, which worsens depression — and in turn, the cycle of restrictive eating continues.
It becomes a vicious cycle:
- Isolation deepens depression.
- Depression leads to eating disorder behaviors.
- The eating disorder leads to more isolation.[Ref]
Hereditary and Psychological Causes of Anorexia Nervosa
Anorexia nervosa is often seen as purely a mental health issue, but research shows that both genetics and psychological factors play a big role. Let’s look at how these causes interact and who may be more at risk.
Hereditary Causes
Anorexia often runs in families, suggesting that genetics influence the risk. Studies have found that certain genes related to mood regulation and appetite may increase vulnerability.
- In the general population, the chance of developing anorexia is about 0.5% (1 in 200 people).
- But if a close relative has anorexia, your risk can increase up to 11 times.
This means genetics don’t guarantee anorexia, but they can make someone more likely to develop it when combined with environmental and emotional triggers.
Psychological Causes
Certain personality traits make people more vulnerable to anorexia:
- Perfectionism – wanting to be flawless, never feeling “good enough.”
- Rigid thinking – following strict rules, even about food and exercise.
- High self-control – the ability to resist eating, even when hungry.
- Depression and anxiety – restrictive dieting may temporarily reduce emotional distress, making it harder to stop.
These traits can lock people into harmful eating patterns, even when they know it’s damaging.
Who Is at Risk?
Anorexia is more common in teenage girls and young women, but it can affect anyone. Boys and men are also increasingly being diagnosed, especially as social pressures about body image grow.
High-risk groups include:
- Teens and young adults – rapid body changes, peer pressure, and sensitivity to appearance.
- People with a family history – genetic predisposition increases risk.
- Those exposed to bullying or body-shaming – repeated criticism about weight or looks can trigger anorexia.
- Anyone with depression, anxiety, or low self-esteem.
Other Contributing Factors
1. Starvation and Dieting
Frequent dieting, obsessive weight checks, or extreme fasting can trigger anorexia. Starvation itself changes the brain, affecting mood, appetite, and decision-making, making recovery even harder.
2. Environmental Changes
Big life shifts, such as moving to a new school, workplace, or city, or going through a breakup, can disrupt routines and lead to disordered eating.
3. Cultural and Social Pressures
Western beauty ideals, social media, and peer comparisons all add fuel to the fire. Teens are especially vulnerable to comments about body image.
Treatment for Extreme Anorexia
Recovery usually requires a team-based approach, including doctors, dietitians, and psychotherapists.
1. Hospitalization (in severe cases)
If someone is dangerously underweight, has electrolyte imbalances, or refuses to eat, they may need hospitalization. Feeding tubes (nasogastric tubes) are sometimes required to restore nutrition.
2. Medical Care
Ongoing monitoring of vital signs, electrolytes, hydration, and organ function is crucial. Doctors also address complications like dehydration, malnutrition, and heart rhythm problems.
3. Restoring a Healthy Weight
The first step in recovery is safe weight restoration:
- Doctors monitor progress and medical stability.
- Dietitians design meal plans for balanced nutrition.
- Families provide support, encouragement, and accountability.
4. Psychotherapy
- Family-based therapy (FBT): Effective for children and teens. Parents help re-establish healthy eating routines.
- Cognitive-behavioral therapy (CBT): Helps adults change harmful thought patterns about weight, food, and self-image.
5. Medications
There is no “cure pill” for anorexia, but antidepressants (such as SSRIs) can help manage depression and anxiety. Supportive medications (fluids, electrolyte correction, high-calorie/protein diets) are often needed.
Challenges in Treatment
One of the hardest parts is that many people with anorexia don’t see themselves as sick. They may resist treatment because of:
- Fear of weight gain
- Believing anorexia is just a lifestyle choice
- Thinking they don’t need medical help
Relapse is also common, especially during stressful times or when depression and anxiety resurface. Continuous psychological support and follow-up therapy are key to long-term recovery.
Final Takeaway
Anorexia is not just about food—it’s a complex mix of genetics, personality traits, and life experiences. With timely medical, nutritional, and psychological care, recovery is possible. Early recognition and support can save lives.
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