How to Diagnose Anorexia

Four Parts:Examining Your SymptomsGetting HelpKnowing Your Treatment OptionsHelping a Loved One

Anorexia, also referred to as anorexia nervosa, is an eating disorder in which the person has unusual eating habits, an irrational fear of gaining weight, and obsesses over his or her body shape or size.[1] Anorexia is a serious disease. In fact, it is so dangerous it can be deadly.[2] That's why it is so important to get help. Only a mental health professional can properly diagnose this condition, but you can learn how to identify the signs and symptoms of anorexia in order to seek out professional help.

Part 1
Examining Your Symptoms

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    Know the criteria required for a diagnosis. Mental health professionals agree on a set of symptoms that must exist to diagnose anorexia, which are found in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V). In order to receive a diagnosis of this eating disorder, you must meet the following criteria:[3]
    • Not taking in enough food or calories to grow and develop properly
    • Intense fear of gaining weight, even when underweight
    • Feeling like your body shape and size determine your worthiness or attractiveness to others; being in denial about weighing too little
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    Be aware of obsessive behavior around your weight and body shape. An obsession with weight and body shape is one of the main signs of anorexia. If you or someone you know has anorexia, you may notice the following weight or shape-related behaviors in yourself:[4]
    • Losing dramatic amounts of weight
    • Weighing yourself excessively
    • Measuring your body parts or assessing yourself in the mirror
    • Weight changes, even slight, affect your mood and feelings of self-worth
    • Commenting about feeling "fat" despite low or average weight
    • Working out excessively
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    Consider if you have adopted rigid, restrictive food and eating behaviors. People with anorexia may spend a lot of time obsessing over or thinking about food. Pay attention to warning signs associated with anorexia; however, be aware that simply wanting to lose weight, or following a diet, or restricting carbs is not necessarily a sign of anorexia. Someone with anorexia will likely display a combination signs and symptoms, and will likely show an emotional attachment or investment in these behaviors — the person will rigidly follow these rules and be preoccupied by food and eating behaviors.[5] The following may be signs of anorexia:[6]
    • Following an extremely low-calorie diet
    • Pretending you're not hungry when you are
    • Refusing to eat certain foods or restricting whole food groups (for example, refusing to eat proteins or carbs because their calorie count is too high)
    • Counting calories or fat grams constantly
    • Cooking for others, but not eating
    • Making excuses to avoid mealtimes or events where food is present
    • Using laxatives, diuretics, or diet pills to lose weight and keep weight off
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    Notice if your personality or social behaviors have changed. Researchers have found that people with high risk of having anorexia nervosa often have high-achieving, perfectionist personalities. You may notice the following social and personality changes:[7]
    • Feeling irritable or moody
    • Withdrawing from friends and loved ones
    • Failing to participate in activities that were once pleasurable
    • Showing signs of anxiety (such as feeling nervous or tense, increased heart rate, difficulty sleeping, difficulty concentrating, feeling panicked)[8]
    • Showing signs of depression (such as feelings of hopelessness, fatigue, feeling guilty or worthless, loss of interest in hobbies or things you once enjoyed, feeling empty, thoughts of suicide)[9]
    • Spending time on internet sites or forums that promote anorexia (pro-ana)
    • Feeling low on energy or fatigued (which may be a result of inadequate caloric intake)
    • Becoming defensive when confronted about weight or eating habits
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    Don't think eating disorders affect girls only. If you are a young man who is showing signs of anorexia, do not overlook your symptoms. Many people mistakenly assume that eating disorders are an issue affecting only females, but researchers estimate that males make up approximately a quarter of those suffering from anorexia.[10] Signs and symptoms may present differently in men and women. Men may experience the following:[11]
    • Men may be more likely to over-exercise
    • Men are more likely to report binge eating
    • Risk for mortality among men with eating disorders may be higher, because they are less likely to seek help[12]

Part 2
Getting Help

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    See your primary care doctor. Your general practitioner is usually the first stop for anorexia treatment. When you see your doctor, be sure to prepare as much information about your symptoms to help him diagnose your case. It may also be a good idea to think ahead about how you will answer the following questions:[13]
    • Have you lost any weight lately?
    • Do you make yourself vomit?
    • Are you concerned about your weight?
    • Do you think you have any issues with eating
    • Are you still menstruating? If not, for how long has your period stopped? (for girls)
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    Have a number of tests done. Your doctor my test for a number of possible health problems created by anorexia, as it can lead to complications such as anemia, heart problems, kidney problems, severely low potassium, and constipation.[14] The following are not diagnostic tests to actually diagnose anorexia; but they may reveal any issues created by the disorder, or may reveal a medical condition that causes weight loss:[15][16]
    • A physical exam helps your doctor calculate your body mass index, or BMI. This number factors in your age and height to determine if you are at a healthy weight. Healthy BMIs may range from 18.5 to 24.9. Your GP may show concern for a BMI under 20 or lower.[17] A physical exam will also give information about your vital signs, your heart and lung functioning, problems on the nails or skin, or the abdomen.
    • Lab tests may be conducted to check your complete blood count and the electrolytes and protein in your blood. The doctor may also examine a sample of your urine.
    • Other tests to help your doctor determine the cause of weight loss (and/or loss of menstruation) may include a bone density test, kidney and liver function tests, thyroid function tests, x-rays, or an electrocardiogram.
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    Receive a referral. Once your primary care doctor has evaluated your physical functioning and decided that you have anorexia, he or she should refer you to a mental health professional or eating disorder specialist to confirm the diagnosis and start treatment.
    • When you visit with this professional, he will interview you about your thoughts, feelings, and behaviors. He might also conduct a series of assessments, such as psychological tests.[18]

Part 3
Knowing Your Treatment Options

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    Go inpatient for intensive eating disorder treatment. Depending on how low your body weight is, or if you are severely malnourished, you may have to be admitted into a hospital to be fed intravenously or through a stomach tube.[19]
    • Other reasons for inpatient treatment may include steady weight decline despite treatment, medical complications, psychiatric disorders or suicidal ideation (i.e. thoughts of wanting to kill yourself).
    • Anorexia commonly occurs with other disorders, which must also be addressed. These include major depression, self-harm, anxiety, obsessive-compulsive disorder, social phobia, and alcohol and drug (such as laxatives, diet pills, diuretics as well as opiates and sedatives) misuse.[20]
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    Receive therapy and nutritional counseling on an outpatient basis. Both the physical and psychological aspects of anorexia must be addressed in recovery. That's why an effective treatment team will include your primary care doctor, a dietitian, and a mental health provider like a psychologist.
    • Your primary care doctor will continue to conduct routine tests and exams to monitor your progress.[21]
    • A dietitian will help you determine the right amount of food and calories your body needs to return to a healthy weight. This professional will also help you learn coping strategies to deal with triggers and develop a healthier relationship with food and your body.[22]
    • A psychologist or mental health therapist will help you to identify and change negative thought patterns that have influenced your eating behaviors and your body weight obsession. In therapy, you will also work to improve pre-existing emotional and social problems that contribute to your eating disorder, such as being a perfectionist.[23]
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    Get prescribed medications, if necessary. Some medications that are used to treat mental health disorders may also be useful in improving the mood and outlook of patients with anorexia. Your primary care doctor may prescribe these medications to you, or you may need to see a psychiatrist for them.[24]
    • When used as a part of a well-rounded treatment approach, medications such as those that decrease depressive feelings, improve your mood, reduce worrying or fear (e.g. antidepressants, mood stabilizers, and antipsychotics) can significantly help with treatment outcomes.
    • Not everyone with anorexia will require medications. This will depend on the severity of your eating disorder and any other mental health issues you are dealing with at the same time.
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    Try a combination of treatment approaches for best results. Since anorexia nervosa is a complex disorder affecting many factors of your life, effective treatment should aim to improve your functioning across multiple areas.
    • Because anorexia can affect so many different aspects of a person's life and health, often the patient will work with a multidisciplinary treatment team. This means that not just one doctor will be able to treat you and you may have to try several different treatment approaches to see positive results.[25]
    • This group of health care providers can help you to overcome obsessive thoughts about your body, treat symptoms like depression or anxiety, manage your weight gain, and establish healthier eating patterns.[26]

Part 4
Helping a Loved One

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    Set up a quiet, private talk. Find a time when you both have plenty of time to talk, and get together somewhere private.[27] You may not be able to convince him he has an eating disorder, but you can voice your concerns and let him know you support him. Say something like, "I get concerned when I notice you skipping meals." It may also be helpful to address some of the side effects of anorexia, rather than the eating disorder itself. Address your loved one's depression, isolation, anxiety, or other side effects — he may be more willing to be seen for these issues, which may help initiate treatment for anorexia.[28]
    • When you express your concerns to your loved one, be aware that he may deny he has a problem or even get angry.[29] Try to stay calm and don't react with anger.
    • Remember that this is scary for the person with anorexia. The more empathy you have, the better. While you may not understand why it is difficult for the person to seek help, try to remember that it is stressful, confusing, challenging, and maybe even terrifying for him.[30] Never say anything like "Just do it," or "Just eat." This is not helpful and oversimplifies a very complex issue.[31]
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    Encourage the person to seek help. It can be frustrating and scary to see someone you love struggle with anorexia, especially if she denies there is a problem or refuses treatment. It is absolutely necessary to encourage your loved one to seek treatment.[32]
    • Ask if she wants help setting up an appointment. You can offer to make the appointment for her and/or to accompany her to see the doctor.[33]
    • There are some cases in which a person can be treated against her will. If the person with anorexia is under 18, then it is possible to require her to receive treatment, even if she doesn't believe it is necessary. Or, if the person is at the point where her life is at risk but she is still refusing treatment, doctors may decide to admit her for compulsory treatment.[34]
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    Follow up any promises to see a doctor. The person may try to appease you by promising he will see a doctor or therapist, but never actually follow through. If the person has told you he will take these steps, follow up to make sure he is making — and attending — appointments regularly.[35]
    • Be careful not to make this the only thing you talk about with him, or become combative or overly insistent, or he may begin to avoid you. Just make sure you are regularly checking in and reminding him you love and care about him.[36]
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    Be ready to respond to common objections to treatment. The person might say she is busy, it is expensive, or that it's really not that serious.[37]
    • If the person says she is busy, or is reluctant to miss any school or work, remind her that school and life will still be there after treatment. She may even be able to get treatment without disrupting her life too much.[38]
    • You might ask that, even if she doesn't think it's that bad, she talk to a doctor just to put your worries to rest.[39]
    • If money is an issue, help the person look for a therapist that works on a sliding scale, or suggest she speaks to a school counselor or someone who is available to talk to for free. She may also benefit from a support group or 12-step program that doesn't cost any money.
    • You might also note that, if the person is diagnosed with anorexia according to the DSM-V guidelines, her insurance may help pay for treatment. Examine her insurance plan, checking through the detailed descriptions of her benefits to find out what is covered and for how long. Or, if the insurance is through work, consult with human resources.[40]


  • When deciding whether or not a person has maintained a body weight less than the minimal normal level for age and height, mental health professionals also consider the individual's physical build and their weight history in addition to the symptom patterns. Simply being underweight does not mean that a person suffers from anorexia nervosa.


  • Only qualified mental health professionals can formally diagnose anorexia nervosa. If you or someone you know is possibly suffering from anorexia, please seek out professional help.

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Categories: Eating Disorders | Conditions and Treatments