Anorexia Nervosa (Anorexia)

Anorexia nervosa is the clinical term for the eating disorder that many parents know as anorexia. Both terms refer to the same condition. The Latin technical term appears primarily in doctors’ letters, diagnoses, and guidelines, and is used in child and adolescent psychiatry.

In the International Classification of Diseases, the disorder is listed under code F50.0. It belongs to the group of eating disorders—that is, mental health conditions that manifest strongly through eating behavior. The word “anorexia” literally means “loss of appetite,” but that description is only partially accurate: Those affected are usually hungry but consciously suppress their hunger. At the core of the condition is a deep-seated desire to be thin and a profound fear of gaining weight. This fear persists even when the person’s weight has long since fallen to a dangerously low level.

A healthcare professional determines whether a person has anorexia nervosa based on established criteria. Several characteristics must be present for a diagnosis:

• Significant underweight, which the person brings about themselves, for example through strict fasting, calorie counting, excessive exercise, or self-induced vomiting. In children and adolescents, a weight below the normal range for their age is considered a warning sign.
• An intense fear of gaining weight, even when the person is already underweight.
• Body image disturbance: Those affected perceive themselves as too fat, even though they are underweight. Their self-esteem is heavily influenced by their weight.
• Physical consequences such as the absence of menstruation or delayed physical development.

The American diagnostic system DSM-5 describes the disorder in a very similar way, but does not specify fixed weight limits and focuses more on the overall condition. Both systems emphasize that individuals often lack insight into their condition. This makes it difficult for them to seek help on their own.

Unlike the everyday definition, experts distinguish between two forms of anorexia nervosa. This classification helps in selecting the appropriate treatment.

• In the restrictive type, those affected lose weight primarily by strictly limiting food intake, fasting, and engaging in excessive exercise. Binge eating or self-induced vomiting do not occur regularly in this type.
• In the binge-eating/purging type, binge eating or compensatory behaviors—such as self-induced vomiting, laxatives, or diuretics—also occur.

The lines between the two are blurred, and the form can change over time. Some people with the disorder later develop bulimia nervosa. The purging type is more frequently associated with physical complications because vomiting and laxatives disrupt mineral balance. For parents, this distinction is less important than knowing that both forms are serious and require medical supervision.

There is no single cause. Experts believe it results from a combination of several factors. Genetic predisposition plays a role, as do the neurotransmitters in the brain that regulate hunger, satiety, and reward. Added to this are psychological traits such as pronounced perfectionism, high expectations of oneself, and the need to maintain control.

The disorder often begins during puberty, when the body and self-image are changing. Triggers can include dieting, teasing about one’s figure, traumatic experiences, or intense pressure to perform. Such events do not cause the disorder on their own, but they can set it off if a predisposition is already present. Important for parents: Anorexia nervosa is not caused by parenting mistakes. Blaming the child does not help. It is a recognized illness with both physical and psychological components—it is not a matter of willpower or defiance.

Anorexia nervosa is treatable, and the earlier treatment begins, the better the prognosis. Treatment usually centers on psychotherapy—often cognitive behavioral therapy—combined with gradual, supervised weight gain. For children and adolescents, family-based therapy—in which parents are actively involved—has proven effective. Depending on the severity of the condition, treatment takes place on an outpatient or inpatient basis. Medical checkups ensure that the heart, circulatory system, and metabolism remain stable.

As parents, you can make a big difference by staying calm, patient, and supportive of your child without putting pressure on them, and by seeking support for yourselves. “Rückenwind” is here to support you through coaching and parental guidance.

We cannot provide a diagnosis or medical treatment. Whether anorexia nervosa is present and what therapy is necessary can only be determined by a child and adolescent psychiatrist or a medical or psychotherapeutic specialist. If your child is severely underweight or experiencing rapid weight loss, you should seek this evaluation as soon as possible.