A Parent’s Guide To Anorexia Nervosa

Who develops anorexia?

Anorexia nervosa doesn’t have a single cause—it develops through a combination of biological, psychological, and environmental factors. Often, anorexia begins with what looks like a harmless diet or a desire to “eat healthier.” But over time, restriction can become more extreme and compulsive, leading to serious physical and emotional consequences.

As the disorder progresses, food and body image may begin to dominate a person’s thoughts. These behaviors can become a way to cope with anxiety, self-doubt, or a need for control—making them especially difficult to stop without professional support.

So, who’s most at risk for developing anorexia?

• Those with a family history. Children with a close relative who has had an eating disorder are at higher risk.

• Certain personality traits. Traits like perfectionism, rigidity, and difficulty managing distress can all increase vulnerability. Many kids with anorexia struggle with intense emotions, anxiety being the most common, and try to avoid or control those emotions with disordered eating behaviors.

• Athletes and dancers. While sports like gymnastics, figure skating, and wrestling are well-known risk areas, any sport can raise the risk—especially in performance-focused or body-conscious environments.

Anorexia Myths

Medical complications of anorexia

Anorexia nervosa doesn’t just affect how someone eats—it impacts nearly every organ system in the body. The effects of prolonged malnutrition, along with potential purging behaviors, can lead to serious and sometimes life-threatening medical complications. Many of these issues develop gradually and may not be immediately visible, which is why regular medical monitoring is so important. Below are some of the most common health risks associated with anorexia, especially when the disorder goes untreated.

• Loss of menstrual cycle (amenorrhea) - For girls and teens who have started menstruating, the absence of a period can be a sign the body isn’t getting enough energy to function properly.

• Thinning hair or hair loss - Hair may become dry, brittle, or fall out due to nutritional deficiencies and hormonal changes.

• Lanugo (fine hair growth) - Soft, downy hair may appear on the arms, back, or face as the body tries to stay warm during malnutrition.

• Always feeling cold - Poor circulation and low body fat can make your child feel cold all the time, especially in their hands and feet—even when others are comfortable.

• Hypoglycemia (low blood sugar) - Caused by inadequate food intake, it can lead to shakiness, dizziness, confusion, fainting, and in severe cases, seizures or loss of consciousness.

• Dizziness or fainting - Low blood pressure, dehydration, and inadequate nutrition can cause your child to feel lightheaded or faint.

• Bradycardia (slow heart rate) - A dangerously low heart rate caused by the body conserving energy during malnutrition; can increase the risk of fainting, fatigue, and heart failure.

• Osteopenia & Osteoporosis - Prolonged malnutrition can lead to a reduction in bone density. Even children and adolescents can develop osteopenia or osteoporosis throughout the course of their anorexia.

• Gastroparesis - Also referred to as delayed gastric emptying, malnutrition can cause the stomach to slow down, causing food to linger in the stomach for longer than normal. Symptoms of gastroparesis include extreme bloating, nausea, and the sensation of early fullness (feeling stuffed after just a few bites of food).

• Low energy or fatigue - You may notice your child seems tired, moves slowly, or avoids physical activity—they simply don’t have the fuel to keep up.

• Dental erosion - In those who purge, repeated vomiting can damage tooth enamel, leading to sensitivity, cavities, or visible dental wear.

• Swollen cheeks or jaw - Swelling of the salivary glands from vomiting can cause puffiness in the cheeks or along the jawline.

• Calluses on knuckles - Repeated self-induced vomiting may cause calluses or scars on the back of the hand where it comes into contact with the teeth (known as Russell’s sign).

How would I know if my child has anorexia?

Anorexia often develops gradually, and many of the early warning signs can be subtle or easily dismissed as “normal” teen behavior. However, when viewed together, certain patterns begin to emerge. Below are some of the most common behavioral and emotional signs of anorexia nervosa. While every child is different, these signs may indicate that your child is struggling with restrictive eating or distress around food and body image.

Behavioral Signs

• Preoccupation with weight, food, calories, or exercise - Your child may talk obsessively about “eating healthy,” counting calories, or weight. They might track their intake, follow restrictive social media accounts, or seem obsessed with thoughts about food or their bodies.

• Skipping meals or avoiding eating around others - You may notice frequent excuses like “I already ate” or “I’m not hungry.” They might avoid family meals or feel anxious in social settings that involve food.

• Rigid food rules and food rituals - Behaviors like cutting food into tiny pieces, eating foods in a certain order, or sticking to a narrow list of “safe” foods can signal disordered patterns and an attempt to control anxiety.

• Intense fear of weight gain - Even when underweight, your child may express fear of gaining weight or being fat, talk negatively about their body, or resist efforts to increase food intake.

• Excessive or compulsive exercise - They may insist on exercising daily—even when tired, sick, or injured—and feel anxious or guilty if they miss a workout.

• Body checking behaviors - Frequent mirror-gazing, pinching or touching parts of their body (like stomach, collar bones, or thighs), weighing themselves obsessively, or studying pictures of themselves are all examples of body checking.

• Avoiding social events that involve food - Your child might pull away from parties, celebrations, or outings that involve meals, often using vague excuses to avoid eating in front of others.

• Frequently going to the bathroom after meals - Regularly heading to the bathroom after eating—especially for long periods—may indicate purging behaviors, more common in the binge/purge subtype.

Emotional signs

• Withdrawal from friends, family, and activities - Your child may start pulling away from loved ones or stop participating in hobbies they once enjoyed, especially if those activities involve food or social interaction.

• Obsessive thoughts about food, weight, or body shape - They might spend much of the day thinking about eating, planning meals, or worrying about their body—often at the expense of school, relationships, or rest.

• Guilt or shame after eating - Even after eating small or reasonable amounts, your child may express regret, self-criticism, or engage in compensatory behaviors like restricting or over-exercising.

• Difficulty concentrating or “brain fog” - Lack of nutrition affects brain function. You may notice your child struggling to focus, feeling mentally foggy, or seeming more forgetful or indecisive than usual.

• Heightened anxiety or depression - Many individuals with anorexia experience increased emotional distress, including low mood, irritability, nervousness, or hopelessness.

• Denial of the seriousness of their condition (anosognosia) - Even in the face of medical concerns or visible weight loss, your child may insist they’re “fine” and minimize or reject the idea that anything is wrong.

• Therapist: The therapist plays a central role in your child’s eating disorder treatment team. Their job is to help your child understand why the eating disorder developed, what maintains it, and how to manage the emotional challenges that come with recovery. Therapists work with clients to build skills for coping with anxiety, increasing distress tolerance, managing depression, and addressing the underlying fears—like rejection, isolation, or not being “enough”—that often drive disordered behaviors.

  That intense anxiety your child feels after eating? The therapist helps them learn how to manage it. The fear of being judged or abandoned? The therapist helps them explore and heal those wounds over time. Of all the providers on the team, the therapist is often the one your child will work with the longest, providing a consistent space for emotional growth and support throughout recovery.

• Dietitian: The dietitian on your child’s treatment team plays a crucial role in restoring physical health and supporting a more balanced relationship with food. Their job is to provide accurate, evidence-based nutrition education, correct common myths about dieting or “healthy” eating, and create a structured meal plan tailored to your child’s needs.

  Unlike general dietitians, eating disorder dietitians are trained to work through the emotional side of eating. They spend time exploring your child’s fears around food and weight gain—and help them take gradual steps toward a more flexible and nourishing relationship with food. Because of their expertise in nutrition and the effects of malnutrition on the body, dietitians are also skilled at recognizing early signs of medical instability and will refer to a physician when additional care is needed.

• Medical Providers: Whether it’s a medical doctor, nurse practitioner, or physician assistant, a medical provider becomes an essential part of the treatment team when an eating disorder begins to impact a child’s physical health. These providers monitor key medical indicators—such as lab work, vital signs, and growth patterns—to assess for signs of medical instability. In addition to regular monitoring, they may prescribe medications that support recovery.

  For example, gastrointestinal discomfort is common in eating disorder recovery, and a provider can offer treatments to ease those symptoms and make eating feel more manageable. While medical providers can prescribe basic psychiatric medications, like antidepressants, they will often refer to a psychiatrist for more complex medication needs. It is ideal for your child’s medical provider to have specific training in eating disorders, as many medical complications can be subtle—and easily overlooked by providers without this expertise.

• Psychiatrist: A psychiatrist is a medical doctor who specializes in mental health and is responsible for managing psychiatric medications, such as antidepressants, anti-anxiety medications, or mood stabilizers. Appointments with a psychiatrist may feel similar to therapy sessions, but they tend to focus more on symptom monitoring and medication management. Psychiatrists usually meet with patients less frequently than therapists—often every few weeks or months—to assess progress and make any necessary adjustments to medications.

  While it’s ideal to work with a psychiatrist who has some understanding of eating disorders, they don’t necessarily need to be a specialist. As long as they have a basic awareness of how eating disorders work, they can safely and effectively support your child’s mental health needs without interfering with the overall recovery process.

Treatment approaches

Anorexia treatment should be tailored to the individual, as no single approach works for everyone. Some of the most commonly used evidence-based treatments include:

• Cognitive Behavioral Therapy (CBT): CBT helps individuals identify and challenge unhelpful thoughts and behaviors related to food, body image, and self-worth. It’s especially effective for older teens and adults who can reflect on their thought patterns and motivations.

• Family-Based Treatment (FBT): Also known as the Maudsley Method, FBT is a structured, three-phase approach that empowers parents to take an active role in their child’s recovery. It focuses on early weight restoration and has strong evidence supporting its effectiveness, particularly for adolescents still living at home.

• Dialectical Behavior Therapy (DBT): A modern, skills-based approach that helps individuals learn to regulate their emotions, cope with distress, and practice mindfulness. One of its core concepts, Radical Acceptance, encourages people to acknowledge difficult thoughts or feelings without judgment. DBT can be especially helpful in eating disorder treatment, as many individuals struggle to manage overwhelming emotions or tolerate distress without turning to disordered behaviors.

• Acceptance and Commitment Therapy (ACT): Pronounced like the word “act”—is a modern therapeutic approach that helps individuals respond to difficult thoughts and emotions without turning to self-destructive behaviors. A core goal of ACT is to help people build a values-based life, meaning they learn to make choices aligned with what truly matters to them, even in the presence of emotional pain. For those in eating disorder recovery, ACT can be a powerful tool for reconnecting with purpose and developing healthier, more flexible ways of coping.

• Radically Open Dialectical Behavior Therapy (RO-DBT): A structured treatment approach designed for individuals who struggle with overcontrol—traits like perfectionism, emotional inhibition, and rigid thinking. These traits are common in many people with anorexia and can make recovery especially challenging. RO-DBT helps individuals increase emotional openness, build flexibility, and feel more connected to others—supporting not just symptom reduction, but deeper, lasting change. RO-DBT is traditionally conducted in a group setting and thus makes a great adjunct therapy for someone in anorexia recovery.

The path to recovery:

Full recovery from anorexia is possible—but it often takes time, and the process isn’t always linear. Setbacks will occur, which is why continued support is so important. Long-term recovery typically includes ongoing therapy, nutrition counseling, regular medical check-ins, and community connection through support groups or group therapy. For many adolescents with anorexia, participation in a higher level of care treatment program may be necessary. Every recovery journey is unique. With patience, persistence, and the support of a skilled care team, healing is not only possible—it’s within reach.

How do you treat anorexia?

Anorexia, like all eating disorders, requires a comprehensive, team-based approach to treatment. The most effective care involves a multidisciplinary team that includes a therapist, a registered dietitian, a medical provider, and—when needed—a psychiatrist.

This coordinated model is often referred to as a “treatment team.” For outpatient care, the core team typically includes a therapist and dietitian working together to support both the emotional and nutritional aspects of recovery.

Given the serious medical risks associated with anorexia, regular monitoring by a physician is essential, and psychiatric support may be added to manage co-occurring conditions like anxiety or depression. Every primary provider should have specific training in eating disorders, as non-specialists—though well-intentioned—may unintentionally reinforce disordered behaviors or delay progress.