Educator`s Guide to Anorexia Nervosa

By Leah Davies, M.Ed.

Anorexia nervosa is an eating disorder characterized by self-starvation and acute anxiety regarding gaining weight. It occurs most often in teenage girls, but has also been diagnosed in teenage boys and adults. Ninety to ninety-five percent of anorexics are female, yet the percentage of males is increasing. The illness is usually associated with Caucasians, but it is becoming more common in other ethnic groups. Approximately one percent of the population of the United States suffers from this eating disorder, and about ten percent of those with anorexia will die (

Although symptoms of anorexia nervosa usually begin around puberty, recently psychiatrists have observed girls as young as eight displaying anorexic patterns of behavior. This is of concern since children must have proper nutrition to develop normally. Unlike adults, children’s eating disorders manifest quickly and become debilitating within a few months.

Anorexia is not to be confused with bulimia. Individuals suffering from bulimia eat large amounts of food and then regurgitate. This is called binge and purge. Anorexics starve themselves and exercise compulsively. However, individuals may demonstrate a combination of symptoms from both eating disorders.

Those who suffer from anorexia are obsessed with being thin. They appear emaciated to others, yet continue to think that they are overweight. Anorexics are often perfectionists, but any child can exhibit symptoms -- including individuals who are socially popular, good students and involved in sports and activities. Anorexia nervosa has been associated with persons dedicated to dance, theater, modeling and distance running.

Signs that a Student May Have Anorexia

  • Losing excessive amounts of weight

  • Obsessing over food and calories

  • Denying being hungry

  • Complaining about feeling fat

  • Making excuses for not eating in front of others

  • Refusing to eat from certain food groups

  • Exhibiting strange eating rituals

  • Using laxatives

  • Exercising excessively

  • Wearing baggy clothes to hide weight loss

  • Appearing anxious and/or withdrawn

  • Being moody and/or depressed

  • Having difficulty concentrating

  • Exhibiting fatigue and weakness

  • Having dry skin, hair and nails

  • Losing scalp hair

  • Being sensitive to cold temperatures

  • Developing fine hair all over the body

  • Having irregular or no monthly menstruation

Medical Risks of Anorexia

  • Delayed puberty and infertility in females

  • Low blood pressure and pulse that could lead to heart failure

  • Muscle loss and weakness

  • Mineral bone loss that increase the risk of fractures or osteoporosis

  • Decrease in bowel muscle function

  • Severe dehydration resulting in kidney failure

  • Death


Anorexia is thought to be caused by a combination of cultural, psychological, familial and biological factors. Cultural influences such as slimness promoted by movie stars in the media can influence young people, as well as peer pressure to be thin. Psychological factors include distorted thoughts such as a belief that being thin will solve emotional problems and a feeling that happiness can only occur when extreme thinness is achieved.

Controlling food intake can make anorexics feel beautiful, confident, in charge of their lives and good at something. Parental attitudes toward food and obesity can affect a child’s body image. A controlling parent can also contribute to a child having an eating disorder. However, genetics is thought to be involved, as well. Dr. Walter Kaye, director of an eating disorders clinic at the University of Pittsburgh School of Medicine, and other researchers contend that a complex combination of genes foster an anorexic’s behavior and exaggerated thinking. Dr. Kaye has observed anorexics ignore warning signs of their unsafe habits and claims that brain chemistry severely influences an anorexic’s attitude toward food and other comforts of life( A Genetic Study of Anorexia Nervosa In Families).


When treatment is immediate and intensive the chances of recovery from anorexia are greatly enhanced. However, treatment is often difficult because anorexics believe there is nothing wrong with them. They deny, resist, and become angry when adults try to help. Specialists in child and adolescent medicine, nutrition, psychiatry, and/or psychology are needed to assist them in achieving physical and mental wellness. Treatment can include individual, group and family therapy, as well as medication.
Recently treatment centers have realized the need to include family members in the rehabilitation process. Anorexics with severe malnutrition and dehydration may need hospitalization.

Pro-anorexia Websites

Educators need to be aware of pro-anorexia websites that target girls. These sites provide a place for anorexics to feel understood, accepted and have their behavior validated. The premise of “pro-ana” sites is that the desire to achieve an unnaturally slim figure is not a mental disorder, but an alternative lifestyle. Many of them encourage drastic weight loss and dangerous behaviors through the use of photos of emaciated girls, dieting tips, chatrooms, and tips on how to hide the disorder. Their postings are called “thinspiration.” Due to media attention many pro-ana web sites have become secretive using identifying words such as “perfection” and “thinnest.” In 2000-2002, pro-ana groups had hundreds of websites, but today the movement is less visible due to professional concern and search engine censorship.

It is often difficult for a parent to believe that their child is suffering from anorexia because they do not understand the mental illness or know how dangerous it can be. They may be in denial, saying to themselves, “She must be exercising too much, or she is so busy she doesn’t have time to eat.” Educators on the other hand can be objective observers of weight loss and behavior changes in students. When an eating disorder is suspected, educators must meet with parents to share their concerns. Specialized treatment is typically needed to help these students learn to live a healthy life.

Articles on this site related to this topic are, "Is Family Mealtime Important?" and "Overweight Children."

Used by permission of the author, Leah Davies, and selected from the Kelly Bear website [], 2/06

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