Anorexia nervosa is a severe eating disorder characterized by a persistent restriction of energy intake, an intense fear of gaining weight, and a distorted perception of body shape or weight. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the disorder is diagnosed when a person's body weight is significantly below what is considered normal for their age, sex, and developmental stage. Individuals with anorexia nervosa often perceive themselves as overweight even when they are dangerously underweight, and they may go to extreme lengths to avoid gaining weight.

Globally, the prevalence of anorexia nervosa among women is estimated to be between 0.5% and 1%, while it is significantly lower in men (0.1% - 0.3%). In Turkey, the disorder is becoming increasingly common, particularly among adolescents and young adult women. Research suggests that psychological factors contribute to around 90% of anorexia nervosa cases, and the condition is approximately 80% more prevalent in women than men.

Diagnosis (According to DSM-5)

The DSM-5 outlines three core diagnostic criteria for anorexia nervosa. First, individuals must exhibit a significantly low body weight, typically defined as less than 85% of the expected weight for their age and height or a Body Mass Index (BMI) below 17.5. Second, there must be an intense fear of gaining weight or becoming fat, even when underweight. Third, the individual must demonstrate a disturbance in the way they perceive their body weight or shape, often placing undue importance on body image in self-evaluation. Studies suggest that distorted body perception occurs in approximately 70% of individuals with anorexia nervosa.

In Turkey, clinical diagnosis usually takes place in psychiatric clinics and university hospitals, where DSM-5 criteria are widely used by mental health professionals.

Key Features of Anorexia Nervosa

A central feature of anorexia nervosa is a deep-seated fear of weight gain, which persists even in the face of significant underweight status. Many individuals engage in restrictive eating patterns, often eliminating entire food groups and drastically reducing calorie intake. This behavior can lead to critical weight loss and, in some cases, starvation. It is estimated that about 85% of individuals with anorexia nervosa display restrictive eating behaviors. Another common feature, particularly in female patients, is amenorrhea - the absence of menstruation - which occurs in about 60% of cases due to extremely low levels of body fat.

Types of Anorexia Nervosa

Anorexia nervosa is divided into two clinical subtypes based on eating behavior patterns. The restricting type, which accounts for approximately 70% of cases, involves consistent limitation of food intake without regular engagement in binge-eating or purging behaviors. Individuals with this type may exhibit obsessive calorie counting, rigid food rules, and excessive exercise.

The binge-eating/purging type, representing about 30% of cases, is characterized by recurrent episodes of binge eating followed by purging methods such as self-induced vomiting, misuse of laxatives, or diuretics. About 50% of individuals with this subtype report regular misuse of laxatives. In Turkey, clinical observations suggest that the restricting type is more common among adolescents, particularly females.

Symptoms of Anorexia Nervosa

The symptoms of anorexia nervosa are both physical and psychological. Physical symptoms include rapid and extreme weight loss (sometimes 25% below the minimum healthy weight), persistent fatigue, hair thinning, dry skin, cold intolerance, and irregular heartbeat. Psychological symptoms may include severe anxiety, obsessive thoughts about food and body image, and depression. Around 80% of individuals with anorexia nervosa also experience comorbid mental health conditions such as anxiety disorders or major depression. Social withdrawal is another frequently observed symptom, as individuals may isolate themselves to avoid social eating situations or due to shame about their body.

In psychiatric clinics across Turkey, patients often present with a combination of these symptoms, which guides the development of personalized treatment plans.

Causes of Anorexia Nervosa

Anorexia nervosa is understood to be caused by a complex interplay of psychological, familial, sociocultural, and biological factors. Psychological contributors include low self-esteem, perfectionism, and anxiety disorders. Familial influences, such as overly protective or controlling parenting styles, can exacerbate these tendencies. Sociocultural factors, especially media portrayals of thinness as the ideal body type, have a powerful impact - studies show that up to 70% of young women develop body image dissatisfaction due to societal pressures.

Biologically, genetics and neurochemical imbalances are believed to play a role, with research indicating a 50–60% heritability rate. In Turkey, the rise of social media platforms like Instagram has been linked to increased body dissatisfaction among adolescents, highlighting the role of contemporary social influences.

Treatment of Anorexia Nervosa

The treatment of anorexia nervosa requires a multidisciplinary approach involving medical, nutritional, and psychological interventions. Medical treatment focuses on stabilizing the individual’s physical health, particularly in life-threatening cases involving electrolyte imbalances or cardiac irregularities. In severe cases, hospitalization is necessary.

Psychotherapeutic approaches play a central role in long-term recovery. Cognitive Behavioral Therapy (CBT) is one of the most effective treatments, showing symptom improvement rates of around 70%. Family-Based Therapy (FBT), particularly useful for adolescents, boasts success rates as high as 80%. Individual therapy may also be employed, especially in chronic cases.

Nutritional counseling is crucial for helping patients regain weight safely and restore healthy eating habits. Although there are no medications specifically approved to treat anorexia nervosa, antidepressants or anti-anxiety medications may be prescribed to manage comorbid conditions. In major cities across Turkey, such as Istanbul and Ankara, psychiatric clinics increasingly adopt these evidence-based treatment models.