Understanding Anorexia: Causes, Treatment and the Path to Recovery

Anorexia nervosa is one of the most widely recognised eating disorders, yet it is also one of the most misunderstood. While many people associate anorexia with weight loss, the condition is far more complex than a desire to be thin. It is a serious mental health condition that affects the way a person thinks, feels and behaves around food, weight and their body.

For many people, anorexia gradually begins to dominate daily life. Thoughts about eating, exercise, weight and body shape can become overwhelming, leaving little room for work, relationships, hobbies or enjoyment. Although living with anorexia can feel exhausting, the idea of recovery can also feel frightening, making it difficult to seek help.

The good news is that recovery is possible. With appropriate treatment and support, many people regain not only their physical health but also their confidence, relationships and quality of life.

What is anorexia?

Anorexia nervosa is characterised by persistent restriction of food intake, an intense fear of gaining weight, and behaviours that cause weight loss. People with anorexia often develop a distorted perception of their body, seeing themselves differently from how others see them.

Low weight plays an important role in maintaining the cycle of anorexia, causing a preoccupation with food while also reinforcing a connection between self-worth and body shape or control over eating. Many people describe feeling trapped in an ongoing cycle of rules, rituals and anxiety surrounding food.

Many people with anorexia will also engage in cycles of binging and working hard to rid themselves of the food – via vomiting, laxative use or excessive exercise. These behaviours, known as “compensatory behaviours”, can provide immediate relief, but soon lead to further restriction and re-occurence of binging.

One of the challenges of anorexia is that people often do not recognise how unwell they have become. Others may feel they are “not sick enough” to deserve help because they compare themselves with someone who appears thinner or more unwell. In reality, early intervention leads to better outcomes, and support should be sought regardless of whether someone believes they have reached a particular weight or severity.

What causes anorexia?

There is no single cause of anorexia. Instead, it develops through a combination of genetic, psychological and social factors.

Genetics and personality

Research consistently shows that anorexia has a strong genetic component. Some people inherit a greater vulnerability to developing an eating disorder, particularly when certain personality characteristics are present.

Common personality traits associated with anorexia include:

• Perfectionism
• High levels of self-criticism
• Neuroticism or a tendency to experience emotions intensely
• A strong desire for achievement or control
• Obsessive or detail-focused thinking

These traits are not inherently problematic and are often strengths in many areas of life. However, they can increase vulnerability when combined with other risk factors.

Psychological experiences

Life experiences can also contribute to the development of anorexia. These might include:

• Bullying or teasing about appearance
• Trauma or adverse life experiences
• Sexual abuse
• Experiences that caused low self-esteem

It is important to remember that not everyone with anorexia has experienced trauma, and not everyone who experiences trauma develops anorexia. Rather, these experiences may increase vulnerability in some individuals.

Social and cultural influences

The environment we live in also plays a role. Exposure to unrealistic body ideals, appearance-focused social media and diet culture, have all been shown to contribute to body image dissatisfaction.

As well, you are more vulnerable to poor body image if you have participated in sports and activities that emphasise body size or weight – such as dance, gymnastics or endurance sports.

Unfortunately too, if you have been exposed to frequent role modelling from a loved one where the focus has been on body shape or size, or dieting, then you are also more susceptible to developing an eating disorder.

The common trigger: dieting

While many factors create vulnerability, dieting is often the event that triggers anorexia.

Many people who develop anorexia begin with what appears to be an ordinary attempt to lose weight or “eat healthier.” For someone who is genetically vulnerable, however, dieting can activate the illness. What starts as an attempt to improve health or appearance can gradually become increasingly restrictive, rigid and difficult to stop.

This helps explain why anorexia is never simply a matter of ceasing dieting. Once the illness develops, biological changes caused by starvation begin to reinforce the eating disorder, making recovery much harder than simply choosing to eat more.

Why do people delay seeking treatment?

One of the most challenging aspects of anorexia is that people often feel deeply conflicted about recovery.

On one hand, they may recognise how much the illness has taken from them. On the other, the eating disorder can feel incredibly difficult to let go of.

Common reasons people delay seeking help include:

Fear of weight gain

For many people, gaining weight feels terrifying. Even when someone understands the medical risks of anorexia, the fear of weight restoration can feel overwhelming.

Ambivalence about recovery

People often describe having a love-hate relationship with their eating disorder.

Some days they desperately want recovery. Other days they feel determined to continue losing weight or maintaining strict control over eating. These feelings can fluctuate daily and are often influenced by whether they perceive themselves as having “succeeded” or “failed” in managing their weight or food intake.

This ambivalence is a normal part of anorexia and does not mean someone cannot recover.

The eating disorder can feel protective

Although anorexia causes enormous suffering, it often serves important psychological functions.

People may feel that the eating disorder:

• Provides a sense of control during difficult periods of life.
• Suppresses painful emotions by creating a constant focus on food, weight and numbers.
• Creates a sense of identity, leaving people unsure who they would be without it.
• Helps maintain care, concern or connection from others.

Recognising these functions is an important part of treatment. Recovery is not simply about taking the eating disorder away—it is also about helping someone build healthier ways of coping and rediscovering who they are beyond the illness.

Feeling “not sick enough”

Many people delay treatment because they believe they are not underweight enough or that someone else deserves help more than they do.

This comparison is one of the hallmarks of eating disorders. There is no threshold someone needs to reach before seeking support. Early intervention is associated with better recovery outcomes.

What anorexia treatment options are available?

Treatment for anorexia depends on the severity of the illness, physical health and individual circumstances.

Inpatient hospital treatment

When someone is medically unstable or significantly malnourished, hospital admission may be necessary. Inpatient treatment focuses on medical stabilisation, nutritional rehabilitation and reducing immediate health risks before ongoing outpatient treatment continues.

Outpatient treatment

Many people receive treatment while continuing to live at home. Outpatient treatment commonly includes being connected to a hospital to attend a day program focused on nutritional and meal support alongside group therapy focused on recovery. While attending a day program, a full multi-disciplinary team – GP, psychiatrist, dietician and psychologist – will support the individual weekly.

Private medical and allied health support

Psychological therapy helps people understand the factors maintaining the eating disorder, challenge unhelpful beliefs, develop healthier coping strategies and gradually build a life that is no longer centred around food and weight. Different therapeutic approaches may be used depending on the person’s needs, including Cognitive Behavioural Therapy for Eating Disorders (CBT-E), Maudsley Family-Based Treatment (FBT) and other evidence-based approaches.

A GP also works with the individual to ensure ongoing medical monitoring, especially focusing on the health of the bones, cardiovascular system and any weight changes. A psychiatrist will also typically meet with a client with anorexia weekly, to monitor overall risk and illness progression, whilst treating any co-existing conditions that are interfering with anorexia recovery.

It is also common practice for a client with anorexia to be supported by a dietician, who will provide meal planning support and valuable information to challenge unhelpful eating disorder beliefs.

Why is restoring weight so important?

One of the core goals of anorexia treatment is returning to regular eating patterns and restoring the body to a healthy weight.

This can feel frightening, but there is an important reason why it is necessary.

Research on starvation—including the well-known Minnesota Starvation Experiment—demonstrated that prolonged undernutrition affects far more than physical health. Starvation changes how the brain functions and can cause many of the symptoms people associate with anorexia, including:

• Obsessive thoughts about food
• Increased anxiety
• Depression or low mood
• Irritability
• Poor concentration
• Rigid thinking
• Social withdrawal

As weight is restored, the brain becomes better able to think flexibly, regulate emotions and engage fully in eating disorder recovery. This is why nutritional rehabilitation is considered a fundamental part of recovery rather than simply a physical goal.

How do I get started with recovery?

Recovery rarely begins with feeling completely ready.

Many people start treatment while still feeling frightened about gaining weight or uncertain about letting go of the eating disorder. Instead, recovery often begins with a small part of you recognising that life could be different.

If you think you may be struggling with anorexia, consider:

• Speaking with your GP for an assessment and medical monitoring.
• Reaching out to an experienced psychologist who works with eating disorders.
• Seeking support from an Accredited Practising Dietitian with expertise in eating disorders.
• Talking to someone you trust rather than managing everything alone.

The earlier treatment begins, the greater the opportunity to interrupt the illness before it becomes more entrenched.

Our eating disorder services

At Peaceful Mind Psychology, our psychologists work with adolescents and adults experiencing anorexia and other eating disorders. We understand that recovery can feel overwhelming and that seeking help often comes with mixed emotions.

Our psychologists provide compassionate, evidence-based treatment tailored to each individual’s circumstances. We also place a strong focus on working collaboratively with GPs, dieticians and psychiatrists to ensure care addresses both the psychological and physical aspects of recovery.

Learn more about our comprehensive eating disorder services.

If you would like more understanding anorexia or helpful resources, Inside Out, and The Butterfly Foundation, have built a library of supportive information. 

If you are here for a loved one, you might find it helpful to read our article on How to be there: Supporting someone with an eating disorder.