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Are you or a loved one struggling with anorexia? Explore the warning signs, symptoms, and causes of this serious eating disorder—as well as how to get the help you need.

Anorexia nervosa is a serious eating disorder characterized by a refusal to maintain a healthy body weight, an intense fear of gaining weight, and a distorted body image. Anorexia can result in unhealthy, often dangerous weight loss. In fact, the desire to lose weight may become more important than anything else. You may even lose the ability to see yourself as you truly are.

While it is most common among adolescent women, anorexia can affect women and men of all ages. You may try to lose weight by starving yourself, exercising excessively, or using laxatives, vomiting, or other methods to purge yourself after eating. Thoughts about dieting, food, and your body may take up most of your day—leaving little time for friends, family, and other activities you used to enjoy. Life becomes a relentless pursuit of thinness and intense weight loss. But no matter how skinny you become, it’s never enough.

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The intense dread of gaining weight or disgust with how your body looks, can make eating and mealtimes very stressful. And yet, food and what you can and can’t eat is practically all you can think about.

But no matter how ingrained this self-destructive pattern seems, there is hope. With treatment, self-help, and support, you can break the self-destructive hold anorexia has over you, develop a more realistic body image, and regain your health and self-confidence.

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While people with anorexia often exhibit different habits, one constant is that living with anorexia means you're constantly hiding those habits. This can make it hard at first for friends and family to spot the warning signs. When confronted, you might try to explain away your disordered eating and wave away concerns. But as anorexia progresses, people close to you won't be able to deny their instincts that something is wrong—and neither should you. If eating and weight control your life, you don't have to wait until your symptoms have progressed or your health is dangerously poor before seeking help.

Dieting despite being thin. Following a severely restricted diet. Eating only certain low-calorie foods. Banning “bad” foods such as carbohydrates and fats.

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Pretending to eat or lying about eating. Hiding, playing with, or throwing away food to avoid eating. Making excuses to get out of meals (“I had a huge lunch” or “My stomach isn't feeling good”).

Preoccupation with food. Constantly thinking about food. Cooking for others, collecting recipes, reading food magazines, or making meal plans while eating very little.

Strange or secretive food rituals. Refusing to eat around others or in public places. Eating in rigid, ritualistic ways (e.g. cutting food “just so, ” chewing food and spitting it out, using a specific plate).

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Feeling fat, despite being underweight. You may feel overweight in general or just “too fat” in certain places, such as the stomach, hips, or thighs.

Harshly critical of appearance. Spending a lot of time in front of the mirror checking for flaws. There's always something to criticize. You're never thin enough.

Denial that you're too thin. You may deny that your low body weight is a problem, while trying to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized clothes).

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Using diet pills, laxatives, or diuretics. Abusing water pills, herbal appetite suppressants, prescription stimulants, ipecac syrup, and other drugs for weight loss.

Throwing up after eating. Frequently disappearing after meals or going to the bathroom. May run the water to disguise sounds of vomiting or reappear smelling like mouthwash or mints.

Compulsive exercising. Following a punishing exercise regimen aimed at burning calories. Exercising through injuries, illness, and bad weather. Working out extra hard after bingeing or eating something “bad.”

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There are no simple answers to the causes of anorexia. Anorexia is a complex condition that arises from a combination of many social, emotional, and biological factors. Although our culture's idealization of thinness plays a powerful role, there are many other contributing factors, including your family environment, emotional difficulties, low self-esteem, and traumatic experiences you may have gone through in the past.

Psychological causes. People with anorexia are often perfectionists and overachievers. They tend to be the “good” daughters and sons who do what they’re told, excel in everything they do, and focus on pleasing others. But while they may appear to have it all together, inside they feel helpless, inadequate, and worthless. Through their harshly critical lens, if they’re not perfect, they’re a total failure.

Family and social pressures. In addition to the cultural pressure to be thin, there are other family and social pressures that can contribute to anorexia. These include participation in an activity that demands slenderness, such as ballet, gymnastics, or modeling. It can also include having parents who are overly controlling, put a lot of emphasis on looks, diet themselves, or criticize their children’s bodies and appearance. Stressful life events—such as the onset of puberty, a breakup, or going away to school—can also trigger anorexia.

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Biological causes. Research suggests that a genetic predisposition to anorexia may run in families. If a girl has a sibling with anorexia, she is 10 to 20 times more likely than the general population to develop anorexia herself. Brain chemistry also plays a significant role. People with anorexia tend to have high levels of cortisol, the brain hormone most related to stress, and decreased levels of serotonin and norepinephrine, which are associated with feelings of well-being.

While the causes of anorexia are uncertain, the physical effects are clear. When your body doesn't get the fuel it needs to function normally, it goes into starvation mode and slows down to conserve energy. Essentially, your body begins to consume itself. If self-starvation continues and more body fat is lost, medical complications pile up and your body and mind pay the price.

Deciding to get help for anorexia is not an easy choice to make. It's not uncommon to feel like anorexia is part of your identity—or even your “friend.” You may think that anorexia has such a powerful hold over you that you'll never be able to overcome it. But while change is hard, it

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Admit you have a problem. Up until now, you've been invested in the idea that life will improve—that you'll finally feel good—if you lose more weight. The first step in anorexia recovery is admitting that your relentless pursuit of thinness is out of your control and acknowledging the physical and emotional damage that you've suffered because of it.

Talk to someone. It can be hard to talk about what you're going through, especially if you've kept your anorexia a secret for a long time. You may be ashamed, ambivalent, or afraid. But it's important to understand that you're not alone. Find a good listener—someone who will support you as you try to heal.

Stay away from people, places, and activities that trigger your obsession with being thin. You may need to avoid looking at fashion or fitness magazines, spend less time with friends who constantly diet and talk about losing weight, and stay away from weight loss websites and “pro-ana” sites that promote anorexia.

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Medical treatment. The first priority in anorexia treatment is addressing and stabilizing any serious health issues. Hospitalization may be necessary if you are dangerously malnourished or so distressed that you no longer want to live. You may also need to be hospitalized until you reach a less critical weight. Outpatient treatment is an option when you’re not in immediate medical danger.

Nutritional treatment. A second component of anorexia treatment is nutritional counseling. A nutritionist or dietician will teach you about healthy eating and proper nutrition. The nutritionist will also help you develop and follow meal plans that include enough calories to reach or maintain a normal, healthy weight.

Therapy. Therapy is crucial to anorexia treatment. Its goal is to identify the negative thoughts and feelings that fuel your eating disorder and replace them with healthier, less distorted beliefs. Therapy can also help you deal with difficult emotions, relationship problems, and stress in a productive, rather than a self-destructive, way.

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The food and weight-related issues are in fact symptoms of a deeper issue: depression, anxiety, loneliness, insecurity, pressure to be perfect, or feeling out of control. Problems that no amount of dieting or weight loss can cure.

In order to overcome anorexia, you first need to understand that it meets a need in your life. For example, maybe you feel powerless in many parts of your life, but you can control what you eat. Saying “no” to food, getting the best of hunger, and controlling the number on the scale may make you feel strong and successful—at least for a short while. You may even come to