Current Perspectives on Anorexia Nervosa in Health and Therapy - a review
DOI:
https://doi.org/10.12775/QS.2025.43.61300Keywords
Anorexia nervosa, Eating disorders, Mental health, Health education, Adolescent health, Therapeutic approaches, Public healthAbstract
Introduction and purpose: Anorexia nervosa is a serious mental disorder characterized by persistent food restriction, intense fear of gaining weight, and distorted body image. Despite decades of research, anorexia remains challenging to diagnose and treat due to its complex psychological, social, and biological roots. This review aims to summarize current knowledge on anorexia nervosa, focusing on updated diagnostic criteria, risk factors, treatment strategies, and emerging trends in therapy and healthcare.
Material and method: A narrative literature review was conducted using publications from 2010 to 2024, sourced from databases such as PubMed, Scopus, and Web of Science. Inclusion criteria covered peer-reviewed articles on the epidemiology, diagnosis, treatment, and neurobiological or psychosocial aspects of anorexia nervosa. Studies were selected based on relevance, methodological quality, and applicability to adolescent and adult populations.
Results: The review highlights significant developments in understanding anorexia nervosa. Diagnostic updates in DSM-5 and ICD-11 have influenced prevalence estimates. Risk factors include genetic predisposition, personality traits, and sociocultural pressures. Contemporary treatments integrate psychotherapies (CBT-E, FBT, ACT), digital interventions, and pharmacotherapy. Barriers such as stigma, late diagnosis, and insufficient specialist care persist. Emerging research explores neurobiology, executive functioning, and circadian rhythms.
Conclusions: Anorexia nervosa is a multifactorial disorder requiring interdisciplinary approaches. Advances in diagnosis and treatment must be supported by greater public awareness, early intervention, and integration of educational and therapeutic strategies. Further research is needed to personalize care and improve long-term outcomes.
References
1. Sansfaçon J, Steiger H, Gauvin L, Fletcher É, Israël M. Does Level of Motivation for Change Impact Post-Treatment Outcomes in the Eating Disorders? Protocol for a Systematic Review With Quantitative Analysis. J Eat Disord. 2017;5(1). doi:10.1186/s40337-017-0147-1
2. Zhu J, Yang Y, Touyz S, Park R, Hay P. Psychological Treatments for People With Severe and Enduring Anorexia Nervosa: A Mini Review. Front Psychiatry. 2020;11. doi:10.3389/fpsyt.2020.00206
3. Jansingh A, Danner UN, Hoek HW, Elburg A. Developments in the Psychological Treatment of Anorexia Nervosa and Their Implications for Daily Practice. Curr Opin Psychiatry. 2020;33(6):534-541. doi:10.1097/yco.0000000000000642
4. Lloyd EC, Haase AM, Foster C, Verplanken B. A Systematic Review of Studies Probing Longitudinal Associations Between Anxiety and Anorexia Nervosa. Psychiatry Res. 2019;276:175-185. doi:10.1016/j.psychres.2019.05.010
5. Berg E v. d., Pellemans K, Planting CHM, et al. Treatment of Patients With Anorexia Nervosa and Comorbid Post-Traumatic Stress Disorder; Where Do We Stand? A Systematic Scoping Review. Front Psychiatry. 2024;15. doi:10.3389/fpsyt.2024.1365715
6. Brytek‐Matera A. Prevalence of Anorexia Nervosa and Bulimia Nervosa in Eastern Europe. Psychiatr Psychol Klin. 2023;23(4):332-337. doi:10.15557/pipk.2023.0041
7. Gaudio S, Carducci F, Piervincenzi C, Olivo G, Schiöth HB. Altered Thalamo–cortical and Occipital–parietal–temporal–frontal White Matter Connections in Patients With Anorexia and Bulimia Nervosa: A Systematic Review of Diffusion Tensor Imaging Studies. J Psychiatry Neurosci. 2019;44(5):324-339. doi:10.1503/jpn.180121
8. Bannatyne A, Abel L. Can We Fight Stigma With Science? The Effect of Aetiological Framing on Attitudes Towards Anorexia Nervosa and the Impact on Volitional Stigma. Aust J Psychol. 2015;67(1):38-46. doi:10.1111/ajpy.12062
9. Kennedy S, Krive K. Developmental Consequences of Restrictive Eating Disorders After Childhood Obesity: Two Case Reports. Spartan Med Res J. 2017;1(2). doi:10.51894/001c.5782
10. Mustelin L, Silén Y, Raevuori A, Hoek HW, Kaprio J, Keski‐Rahkonen A. The DSM-5 Diagnostic Criteria for Anorexia Nervosa May Change Its Population Prevalence and Prognostic Value. J Psychiatr Res. 2016;77:85-91. doi:10.1016/j.jpsychires.2016.03.003
11. Forney KJ, Rezeppa TL, Hill NG, Bodell LP, Brown TA. Examining the Placement of Atypical Anorexia Nervosa in the Eating Disorder Diagnostic Hierarchy Relative to Bulimia Nervosa and Binge‐eating Disorder. Int J Eat Disord. 2024;57(4):839-847. doi:10.1002/eat.24122
12. Walsh BT, Hagan KE, Lockwood C. A Systematic Review Comparing Atypical Anorexia Nervosa and Anorexia Nervosa. Int J Eat Disord. 2022;56(4):798-820. doi:10.1002/eat.23856
13. Quadflieg N, Voderholzer U, Meule A, Fichter MM. Comparing ICD‐11 and DSM‐5 Eating Disorder Diagnoses With the Munich Eating and Feeding Disorder Questionnaire (ED‐Quest). Int J Eat Disord. 2023;56(9):1826-1831. doi:10.1002/eat.24010
14. Dang AB, Granero R, Sánchez I, et al. Unveiling Severity Indicators for Anorexia and Bulimia Nervosa Treatment Success: DSM–5 Versus ICD–11 Versus Drive for Thinness. Eur Eat Disord Rev. 2024;33(3):460-471. doi:10.1002/erv.3156
15. Attia E, Guarda ÁS. OSFED Subtypes: The Need for Better Definitions. Int J Eat Disord. 2024;57(10):2053-2055. doi:10.1002/eat.24275
16. Smink FRE, Hoeken D v., Hoek HW. Epidemiology, Course, and Outcome of Eating Disorders. Curr Opin Psychiatry. 2013;26(6):543-548. doi:10.1097/yco.0b013e328365a24f
17. Westmoreland P, Mehler PS. Feeding and Eating Disorders. Medicine (Baltimore). Published online 2021. doi:10.2310/im.13038
18. Attia E, Becker AE, Bulik CM, et al. Defining Eating Disorders. Published online 2017:289-314. doi:10.1093/med-psych/9780199928163.003.0013
19. Mancuso SG, Newton R, Bosanac P, Rossell SL, Nesci JB, Castle D. Classification of Eating Disorders: Comparison of Relative Prevalence Rates Using DSM-IV and DSM-5 Criteria. Br J Psychiatry. 2015;206(6):519-520. doi:10.1192/bjp.bp.113.143461
20. Kramarova V, Polonska L, Tyravska Y. Influence of Carbohydrate-Restricted Diet on Some Hemostasis Parameters in Arterial Hypertension Patients With Increased Body Mass Index. Published online 2020. doi:10.36074/03.04.2020.v2.07
21. Düplois D, Brosig L, Hiemisch A, et al. Distribution and Clinical Comparison of Restrictive Feeding and Eating Disorders Using ICD‐10 and ICD‐11 Criteria. Int J Eat Disord. 2023;56(9):1717-1729. doi:10.1002/eat.23994
22. Meng B. The Advances of Eating Disorders in Adolescent. Published online 2021. doi:10.2991/assehr.k.211220.349
23. Garaci F, Vasili E, Bocchinfuso F, et al. Paucisymptomatic Pulmonary and Right Ear Tuberculosis in Young Woman Suffering From Anorexia and Bulimia Nervosa. Radiol Case Rep. 2019;14(3):423-426. doi:10.1016/j.radcr.2018.10.019
24. Silén Y, Sipilä PN, Raevuori A, et al. DSM‐5 Eating Disorders Among Adolescents and Young Adults in Finland: A Public Health Concern. Int J Eat Disord. 2020;53(5):790-801. doi:10.1002/eat.23236
25. Eli K. Latin American Countries Lead in Google Search Volumes for Anorexia Nervosa and Bulimia Nervosa: Implications for Global Mental Health Research. Int J Eat Disord. 2018;51(12):1352-1356. doi:10.1002/eat.22969
26. Dagenais S, Fielding RA, Clark S, Cantu C, Prasad SM, Groarke J. Anorexia in Medicare Fee-for-Service Beneficiaries: A Claims-Based Analysis of Epidemiology and Mortality. J Nutr Health Aging. 2023;27(3):184-191. doi:10.1007/s12603-023-1882-4
27. Nomoto A, Shimizu A, Ohno T, et al. Poor Oral Health and Anorexia in Older Rehabilitation Patients. Gerodontology. 2021;39(1):59-66. doi:10.1111/ger.12600
28. Cox N. Consequences of Anorexia of Aging in Hospital Settings: An Updated Review. Clin Interv Aging. 2024;Volume 19:451-457. doi:10.2147/cia.s431547
29. Francesco VD, Pellizzari L, Corrà L, Fontana G. The Anorexia of Aging: Impact on Health and Quality of Life. Geriatr Care. 2018;4(2). doi:10.4081/gc.2018.7324
30. Wei S, Liu C, Wu Y. Examining Studies on the Effectiveness of Cognitive Behavioral Therapy in Treating Eating Disorders: A Look at Both Western and Asian Studies. Published online 2024:63-75. doi:10.2991/978-2-38476-222-4_9
31. Adams DM, Reay WR, Cairns MJ. Multiomic Prioritisation of Risk Genes for Anorexia Nervosa. Published online 2022. doi:10.1101/2022.06.04.22275898
32. Phillipou A, Carruthers SP, Biase MAD, et al. White Matter Microstructure in Anorexia Nervosa. Hum Brain Mapp. 2018;39(11):4385-4392. doi:10.1002/hbm.24279
33. Meier S, Bulik CM, Thornton LM, Mattheisen M, Mortensen PB, Petersen L. Diagnosed Anxiety Disorders and the Risk of Subsequent Anorexia Nervosa: A Danish Population Register Study. Eur Eat Disord Rev. 2015;23(6):524-530. doi:10.1002/erv.2402
34. Fairweather‐Schmidt AK, Wade T. Weight-Related Peer-Teasing Moderates Genetic and Environmental Risk and Disordered Eating: Twin Study. Br J Psychiatry. 2017;210(5):350-355. doi:10.1192/bjp.bp.116.184648
35. Mitchison D, Dawson L, Hand L, Mond J, Hay P. Quality of Life as a Vulnerability and Recovery Factor in Eating Disorders: A Community-Based Study. BMC Psychiatry. 2016;16(1). doi:10.1186/s12888-016-1033-0
36. Dudová I, Koutek J, Kocourková J. Suicidal Behavior and Self-Harm in Girls With Eating Disorders. Neuropsychiatr Dis Treat. Published online 2016:787. doi:10.2147/ndt.s103015
37. Nowakowski ME, McFarlane T, Cassin SE. Alexithymia and Eating Disorders: A Critical Review of the Literature. J Eat Disord. 2013;1(1). doi:10.1186/2050-2974-1-21
38. Carpiniello B, Pinna F, Sanna L. Alexithymia in Eating Disorders: Therapeutic Implications. Psychol Res Behav Manag. Published online 2014:1. doi:10.2147/prbm.s52656
39. Sandri E, Larumbe EC, Cerdá‐Olmedo G, et al. Anorexia and Bulimia Nervosa in Spanish Middle-Aged Adults: Links to Sociodemographic Factors, Diet, and Lifestyle. Nutrients. 2024;16(16):2671. doi:10.3390/nu16162671
40. Jarvers I, Ecker A, Schleicher D, Kandsperger S, Otto A, Brunner R. Anorexia Nervosa During COVID-19: Loss of Personal Control and Alexithymia as Important Contributors to Symptomatology in Adolescent Girls. J Eat Disord. 2023;11(1). doi:10.1186/s40337-023-00905-w
41. Aprahamian I, Coats AJ, Morley JE, Klompenhouwer T, Anker SD. Anorexia of Aging: An International Assessment of Healthcare Providers’ Knowledge and Practice Gaps. J Cachexia Sarcopenia Muscle. 2023;14(6):2779-2792. doi:10.1002/jcsm.13355
42. Wysokiński A, Sobów T, Kłoszewska I, Kostka T. Mechanisms of the Anorexia of Aging—a Review. Age. 2015;37(4). doi:10.1007/s11357-015-9821-x
43. Donini LM, Domínguez LJ, Barbagallo M, et al. Senile Anorexia in Different Geriatric Settings in Italy. J Nutr Health Aging. 2011;15(9):775-781. doi:10.1007/s12603-011-0048-y
44. Yu W, Yu W, Liu X, et al. Associations Between Malnutrition and Cognitive Impairment in an Elderly Chinese Population: An Analysis Based on a 7‐year Database. Psychogeriatrics. 2020;21(1):80-88. doi:10.1111/psyg.12631
45. Regan PC, Cachelin FM, Minnick AM. Initial Treatment Seeking From Professional Health Care Providers for Eating Disorders: A Review and Synthesis of Potential Barriers to and Facilitators of “First Contact.” Int J Eat Disord. 2017;50(3):190-209. doi:10.1002/eat.22683
46. Baffsky R. Eating Disorders in Australia: A Commentary on the Need to Address Stigma. J Eat Disord. 2020;8(1). doi:10.1186/s40337-020-00287-3
47. Gumz A, Reuter L, Löwe B, et al. Factors Influencing the Duration of Untreated Illness Among Patients With Anorexia Nervosa: A Multicenter and Multi‐informant Study. Int J Eat Disord. 2023;56(12):2315-2327. doi:10.1002/eat.24069
48. Reuter L, Kästner D, Schmidt JA, et al. The Development and Psychometric Evaluation of FABIANA-checklist: A Scale to Assess Factors Influencing Treatment Initiation in Anorexia Nervosa. J Eat Disord. 2021;9(1). doi:10.1186/s40337-021-00490-w
49. Carr A, Tchanturia K, Dufour E, Cowan M, Himmerich H. Evidence-Based and Novel Psychological Therapies for People With Anorexia Nervosa. Published online 2020. doi:10.5772/intechopen.92680
50. Zeeck A, Herpertz‐Dahlmann B, Friederich HC, et al. Psychotherapeutic Treatment for Anorexia Nervosa: A Systematic Review and Network Meta-Analysis. Front Psychiatry. 2018;9. doi:10.3389/fpsyt.2018.00158
51. Watson HJ, Bulik CM. Update on the Treatment of Anorexia Nervosa: Review of Clinical Trials, Practice Guidelines and Emerging Interventions. Psychol Med. 2012;43(12):2477-2500. doi:10.1017/s0033291712002620
52. Fox AP, Leung N. Existential Well‐being in Younger and Older People With Anorexia Nervosa—a Preliminary Investigation. Eur Eat Disord Rev. 2008;17(1):24-30. doi:10.1002/erv.895
53. Hill L, Peck SK, Wierenga CE, Kaye WH. Applying Neurobiology to the Treatment of Adults With Anorexia Nervosa. J Eat Disord. 2016;4(1). doi:10.1186/s40337-016-0119-x
54. McIntosh VVW, Jordan J, Carter FA, et al. Three Psychotherapies for Anorexia Nervosa: A Randomized, Controlled Trial. Am J Psychiatry. 2005;162(4):741-747. doi:10.1176/appi.ajp.162.4.741
55. Hay P, Touyz S. Treatment of Patients With Severe and Enduring Eating Disorders. Curr Opin Psychiatry. 2015;28(6):473-477. doi:10.1097/yco.0000000000000191
56. Munro C, Thomson V, Corr J, et al. A New Service Model for the Treatment of Severe Anorexia Nervosa in the Community: The Anorexia Nervosa Intensive Treatment Team. Psychiatr Bull. 2014;38(5):220-225. doi:10.1192/pb.bp.113.044818
57. Young B. Consent or Caring? Issues of Autonomy and Paternalism in the Treatment of Anorexia Nervosa. doi:10.26686/wgtn.17006794.v1
58. Jewell T, Blessitt E, Stewart C, Simic M, Eisler I. Family Therapy for Child and Adolescent Eating Disorders: A Critical Review. Fam Process. 2016;55(3):577-594. doi:10.1111/famp.12242
59. Sydow K v., Retzlaff R, Beher S, Haun MW, Schweitzer J. The Efficacy of Systemic Therapy for Childhood and Adolescent Externalizing Disorders: A Systematic Review of 47 RCT. Fam Process. 2013;52(4):576-618. doi:10.1111/famp.12047
60. García LJ, García MVH, Baena S, León AP d., Lara BL. Effectiveness of Structural–Strategic Family Therapy in the Treatment of Adolescents With Mental Health Problems and Their Families. Int J Environ Res Public Health. 2019;16(7):1255. doi:10.3390/ijerph16071255
61. Jong M d., Schoorl M, Hoek HW. Enhanced Cognitive Behavioural Therapy for Patients With Eating Disorders. Curr Opin Psychiatry. 2018;31(6):436-444. doi:10.1097/yco.0000000000000452
62. Jong M d., Spinhoven P, Korrelboom K, et al. Effectiveness of Enhanced Cognitive Behavior Therapy for Eating Disorders: A Randomized Controlled Trial. Int J Eat Disord. 2020;53(5):717-727. doi:10.1002/eat.23239
63. Foley S, Badinlou F, Brocki KC, Frick MA, Ronchi L, Hughes C. Family Function and Child Adjustment Difficulties in the COVID-19 Pandemic: An International Study. Int J Environ Res Public Health. 2021;18(21):11136. doi:10.3390/ijerph182111136
64. Latzer Y, Herman E, Ashkenazi R, et al. Virtual Online Home-Based Treatment During the COVID-19 Pandemic for Ultra-Orthodox Young Women With Eating Disorders. Front Psychiatry. 2021;12. doi:10.3389/fpsyt.2021.654589
65. Woodford J, Månberg J, Cajander Å, et al. Help-Seeking Behaviour and Attitudes Towards Internet-Administered Psychological Support Among Adolescent and Young Adults Previously Treated for Cancer During Childhood: Protocol for a Survey and Embedded Qualitative Interview Study in Sweden. BMJ Open. 2021;11(4):e041350. doi:10.1136/bmjopen-2020-041350
66. Andersson G. Internet Interventions: Past, Present and Future. Internet Interv. 2018;12:181-188. doi:10.1016/j.invent.2018.03.008
67. Murphy R, Calugi S, Cooper Z, Grave RD. Challenges and Opportunities for Enhanced Cognitive Behaviour Therapy (CBT-E) in Light of COVID-19. Cogn Behav Ther. 2020;13. doi:10.1017/s1754470x20000161
68. Aviram A, Nadan Y. Online Clinical Supervision in Couple and Family Therapy: A Scoping Review. Fam Process. 2022;61(4):1417-1436. doi:10.1111/famp.12809
69. Lewis YD, Elran‐Barak R, Tov RG, Zubery E. The Abrupt Transition From Face-to-Face to Online Treatment for Eating Disorders: A Pilot Examination of Patients’ Perspectives During the COVID-19 Lockdown. J Eat Disord. 2021;9(1). doi:10.1186/s40337-021-00383-y
70. Apolinário-Hagen J, Vehreschild V, Alkoudmani RM. Current Views and Perspectives on E-Mental Health: An Exploratory Survey Study for Understanding Public Attitudes Toward Internet-Based Psychotherapy in Germany. Jmir Ment Health. 2017;4(1):e8. doi:10.2196/mental.6375
71. Drissi N, Ouhbi S, Marques G, Isabel de la Torre Díez, Ghogho M, Idrissi MAJ. A Systematic Literature Review on E-Mental Health Solutions to Assist Health Care Workers During COVID-19. Telemed J E Health. 2021;27(6):594-602. doi:10.1089/tmj.2020.0287
72. Connolly JJ, Glessner J, Kao C, Elia J, Hákonarson H. Attention-Deficit Hyperactivity Disorder and Pharmacotherapy—Past, Present, and Future: A Review of the Changing Landscape of Drug Therapy. Ther Innov Regul Sci. 2015;49(5):632-642. doi:10.1177/2168479015599811
73. Mishra S, Tomar R, Mishra S, Sharma S. Pharmacotherapy Strategies for Metabolic and Endocrine Disorder. Ijppr. 2024;15(2):74-81. doi:10.69580/ijppr.15.2.2024.74-81
74. Patne AY, Mohapatra S, Mohapatra SS. Role of Nanomedicine in Transforming Pharmacotherapy for Substance Use Disorder (SUD). Wiley Interdiscip Rev Nanomed Nanobiotechnol. 2025;17(2). doi:10.1002/wnan.70008
75. Zandy M, Kurdi SE, Samji H, McKee GR, Gustafson R, Smolina K. Mental Health-Related Healthcare Service Utilisation and Psychotropic Drug Dispensation Trends in British Columbia During COVID-19 Pandemic: A Population-Based Study. Gen Psychiatry. 2023;36(1):e100941. doi:10.1136/gpsych-2022-100941
76. Schuman I, Wang J, Ballard IC, Lapate RC. Waiting for It: Anorexia Risk, Future Orientation, and Intertemporal Discounting. Published online 2024. doi:10.21203/rs.3.rs-4002723/v1
77. King JA, Bernardoni F, Geisler D, et al. Intact Value-Based Decision-Making During Intertemporal Choice in Women With Remitted Anorexia Nervosa? An fMRI Study. J Psychiatry Neurosci. 2020;45(2):108-116. doi:10.1503/jpn.180252
78. Robinovitz ML, Montalto GJ, Afzal KI, et al. Anorexia Nervosa, Conduct Disorder, and the Juvenile Justice System: A Case of Applying Traditional Treatment Modalities in a Non-Traditional Setting. Biopsychosoc Med. 2021;15(1). doi:10.1186/s13030-021-00227-w
79. Wilcox H, Paz V, Saxena R, Winkelman JW, Garfield V, Dashti HS. The Role of Circadian Rhythms and Sleep in Anorexia Nervosa. Jama Netw Open. 2024;7(1):e2350358. doi:10.1001/jamanetworkopen.2023.50358
80. Keegan E, Byrne SM, Hay P, et al. An Exploratory Examination of Executive Functioning as an Outcome, Moderator, and Predictor in Outpatient Treatment for Adults With Anorexia Nervosa. J Eat Disord. 2022;10(1). doi:10.1186/s40337-022-00602-0
81. Keegan E, Tchanturia K, Wade T. Central Coherence and set‐shifting Between nonunderweight Eating Disorders and Anorexia Nervosa: A Systematic Review and meta‐analysis. Int J Eat Disord. 2020;54(3):229-243. doi:10.1002/eat.23430
82. Lloyd EC, Powell C, Schebendach J, Walsh BT, Posner J, Steinglass J. Associations Between Mealtime Anxiety and Food Intake in Anorexia Nervosa. Int J Eat Disord. 2021;54(9):1711-1716. doi:10.1002/eat.23589
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Wojciech Bieńkowski, Julia Charkot, Bartłomiej Kusy, Michał Bieńkowski, Mikołaj Charkot, Piotr Kucharczyk, Irmina Jaszczuk , Patrycja Retman
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 19
Number of citations: 0
