anorexia-if-stress leads to compulsive weight control Image©KatarzynaBialasiewicz - iStockphoto

Anorexia: When stress leads to compulsive weight control

Anorexia, like bulimia and the Binge Eating Disorderto get a mental illnesswhich has a negative effect on both body weight and eating behaviour. We explain what anorexia is and show how stress is related to the disorder.

What is anorexia?

Anorexia (med.: Anorexia Nervosa), also known as anorexia is a disorder in which the affected person compulsively controlling and minimizing food intake. This leads to a strong weight loss. Anorexia is associated with a limited body perception. Even if those affected have long been severely underweight, they still feel too fat.

Due to malnutrition and underweight, physical symptoms such as strong sensation of cold, fluffy body hair and, in women, the absence of menstruation occur. If the anorexia lasts for a long time, the Muscular atrophy, organ damage, osteoporosis and low blood pressure in addition. According to data from the Federal Ministry of Health, every tenth patient dies within the first ten years of the disease.

What forms of anorexia are there?

Anorexia appears in different ways, also vomiting, laxative and ravenous attacks of the so-called eating-binge eating addiction are possible in connection with the eating disorder. Doctors differentiate according to the  International statistical classification of diseases and related health problems (short: ICD) in the diagnosis between active (F 50.01) and passive (50.00) anorexia. The latter form is also called the ascetic form of anorexia. Affected persons only follow a strict diet without taking any further measures to reduce weight.

In the active form, in addition to a strict diet, those affected take other measures to reduce their weight, such as vomiting, excessive physical activity, as well as taking appetite suppressants, laxatives or dehydrating agents.

How to recognise people with anorexia?

To find out whether someone is suffering from anorexia or not, outsiders must look closely. Apart from weight, eating habits are the most important factor here. According to the ICD, the following symptoms indicate an existing anorexia:

  • The weight loss leads to a body weight that at least 15 % below the weight considered normal for a given height. The normal weight is determined by the so-called Body Mass Index (short: BMI). In children, possible anorexia is expressed by the fact that they do not continue to gain weight, but above all have hardly any growth in length.
  • The weight loss is not caused by other diseases, but self-inflicted. This can include avoiding fatty foods, skipping meals and not eating sweets. Some people take appetite suppressants to suppress hunger.
  • Anorexia is also manifested by disturbed self-perception of affected people who always perceive their body as "too fat". This feeling is connected with the fear of gaining weight and becoming fat.
  • Affected persons define a very low weight as acceptable for themselves. If this is achieved, anorexics set a new low threshold. They make themselves dependent on the number on the scale.
  • In the course of the nutrient deficiency, an endocrine disorder of the pituitary-gonadal axis develops in affected persons. It manifests itself in women as amenorrhoea (amenorrhoea), for men as lack of interest in sexual activity and in the form of loss of potency.
  • In contrast to bulimia, anorexic patients have no regular eating fitswhich are caused by the strong "greed" for food.

Behaviour pattern

In addition, on close observation of those affected, abnormal patterns of behaviour are also noticeable, some of which are related to disturbed self-perception and partly related to the disturbed relationship with food. If anorexia is suspected, friends and family members can look out for the following behaviours:

  • as a rule, anorexics and bulimics suffer from Body Scheme Disorder. The affected persons estimate body measurements wrong and bigger than they are in reality
  • People with advanced anorexia often wear oversized clothesto cover the unloved body that is considered too fat. Sometimes clothing is also used to keep weight loss a secret from relatives. This can be particularly the case if friends or family members have already pointed out the weight loss.
  • Food triggers panic attacks. This manifests itself in the form of introverted or irritable behaviour at table. Conspicuous behaviour can also occur when food is overly discussed in general or in conversations.
  • In order not to gain weight, anorexics tend to keep Strict control of eating behaviour. This starts with the selection, the quantity and the composition of the food. In some cases, ritualized eating behavior develops from this, or there are constraints such as chewing food the same number of times, eating food of one color or counting the number of foods exactly.
  • In everyday life, people with restrictive anorexia or anorexia with vomiting (the atypical anorexia) in particular do not notice until the disorder is already advanced. This is because people with eating disorders develop targeted strategies in order not to attract "unpleasant" attention. In order to eat less food, affected persons eat excessively slowly, pretend to have allergies or intolerances or dispose of food inconspicuously in napkins. Frequent visits to the toilet during meals can also indicate that the food is spat out or vomited.
  • Although anorexics hardly take any food at all, and at times not at all, in contrast to this, those affected sometimes prepare Excessive food for others closed without eating out

Where can I get advice and first aid for eating disorders?

In order not to unsettle potentially affected persons, it is advisable, if anorexia or bulimia is suspected, to first Contact experts. If necessary, they can also help to find a suitable therapy and give tips to relatives on how to communicate about the eating disorder.

Dealing with data subjects requires a high level of Caution and tactas there is usually no insight into the disease and no motivation for therapy. Help for affected persons and their relatives is provided by Advice centre of the Federal Centre for Health Education (short: BZgA). A anonymous online consulting affected families can make use of Caritas. In addition, families can contact advice centres of the Action group for eating and anorexia turn around.

Stress as a trigger for anorexia?

The development of anorexia is multifactorial. Triggers for anorexia can be stress factors in the Familyor in the circle of friends or in the Partnership be. Eva Hitzler emphasizes this, Head of the Caritas specialist outpatient clinic for eating disorders in an interview:

To what extent can stress lead to eating disorders?

Eva Hitzler: Eating disorders occur especially when I am dissatisfied with my body, my self-confidence is very low, there is too high a demand for perfection and self-criticism is a strict and permanent companion. This has to do above all with the attitude towards my body. This attitude can be disturbed by various stress factors - for example by abuse or by an unconscious contract that one has made with oneself because of certain beliefs.

Furthermore, restricted eating rituals of the family can also contribute to the development of eating disorders. If special emphasis is placed within the family on "being thin" and others from the extended family are criticised for their figure, this can also play a role in the development of eating disorders.

A lack of harmony and acceptance in the family can also chronic stress and thus bring about a change in eating habits. Sometimes an eating disorder is also a reaction to being put in a certain role but not wanting to accept it. In addition, pressure to perform and the Perfectionism of the parents, can be the trigger for an eating disorder in childhood and adolescence.

In adulthood an eating disorder can Component of other stress-related diseases be. For example, an eating disorder in men often occurs in combination with burnout syndromewith depression or due to an inappropriate family situation.

Does stress affect the development of eating disorders differently depending on the type of eating disorder (anorexia, bulimia, eating addiction)?

Eva Hitzler: The main symptoms of anorexia are Pressure to perform, the need to be perfect and having to please everybody. Anorexics often display altruistic behavior and ignore their own feelings. On the other hand, those affected are characterized by strong ego structure and a correspondingly strong selfishness. A combination that puts anorexic people under constant stress.

In bulimia, as in eating addiction, negative feelings and inner desperation are considered to be stress factors and triggers for eating fits. The latter have a calming effect on those affected who have no other way to deal with negative feelings.

How can eating disorders be prevented?

Eva Hitzler: Often the Cause of an eating disorder among others in the family. Thus, it is sometimes apparent in those affected that they have not learned to deal with their feelings, they project them to the outside and like to blame others. That is why it is important in everyday life to allow feelings to enter. Parents should therefore show their children how to show affection, talk about disappointment, etc. Within the family it is important to be able to talk about "everything" in a relaxed manner.

However, parents are not only a role model when it comes to open and honest communication within the family. Parents can also be a positive role model in terms of body awareness and eating habits. So it is advisable not to make negative comments about the figure of others. Excessive talk about food can also contribute to the development of an eating disorder. Parents should not tell their children too much about what to eat, nor should they try to show their children how to eat.

Lastly, it is important for children not to put too much pressure to perform or a strong sense of perfectionism. This attitude of the parents can be transferred to the children and later lead to an excessive attitude of entitlement. Physical contact, movement without excessive demands, joint activities, playing outdoors promote social cohesion, one's own sensual perception and convey a holistic feeling for the body. In this context, the attitude that one is not good enough is fundamental for the development of an eating disorder.

Physical stressors as trigger and maintenance factor of anorexia

In general, anorexia is considered a disorder that is directly related to social values and beauty ideals and is thus caused in particular by external stress factors. However, findings from neurobiology indicate that there may also be physical factors that favour the development of anorexia.

For example, the University of San Diego, California, School of Medicine, as part of the Eating Disorders Treatment and Research Program, conducted research measuring brain activity in women diagnosed with anorexia.

It turned out that the Reward system of anorexics works differentlythan in people without anorexia. While the latter responded positively to reward, brain activity was less pronounced in anorexic people in this case. On the other hand, people with anorexia were over-sensitive to punishment.

In concrete terms, this means that while a person without an eating disorder may feel that sweets or pastries are a reward, negative thoughts such as "the cake is unhealthy and makes you fat" automatically predominate in anorexics. The cause seems to be a Abnormal functioning of dopamine a neurotransmitter responsible for making us feel rewarded.

The measurements also showed an increased activity of the right insula. This part of the brain is responsible for the sensation of taste during food intake. In addition, the right insula is responsible for the perception of the body.


In an interview from 2016, Walter Kaye, director of the Medical Faculty's programme for the treatment and research of eating disorders, speaks of anorexia in anorexic patients. Hypersensitivity of the own body.

While people without eating disorders mainly notice discomfort such as stomach upset, people with anorexia are hypersensitive to processes taking place in the body. Kaye points out that the need to starve can be seen as a protective reaction of the body.

These findings could help those affected in the future to treat eating disorders holistically and to address social stress factors as well as physical weaknesses. However, Kaye stresses that here some more research needed is. It is not yet clear which neurobiological abnormalities precede the disorder and which arise only in the course of the disease.

Text: Natalie Grolig