Anorexia Nervosa Overview | Madison Avenue TMS & Psychiatry

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By Dr. David Woo - February 24, 2025

Anorexia nervosa, commonly referred to as anorexia, is a serious and potentially life-threatening eating disorder characterized by an intense fear of gaining weight and a distorted body image. Individuals with anorexia nervosa often engage in extreme dieting, excessive exercise, or other behaviors to control their weight, leading to severe health consequences. In many cases, anorexia is accompanied by mood disorders such as depression, anxiety, or obsessive-compulsive disorder (OCD). This article explores anorexia nervosa symptoms, diagnosis, and how treatment options available at Madison Avenue TMS & Psychiatry, such as medication management and transcranial magnetic stimulation (TMS), can help.

Understanding Anorexia Nervosa

Anorexia nervosa is more than just a desire to be thin; it is a complex mental health condition that requires specialized care. According to the DSM-5, anorexia nervosa diagnostic criteria include:

Restriction of energy intake relative to requirements, leading to significantly low body weight.
Intense fear of gaining weight or persistent behavior that interferes with weight gain.
Distorted self-image or lack of recognition of the seriousness of low body weight.

Although discussions of anorexia can bring to mind disturbing images of dramatically emaciated bodies, someone doesn’t have to “look anorexic” to be struggling with the disease. While anorexia is often perceived as a condition that mainly affects teenage girls, it can impact people of all ages and genders and carries a heightened risk of mortality (1).

There is also atypical anorexia nervosa, where individuals meet the psychological criteria for anorexia but maintain a weight that is considered normal or above normal. This form of anorexia can be equally dangerous and requires professional attention.

Anorexia Nervosa Symptoms

Recognizing the signs of anorexia nervosa is crucial for timely intervention. Common anorexia symptoms and signs include:

Significant weight loss or failure to maintain expected growth in adolescents.
Preoccupation with food, dieting, or body image.
Avoidance of meals or eating in public.
Ritualistic eating behaviors, such as cutting food into small pieces or eating very slowly.
Excessive exercise despite exhaustion or injury.
Physical side effects of anorexia, such as:
- Fatigue and weakness.
- Dizziness or fainting.
- Brittle hair and nails.
- Dry or yellowish skin.
- Amenorrhea (loss of menstrual cycle in women).
- Gastrointestinal issues such as constipation.

Anorexia Nervosa Diagnosis

Diagnosing anorexia involves a comprehensive evaluation based on the DSM-5 criteria. This typically includes:

Physical exams: Assessing the side effects of anorexia, such as malnutrition and organ function.
Psychological assessments: Identifying thoughts and behaviors associated with eating and body image.
Laboratory tests: Checking for anemia, electrolyte imbalances, and other medical issues linked to anorexia symptoms.

Anorexia And Co-Occurring Mental Health Conditions

Anorexia often occurs alongside other mental health conditions, which can complicate diagnosis and treatment. These include:

Depression: Feelings of worthlessness, hopelessness, and lack of interest in life are common.
Anxiety: Often tied to food and body image.
Post-Traumatic Stress Disorder (PTSD): Trauma can contribute to the development of disordered eating.
OCD: Intrusive thoughts about body size and rituals around food intake are prevalent.
Attention-Deficit Hyperactivity Disorder (ADHD): Impulsivity or hyperfocus can influence eating behaviors.
Bipolar disorder: Mood swings may exacerbate disordered eating patterns.
Borderline personality disorder (BPD): Emotional dysregulation can lead to unhealthy coping mechanisms, including restrictive eating.

Effective Anorexia Nervosa Treatments

Recovery from anorexia nervosa is possible with the right approach. Treatment often involves a combination of therapies and medical care to address the eating disorder and any co-occurring mood disorders, e.g., depression or OCD.

Talk therapy, such as cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) is often employed as a first-line treatment to manage emotional regulation in individuals with anorexia.

Nutritional counseling with the guidance of dietitians can also help to restore healthy eating patterns.

Because anorexia typically co-occurs with mood disorders such as depression, anxiety, and OCD, a medical intervention is often required. These include:

Medication Management

Antidepressants or anti-anxiety medications may be prescribed to balance the brain chemistry, which can assist in emotional regulation and address co-morbid conditions. However, it’s important to note that they do not work for everyone. While some individuals tolerate certain antidepressants well, others may find them ineffective or experience side effects that are difficult to manage. Regular consultations with a mental health professional are essential to monitor the medication’s effectiveness. They can adjust the dosage, switch to a different medication, or explore alternative treatments.

At Madison Avenue TMS & Psychiatry, we offer medication management services to help you find the right prescription or explore drug-free depression treatments like TMS. Our convenient telehealth video consultations allow you to manage your treatment plan on your schedule, all from the comfort of your home.

TMS (Transcranial Magnetic Stimulation)

TMS is a non-invasive treatment that can alleviate symptoms of depression, OCD, and anxiety associated with anorexia. It uses a helmet-like device to deliver slight magnetic pulses to targeted brain areas. By stimulating these regions, TMS helps restore healthy brain activity and balance. Research has shown TMS to be an effective treatment to combat the emotional dysregulation aspects of anorexia and can be combined with other therapies to support long-term recovery (2,3).

At Madison Avenue TMS & Psychiatry, we provide TMS as part of our holistic mental health care approach. TMS is well-tolerated and safe, making it an excellent option for individuals seeking alternatives to traditional treatments or who haven’t found relief with other methods.

Anorexia Treatment In New York

If you or a loved one is struggling with anorexia nervosa or related conditions in the New York area, Madison Avenue TMS & Psychiatry is here to help. As New Yorkers, we understand the pressures and stressors of living in the city and how it can affect our relationship with our bodies and food.

Our medication management and TMS services can support your journey to mental wellness by alleviating the co-occurring mood disorders that make anorexia recovery so challenging.

Contact us online today or call (212) 731-2033 to schedule an appointment or consultation and learn more about our anorexia nervosa treatments. Together, we can help you regain your health and well-being.

Sources:

van Eeden AE, van Hoeken D, Hoek HW. Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry. 2021;Nov 1;34(6):515-524. Link. Accessed January 26, 2025.
Marcolini F, Ravaglia A, Tempia Valenta S, Bosco G, Marconi G, De Ronchi D, Atti AR. Severe enduring anorexia nervosa (SE-AN) treatment options and their effectiveness: a review of literature. J Eat Disord. 2024;Apr 23;12(1):48. Link. Accessed January 26, 2025.
Wu, K., Lo, Y. T., Cavaleri, J., Bergosh, M., Ipe, J., Briggs, R. G., Jann, K. B., Murray, S. B., Mason, X. L., Liu, C. Y., & Lee, D. J. Neuromodulation of Eating Disorders: A Review of Underlying Neural Network Activity and Neuromodulatory Treatments. Brain Sciences. 20204;14(3), 200. Link. Accessed January 26, 2025.

Dr. David Woo

Dr. David Woo is the owner and head clinical psychiatrist at Madison Avenue TMS and Therapy in New York City. Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.

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