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Undereating is a relative term. It refers to a negative energy imbalance that results when energy intake is less than energy that is expended. This negative energy imbalance can occur as a consequence of social conditions (e.g., poverty), medical conditions (e.g., cystic fibrosis), or psychological conditions (e.g., depression). It can also occur during any developmental period, such as in failure-to-thrive infants and in the elderly, who can suffer fat loss as part of normal aging processes. In these instances, undereating is considered to be involuntary because it is attributable to impecuniousness, nutrient malabsorption, or loss of appetite. Undereating, however, can also be intentional, as in self-starvation. Most notably, intentional undereating is pathognomonic in the eating disorder anorexia nervosa.

Anorexia nervosa is characterized by refusal to maintain at least 85 percent of normal body weight for ones age, height, and gender; fear of weight gain; disturbance in body perception; and self-worth based on body weight and shape. These core symptoms cause the individual to relentlessly pursue caloric restriction through behaviors such as dieting, fasting, excessive exercise, and vomiting. Anorexia can also include purging after binge-eating. It is often comorbid with other psychopathology such as depression and substance abuse. Other adverse medical consequences of undereating include emaciation, anemia, tooth decay, hair loss, bone loss, heart and kidney failure, and even death.

As of 2007, the lifetime prevalence rate of anorexia nervosa is estimated to be approximately 1 percent. It is most prevalent in adolescents and young adults who are white, female, and of mid-to-upper socioeconomic status. It is, however, increasingly being diagnosed at younger ages, in males, across U.S. ethnic minorities, and at all levels of socioeconomic status. The research, though limited, suggests that self-starvation is more prevalent in Western countries but that it is on the rise in non-Western countries.

The apparent general increase in prevalence of anorexia across groups and cultures likely reflects the strong influence of regnant sociocultural values. With globalization, the Western media exert a powerful and pervasive influence, conveying explicit and implicit messages that uphold the thin body as the ideal to which many females feel they should aspire. Although sociocultural explanations of anorexia are compelling, studies show that a predisposition to anorexia may be genetically based. Psychological factors such as early trauma (e.g., abuse), a major negative life event (e.g., parental divorce), or a critical transition (e.g., college) may then precipitate disease onset in individuals who are susceptible. It has been suggested that, although maladaptive, the ability to tightly control ones caloric intake may serve to restore an individuals sense of power over his or her life.

Anorexia is viewed as both a medical and psychological condition and is notoriously intractable to treatment, with relapse common. A multidisciplinary approach is recommended. When patients are very underweight, hospital or day-program treatment is required, consisting of psychological counseling, nutritional education, and a supervised diet of from 2,000 to 4,000 calories per day. Cognitive-behavioral therapy and family-systems therapy appear to be the most widely used psychotherapeutic approaches. Research is needed, however, to identify the approach that is most effective. Psychopharmacotherapy to treat anorexia has so far met with little success, but research is ongoing in this regard.

SEE ALSO Body Image; Disease; Food; Malnutrition; Obesity; Overeating; Self-Esteem


American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed., text rev. Washington, DC: Author.

Hudson, James I., Eva Hiripi, Harrison G. Pope Jr., and Ronald C. Kessler. 2007. The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry 61: 348358.

Makino, Maria, Koji Tsuboi, and Lorraine Dennerstein. 2004. Prevalence of Eating Disorders: A Comparison of Western and Non-Western Countries. Medscape General Medicine 6 (3): 49.

Joan K. Orrell-Valente