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What is Anorexia Nervosa?

It’s common to sometimes wish you looked different or could fix something about yourself, but when a preoccupation with being thin takes over your eating habits, thoughts, and influences areas of your life, it’s a sign of disordered eating. Anorexia, can mean that the desire to lose weight becomes more important than anything else. You may even lose the ability to see yourself as you really are. Anorexia is a serious eating disorder, which if left untreated can damage your health and even threaten your life.

Anorexia nervosa is a complex eating disorder but usually has three key features:

  bullet Refusal to maintain a healthy body weight
  bullet An intense fear of gaining weight
  bullet Restriction of food and/or use of behaviours such as excessive exercise or vomiting

Because of your dread of becoming overweight and how your body looks, eating and mealtimes may be very stressful. Thoughts about dieting, food, and your body may take up a lot of your day leaving little time for friends, family, and other activities you used to enjoy. Although it may not seem so to others, Anorexia isn’t just about food and weight. Eating disorders are much more complicated than that. The food and weight-related issues are symptoms of something deeper: things like depression, loneliness, insecurity, pressure to be perfect, or feeling out of control. Things that no amount of dieting or weight loss can cure.

Fortunately, recovery is possible. With proper treatment and support, you or someone you care about can break anorexia’s self-destructive pattern and regain health and self-confidence.

Can you relate to the following?

  bullet Do you feel overweight, even though people tell you you’re not?
  bullet Are you terrified of gaining weight?
  bullet Do you lie about how much you eat or hide your eating habits from others?
  bullet Are your friends or family concerned about your weight loss, eating habits, or appearance?
  bullet Do you diet, compulsively exercise, or purge when you’re feeling overwhelmed or bad about yourself?
  bullet Do you feel powerful or in control when you go without food, over-exercise, or purge?
  bullet Do you base your self-worth on your weight or body size?


What does Anorexia do for you?

It’s important to understand that anorexia meets a need in your life. For example, you may 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. You may even come to enjoy your hunger pangs as reminders of a “special talent” that other people can’t achieve.

Anorexia may also be a way of distracting yourself from difficult emotions. When you spend most of your time thinking about food, dieting, and weight loss, you don’t have to face other problems in your life or deal with complicated emotions.

Unfortunately, any boost you get from starving yourself or reducing weight is extremely short-lived. Dieting and weight loss can’t repair the negative self-image at the heart of anorexia. The only way to do that is to identify the emotional need that self-starvation fulfils and find other ways to meet it.


The difference between dieting and anorexia

Healthy Dieting
Anorexia

Healthy dieting is an attempt to control weight when you are clinically overweight.

Anorexia is an attempt to control your life and emotions.

Your self-esteem is based on more than just weight and body image.

Your self-esteem is based on how much you weigh and how thin you are.

You view weight loss as a way to improve your health. You view weight loss as a way to achieve happiness.
Your goal is to lose weight in a healthy way. Becoming thin is all that matters; health is not a concern.


Signs and symptoms of anorexia

Living with anorexia means you may hide your habits. This makes 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 their concerns. As anorexia develops, you become increasingly preoccupied with the numbers on the scale, how you look in the mirror, and what you can and can’t eat.


Signs and symptoms

  bullet Dieting despite being thin – Following a severely restricted diet. Eating only certain low-calorie foods. Banning “bad” foods such as carbohydrates and fats.
  bullet Obsession with calories and nutrition – Reading food labels, measuring and weighing portions, keeping a food diary, reading diet books.
  bullet 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.”).
  bullet Preoccupation with food – Constantly thinking about food. Cooking for others, collecting recipes, reading food magazines, or making meal plans while eating very little.
  bullet Strange or secretive food rituals – Refusing to eat around others or in public places. Eating in rigid, ritualistic ways (e.g. cutting food, chewing food and spitting it out, using a specific plate).
  bullet Feeling overweight, despite being underweight – You may feel overweight in general or just “too fat” in certain places such as the stomach, hips, or thighs.
  bullet Fixation on body image – Obsessed with weight, body shape, or clothing size. Frequent weigh-ins and concern over tiny fluctuations in weight.
  bullet Harshly critical of appearance – Spending a lot of time in front of the mirror checking for flaws. There’s always something to criticise. You’re never thin enough, even if others saw you look emaciated and ill.
  bullet Being sick 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.
  bullet 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.”


Major risk factors for anorexia nervosa

  bullet Body dissatisfaction bullet Perfectionism
  bullet Strict dieting bullet Troubled family relationships
  bullet Low self-esteem bullet History of physical or sexual abuse
  bullet Difficulty expressing feelings bullet Family history of eating disorders


Getting help for anorexia

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 is possible.


Steps to anorexia recovery


  bullet Admit you have a problem. Up until now, you’ve been invested in the idea that life will be better—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.
  bullet 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 get better.
  bullet 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 web sites and “pro-ana” sites that promote anorexia.
  bullet Seek professional help. The advice and support of trained eating disorder professionals can help you regain your health, learn to eat normally again, and develop healthier attitudes about food and your body.


What will happen when I see a health professional?

It maybe your GP who you speak to first of all. and they might want you to then see a psychiatrist or they may be happy to refer you to Insighteating for an assessment. Your GP is likely to ask if you are willing to be weighed and, depending on how much weight you've lost, you may need a physical examination and blood tests. You will see a therapist regularly, both to check your weight and for support.

This involves talking with a psychologist, perhaps for 1 hour every week, about your thoughts and feelings. It can help you to understand how the problem started, and how you can change some of the ways you think and feel about things. It can be upsetting to talk about some things, but a good therapist will help you to do this in a way which helps you to cope better with your difficulties. They will also help you value yourself more, and rebuild your sense of self-esteem.

Other members of your family can be included with your permission. They may also be seen separately for sessions to help them understand what has happened to you, how they can work together with you, and how they can cope with the situation.


Advice and help with eating

  bullet More than half of sufferers make a recovery, although they will on average, be ill for five to six years.
  bullet Full recovery can happen even after 20 years of severe anorexia.
  bullet Past studies of the most severely-ill people admitted to hospital have suggested that 1 in 5 of these may die. With up-to-date care, the death rate is much lower, if the person stays in touch with medical care.
  bullet As long as the heart and other organs have not been damaged, most of the complications of starvation seem to improve slowly once a person is eating enough.

To download a general advice / meal plans click here.


Medical treatment for anorexia

The first priority in anorexia treatment is addressing and stabilising any serious health issues. Hospitalisation may be necessary if you are dangerously malnourished or so distressed that you no longer want to live. You may also need to be hospitalised until you reach a less critical weight (usually below BMI of 15). Outpatient treatment is an option when you’re not in immediate medical danger.

BMI Risk Treatment recommended

15-17.5Kg/m2

Low-moderate
Lack of periods, and loss of structure from all muscles and organs. Memory and concentration problems. Anxiety increased. High osteoporosis risk
Regular physical monitoring – 2 x weekly to monthly. Psychological support as outpatient alongside gradual nutritional rehabilitation and weight gain.

13- 14.9 Kg/m2

Moderate to high
Severe Anorexia. All organs compromised heart, bone, muscle. Metabolism reduced by up to 50%. Stress hormones dominate- anxiety high.
Memory and concentration problems more severe.

Physical monitoring a priority e.g. weekly/fortnightly. Intensive outpatient support or In- patient treatment recommended from specialist ED service. Intensive psychological support alongside nutritional rehabilitation and steady weight gain. DVLA recommend you do not drive and some airline will not allow you to fly. Possible restricted duties at work e.g. not operating machinery or travelling long distances.
<13kg/m2 High
Life threatening Anorexia
Organs begin to fail. All organs severely compromised - heart, bone, muscle. Metabolism reduced by up to 50%. Stress hormones dominate- anxiety high. Memory and concentration problems severe.
Close physical monitoring needed e.g. EGC and regular bloods 2 x week. Specialist eating disorders unit admission needed urgently. Intensive psychological support alongside careful nutritional rehabilitation and urgent weight gain.

Helping a person with anorexia nervosa

Encouraging a friend or family member with anorexia to get treatment is the most caring and supportive thing you can do. However, you need to listen carefully and not overwhelm them eg by waving around articles about the dire effects of anorexia or declaring “You’ll die if you don’t eat!”. A better approach is to gently express your concerns and let the person know that you’re available to listen. If your loved one is willing to talk, listen without judgment, no matter how out of touch the person sounds.

It’s deeply distressing to know that your child or someone you love may be struggling with anorexia. There’s no way to solve the problem yourself, but here are a few ideas for what you can do now to help make a difference for someone you love.


Tips for helping a person with anorexia

  bullet Think of yourself as an “outsider.” In other words, someone not suffering from anorexia. In this position, there isn’t a lot you can do to “solve” your loved one’s anorexia. It is ultimately the individual’s choice to decide when they are ready.
  bullet Be a role model for healthy eating, exercising, and body image. Don’t make negative comments about your own body or anyone else’s.
  bullet Take care of yourself. Seek advice from a health professional, even if your friend or family member won’t. And you can bring others—from peers to parents—into the circle of support.
  bullet Don’t act like the food police. A person with anorexia needs compassion and support, not an authority figure standing over the table with a calorie counter.
  bullet Avoid threats, scare tactics, angry outbursts, and put-downs. Bear in mind that anorexia is often a symptom of extreme emotional distress and develops out of an attempt to manage emotional pain, stress, and/or self-hate. Negative communication will only make it worse.


Self Help Advice

beat (formerly the Eating Disorders Association)

Helpline: 0845 634 1414 (Mon- Fri, 10:30-8.30pm, and Saturday 1.00- 4:30pm.
beat youth helpline: 0845 634 7650 (Mon- Fri, 4.00-6.30pm and Saturday: 1.00-4:30 pm.)

beat is an organisation that campaigns, that challenges the stigma faced by people with eating disorders and that gives people the help and support they need.

Eating Disorder Hope

American website offering information, eating disorder treatment options, recovery tools and resources to those suffering from eating disorders, their treatment providers and loved ones.

NHS Direct

Tel: 0845 4647 (24hr)
Advice from a nurse on all health topics.
Overcoming Anorexia
www.overcominganorexiaonline.co.uk


Further Reading

Anorexia Nervosa- hope for recovery. Agnes Ayton
Breaking free from anorexia nervosa: a survival guide for families, friends and sufferers by Janet Treasure (Psychology Press).
Understanding your eating. Julia Buckroyd
Skills-based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Method. Janet treasure
Anorexia Nervosa and Related Eating Disorders (ANRED).
Self-help tips: www.anred.com/slf_hlp.html


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