Anorexia nervosa

With this serious emotional disorder, a person wants to weigh as little as possible. They develop an aversion to food and their appetite reduces as they eat less and less.

What is it?

A person with anorexia becomes so afraid of gaining weight that they cannot eat normally. They may take appetite suppressants, laxatives, or diuretics (to remove body fluid), or make themselves vomit after meals (bulimia nervosa, pp.92−93), but they may also binge (binge-eating disorder, p.94). Many factors can trigger anorexia.
Pressures at school, such as exams or bullying (particularly if the focus is on body weight or shape), can contribute, as can occupations such as dancing or athletics where being thin is considered “the ideal.” The disorder can also be a response to stress in childhood or lack of control over life events, such as losing a job, relationship breakdown, or bereavement, which makes the person exert excessive control over internal processes that are within their power. Anorexia affects more females
than males. Many of those who develop it share personality and behavioral traits. They are often emotionally controlled, have a tendency toward depression and anxiety, find it difficult to handle stress, and worry excessively. Many individuals set themselves strict, demanding goals. They may have feelings of obsession and compulsion, but not necessarily OCD . Living withanorexia can make it hard to maintain relationships. It can also have an irreversible impact on the body and cause infertility or serious pregnancy complications.

How is it diagnosed?

The GP, clinical psychologist, or specialist health professional asks the individual questions about their personal and family history, weight, and eating habits. The person needs treatment as early as possible to reduce the risk of complications. In most cases, the treatment plan involves psychotherapy and individually tailored advice on eating and nutrition. Recovery can take years.

Symptoms of anorexia

All symptoms relate to self-esteem, body image, and feelings, and divide into three main categories: cognitive (feelings and thoughts), behavioral, and physical.

Cognitive symptoms

❯ Expresses a fear of gaining weight and becomes obsessed with body shape.

❯ Believes that being thin is good and is convinced that they are overweight.

❯ Measures self-worth in terms of body weight and shape.

❯ Obsesses about food and the perceived negative consequences of eating.

❯ Becomes irritable, moody, and unable to concentrate (partly due to hunger), which impacts school or work.

Behavioral symptoms

❯ Behaves obsessively around food and diets, and counts calories excessively. Avoids “fatty” foods and/or eats only low-calorie foods. May skip meals.

❯ Avoids eating in front of others, and/or purges after eating.

❯ Lies about how much they eat.

❯ Repeatedly weighs themselves or checks their body shape in the mirror.

❯ Exercises obsessively.

❯ Becomes socially withdrawn.

Physical symptoms

❯ Obvious weight loss.

❯ Irregular or absent periods in females.

❯ Poor dental health and smelly breath due to persistent vomiting.

❯ Soft, fine, “downy” hair growing on the body, while head hair falls out.

❯ Has difficulty sleeping but is very tired.

❯ Is weak, light-headed, and dizzy.

❯ Has stomach pains, and is constipated and bloated.

❯ Has swollen hands and feet.

TREATMENTS

❯ Multidisciplinary care team, including a GP, psychiatrists, specialist nurses, and dietitians to ensure that a person gains weight safely and to support family and close friends.

❯ Cognitive behavioral therapy to help the person understand and explain their problem and see it as a cycle of triggers, thoughts, feelings, and behaviors. Therapist and patient collaborate on interventions that break the chain of thoughts maintaining anorexia.

❯ Cognitive analytic therapy to examine the way the person thinks,feels, and acts, as well as the events and relationships that underlie their past experiences—often in childhood.

❯ Interpersonal therapy to resolve problems with attachment and relating to other people.

❯ Focal psychodynamic therapy to explore how early-childhood experiences may have affected the person.

❯ In-patient treatment for severe cases; supervised weight gain through strict daily routines and eating plans, often including group therapy for peer support.

46%
of people with anorexia recover fully