Anorexia nervosa is characterized by emaciation, a relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight, a distortion of body image and intense fear of gaining weight, a lack of menstruation among girls and women, and extremely disturbed eating behavior. Some people with anorexia lose weight by dieting and exercising excessively; others lose weight by self-induced vomiting, or misusing laxatives, diuretics or enemas.
Many people with anorexia see themselves as overweight, even when they are starved or are clearly malnourished. Eating, food and weight control become obsessions. A person with anorexia typically weighs herself or himself repeatedly, portions food carefully, and eats only very small quantities of only certain foods. Some who have anorexia recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic form of anorexia, in which their health deteriorates over many years as they battle the illness.
There is a lot of uncertainty about the causes of all forms of eating disorder. Many people still think of them as `slimmer’s diseases’. While it is true that both anorexia and bulimia nervosa can develop from a strict diet, the reasons for a diet turning into an eating disorder involve more than just the wish to lose weight. The name `anorexia’ is confusing as literally it means `loss of appetite’. People with anorexia nervosa do not lose their appetite, they still feel hungry, but fear weight gain so much that they lose the ability to eat a normal diet.
- Some people attribute anorexia nervosa to media and fashion and it is clear that they both play their part. Many people who do not conform to the ideals presented by the fashion industry and the media feel that they need to diet. For some people this presents no problem while for others it can turn into anorexia nervosa. The media can also perpetuate problems for people who have an eating problem as it is very difficult to break away from the dieting cycle if you are constantly being presented with images of desirable thin models.
- People with anorexia nervosa develop a fear of fatness which goes far beyond that which most dieters feel. For someone with anorexia nervosa, the need to make themselves thinner dominates all other emotions. Some people with the condition lose their ability to see themselves as they really are, and instead become terrified that they are fat even when they have become seriously malnourished and underweight. Others are able to see that they are thinner than most other people, but still strive to lose whatever body fat they feel remains. In many cases, they feel driven to continue to lose weight because they feel that their value as a person depends on their weight and body shape and that they will only be liked and appreciated if they are able to make themselves increasingly thinner.
- They often have emotional needs which are not being met in their lives. They may not have a stable family background, may have trouble making friends socially or at work or feel uncomfortable about sexual relationships. It is important to realise though that anorexia nervosa is not anyone’s fault. It cannot be seen to hinge entirely on relationships, this is simply one factor which may play a part. People can develop anorexia nervosa even if they have very supportive families and partners and a wide circle of friends. Anorexia nervosa often starts in teenage years and can be a mechanism for dealing with all the complicated emotions connected with becoming an adult. Some teenage girls are terrified of becoming women. This may be because they have been abused as children, because they have seen their mother or other female relatives being unhappy, because they are concerned about their sexuality or simply because they are anxious about all the changes which they can feel taking place within them. Anorexia nervosa can offer them a way of delaying some of the physical signs that they are becoming women. Teenage girls with anorexia nervosa do not have such developed breasts or hips as other girls their age because they have so little body fat. They may also delay the start of their periods. This can be very comforting for girls who do not feel ready for these physical developments.
- People who have anorexia nervosa often feel that they are underachievers in academic or work life. This is usually not the case and evidence has shown that many people with this condition are in fact very high achievers. They are, however, often people who set themselves standards which are simply impossible to achieve and leave them with feelings of inadequacy.
- For a person with little confidence, their eating problems may seem to be the only thing about them which is special or different. Their ability to feel hungry and yet refuse to eat can feel like a special talent that most people are unable to achieve and can give a real sense of pride. It feels very disciplined to be able to count calories and to be able to impose strict limits on how much you consume. For people who have low self-esteem and who can see virtually no other area in their lives in which they are successful, this can suddenly offer them a sense of purpose.
- Anorexia nervosa can also be a way of coping with difficult emotions. The amount of time and energy spent thinking about food and weight loss can leave very little room to deal with any other emotions. Anorexia nervosa can therefore act as a kind of protective barrier against the difficulties and emotional pressures of everyday life.
It is important to understand that anorexia nervosa can fulfil some needs and not to expect someone to give it up without having their needs met in some other way.
There are many symptoms associated with anorexia and these can vary from person to person. Some of these are connected to how you behave and think, and some are physical. Behavioural symptoms include:
- eating very little, if at all, or restricting certain foods, such as those containing fat
- being secretive about food
- obsessively weighing yourself, and measuring and examining your body
- being obsessed with exercise
- being restless
- using appetite suppressants, such as diet pills
- making yourself sick after meals or using laxatives or diuretics (water tablets)
- wearing baggy clothes to disguise weight loss
- punishing yourself if you don’t lose enough weight or eat something you wouldn’t usually eat
- lying about eating
With anorexia, you become preoccupied with your weight and body size. You may:
- have a distorted body image
- deny being underweight or having a problem with food
- have mood swings
- feel depressed
- lose interest in other people
- go off sex
- find it difficult to concentrate
- worry more and more about your weight
- carry on losing weight, even when you’re below a healthy weight
If you have anorexia, you will probably have a body weight that is much lower than expected for your age and height in adults, this is usually a body mass index (BMI) of less than 17.5. BMI is commonly used to work out whether you’re a healthy weight it takes into account your weight and height. You’re a healthy weight if your BMI is between 18.5 and 24.9 a BMI much above or below this means you may be at risk of serious health problems.
As well as weight loss, the physical signs of anorexia can include:
- fine, downy hair on your body and face
- feeling cold all the time
- red or purple hands and feet
- light-headedness and dizziness
- stomach pains
- hair falling out
- poor sleep
- dry, yellowish skin
- heartburn (indigestion)
- delayed puberty (because anorexia affects your hormones) and not growing to your full height
- missing three or more monthly periods (in women or girls who aren’t pregnant or using certain types of hormonal contraceptive, such as the pill)
- not being able to get or keep an erection (in men and boys)
Over time, anorexia can cause serious long-term health problems.
- You’re at an increased risk of osteoporosis, which means you’re more likely to break a bone. The more weight you lose, the more severe the condition will become, and the longer you have anorexia, the less likely it is that your bones will recover.
- There is a great risk of damage to your heart, including abnormal heart rhythms and heart failure. These are the most common causes of death in people with anorexia an abnormal heart rhythm can quickly become life-threatening, even in teenagers.
- You’re likely to have problems with fertility and pregnancy. If your periods have stopped, it’s likely that you won’t be able to get pregnant and if you do, you’re at a greater risk of miscarriage and postnatal depression. Your baby is also more likely to have a low birth weight. See our frequently asked questions for more information.
- If you have anorexia, you’re more likely to develop mental health problems, such as anxiety and depression, and also to abuse alcohol or illegal drugs. People with anorexia are at a much greater risk of attempting suicide it’s thought that up to one in five people with anorexia try to kill themselves.
If you have severe anorexia, it’s important that you receive appropriate treatment. If left untreated, the condition and its complications can be fatal.
Treatment includes both short- and long-term measures, and requires assessment by dietitians and psychiatrists as well as medical specialists. Therapy is often complicated by the patient’s resistance or failure to carry out a treatment plan.
Treatment aims to:
- promote weight gain
- promote healthy eating patterns
- address thoughts, feelings and beliefs concerning food and body image
- treat any physical complications or associated mental health problems
- enlist family support.
Hospitalization is recommended for anorexics with any of the following characteristics:
- weight of 40% or more below normal; or weight loss over a three-month period of more than 30 pounds
- severely disturbed metabolism
- severe binging and purging
- signs of psychosis
- severe depression or risk of suicide
- family in crisis
Hospital impatient care is first geared toward correcting problems that present as immediate medical crises, such as severe malnutrition, severe electrolyte imbalance, irregular heart beat, pulse below 45 beats per minute, or low body temperature. In extreme cases, hospitalized patients may be force-fed through a tube inserted in the nose (nasogastric tube) or by over-feeding (hyperalimentation techniques). There is often a high level of resistance to treatment. After the individual is physically stable, treatment includes individual and group therapy as well as re-feeding and monitoring of the patient’s physical condition. Treatment usually requires two to four months in the hospital.
Anorectics who are not severely malnourished may be treated by outpatient psychotherapy and nutritional counseling. The types of treatment recommended are supportive rather than insight-oriented, and include behavioral approaches as well as individual and/or group therapy. Family therapy is often recommended when the patient’s eating disorder is closely tied to family dysfunction. Self-help groups often are useful in helping anorectics find social support and encouragement. Psychotherapy with anorectics is a slow and difficult process; about 50% of patients continue to have serious psychiatric problems after their weight has stabilized.
Anorectics are treated with a variety of medications to address physical problems brought about by their eating disorder and to treat additional psychiatric problems such as depression, anxiety, and suicidal thoughts. The medications used will vary depending on the individual, however, depression is common among anorectics and is treated often treated with antidepressant drugs.
Keeping a diary of your eating habits and learning about healthy eating and sensible weight control may help.
You may find that support groups are useful. It can be comforting to talk to others who have had the same feelings and experiences. Family members may also find it useful to attend self-help meetings for relatives and carers.
Talking therapies (for example, counselling) are often used to treat anorexia. They can help you to identify the feelings and fears that caused you to stop eating, and develop a healthier attitude towards food and your body.
There are various types of talking treatment that can help with anorexia, such as cognitive behavioural therapy (CBT). You may need to continue with these for months or years.
You may also find it helpful to have therapy that involves your family, either together with you or having separate counselling sessions. This helps everyone in the family to understand the disorder properly and support each other.
When to Contact a Medical Professional
Talk to your health care provider if someone you care about is:
- Too focused on weight
- Limiting the food he or she eats
- Very underweight
Getting medical help right away can make an eating disorder less severe.
Short of major long-term changes in the larger society, the best strategy for prevention of anorexia is the cultivation of healthy attitudes toward food, weight control, and beauty (or body image) within families
Some specific ways to reduce the likelihood that anorexia nervosa will develop follows:
- If you are a parent, do not obsess about your own weight and appearance in front of your children.
- Do not tease your children about their body shapes or compare them to others.
- Make it clear that you love and accept your children as they are.
- Try to eat meals together as a family whenever possible.
- Remind children that the models they see on television and in fashion magazines have extreme, not normal or healthy bodies.
- Do not put your child on a diet unless advised to by your pediatrician.
- Block your child from visiting pro-anorexia Web sites. These are sites where people with anorexia give advice on extreme weight loss techniques and support each other’s distorted body image.
- If your child is a competitive athlete, get to know the coach and the coach’s attitude toward weight.
- If you think your child has an eating disorder, do not wait to intervene and the professional help. The sooner the disorder is treated, the easier it is to cure.
Anorexia nervosa is a serious condition that can be life-threatening. Treatment programs can help people with the condition return to a normal weight. But it is common for the disease to return.
Women who develop this eating disorder at an early age have a better chance of recovering completely. Most people with anorexia will continue to prefer a lower body weight and be very focused on food and calories.
Weight management may be hard. Long-term treatment may be needed to stay at a healthy weight.