The condition often develops out of an
anxiety about body shape and weight that originates from a fear of being fat or
a desire to be thin. Many people with anorexia have a distorted image of
themselves, thinking they're fat when they are not.
Anorexia most commonly affects girls and women, although it has become more common in boys and men in recent years. On average, the condition first develops at around the age of 16 to 17.
Signs and
symptoms of anorexia
People with anorexia often go to great lengths to hide their behaviour from family and friends by lying about what they've eaten or pretending to have eaten earlier. Signs someone may have anorexia or another eating disorder include:
- missing
meals, eating very little, or avoiding eating any fatty foods
- obsessively
counting calories in food
- leaving
the table immediately after eating so they can vomit
- taking
appetite suppressants, laxatives, or diuretics (a type of
medication that helps remove fluid from the body)
- repeatedly
weighing themselves or checking their body in the mirror
- physical
problems, such as feeling lightheaded or dizzy, hair loss, or dry skin.
Anorexia can also be associated with other
psychological problems, such as depression, anxiety, low self-esteem, alcohol misuse, and self-harm.
Schematic diagram showing the symptoms and signs of anorexia nervosa.
Getting
help
People with anorexia often do not seek help, perhaps because they are afraid or do not recognise they have a problem. Many have hidden their condition for a long time – sometimes years.
The most important first step is for someone
with anorexia to realise they need help and want to get better. If you think someone you know has anorexia, try
talking to them about your worries and encourage them to seek help.
This can be a very difficult
conversation because they may be defensive and refuse to accept they
have a problem. However, it is important not to criticize or pressure
them as this can make things worse.
You may want to seek advice from an eating disorder support group such as Beat about the best way to raise the subject.
If you think you may have anorexia, try to seek
help as soon as possible. You could start by talking to a person you trust,
such as a member of your family or a friend, and perhaps ask them to go
with you to see your doctor/ GP.
Treating
anorexia
Before anorexia can be treated, a physical, psychological and social needs assessment will need to be carried out by a GP or an eating disorders specialist. This will help them work out a suitable care plan.
In most cases, treatment will involve a combination
of psychological therapy and individually tailored advice on eating and
nutrition to help gain weight safely.
A range of different healthcare professionals will usually be involved in your care, such as GPs, psychiatrists, specialist nurses and dietitians.
Most people are able to be treated on an outpatient basis, which means you can go home between appointments. More serious cases are treated in hospital or specialist eating disorder clinics.
Schematic diagram showing how anorexia nervosa may affect the different parts of the human body.
Outlook
It can take several years of treatment
to fully recover from anorexia, and relapses are common. For example, a
woman may relapse if she tries to lose weight gained during pregnancy.
Around half of people with anorexia will continue
to have some level of eating problem despite treatment. If anorexia remains unsuccessfully treated for a
long time, a number of other serious problems can develop. These can include
fragile bones (osteoporosis), infertility, an irregular heartbeat, and
other heart problems.
Despite being an uncommon condition, anorexia is one of the leading causes of mental health-related deaths. This can be because of the effects of malnutrition or as a result of suicide.
Symptoms of anorexia
The main symptom of anorexia is deliberately losing a lot of weight, although there are often a number of other physical and psychological signs there is a problem.
Intentional
weight loss
A person with anorexia will want to weigh as little
as possible – much less than is healthy for their age and height.
They're so afraid of gaining weight they cannot eat normally. In an attempt to lose weight, they may:
- miss
meals, eat very little, or avoid eating any fatty foods
- lie
about what and when they've eaten
- obsessively
count the calories in food
- lie
about how much they weigh
- exercise
excessively
- take
appetite suppressants, such as slimming or diet pills
- make
themselves vomit – you may notice they leave the table
immediately after meals or have dental problems such as tooth decay or bad breath caused by the acid in
vomit.
They may also take laxatives or diuretics, a
type of medication that removes fluid from the body, although in
reality these have little effect on calories absorbed from food.
Self-esteem,
body image and feelings
People with anorexia often believe their value as a person hinges on their weight and how they look. They may think others will like them more or they will feel happier if they are thinner, and see their excessive weight loss in a positive way.
They often have a distorted view of what they look
like, thinking they look fat when they are not.
Some people with anorexia may try to hide how
thin they are by wearing loose or baggy clothes. Many people with the disorder also practise a
type of behaviour known as "body checking", which involves
persistently and repeatedly:
- weighing
themselves
- measuring
themselves, such as their waist size
- checking
their body in the mirror.
People with anorexia also usually have low
self-esteem or self-confidence. They may withdraw from relationships, become
distant from family and friends, and lose interest in activities they
previously enjoyed. Anorexia can also affect the person's school work
or how well they perform their job.
Other
signs of anorexia
Eating too little for a long time can also cause physical symptoms, such as:
- bloating
or constipation
- headaches
- feeling lightheaded or dizzy
- feeling
very tired
- feeling cold
- discoloured
hands and feet caused by poor circulation
- dry
skin
- hair loss from the scalp
- abdominal pain
- problems sleeping
- fine
downy hair (lanugo) growing on the body
- brittle nails.
In children with anorexia, puberty and the associated growth
spurt may be delayed. They may gain less weight than expected – if
any – and may be smaller than others of the same age.
Women and older girls with anorexia may stop having
their monthly periods, known as amenorrhoea, or absent periods.
Causes of anorexia
The exact causes of
anorexia nervosa are unclear, but most specialists believe it's likely to be
the result of a combination of factors.
Psychological
factors
Many people who develop anorexia share certain personality and behavioural traits that may make them more likely to develop the condition. These include:
- a
tendency towards depression and anxiety
- finding
it difficult to handle stress
- excessive
worrying and feeling scared or doubtful about the future
- perfectionism – setting
strict, demanding goals or standards
- being
very emotionally restrained
- having
feelings of obsession and compulsion, but not necessarily obsessive compulsive disorder (OCD) – unwanted
thoughts, images or urges that compel them to perform certain
acts.
It has also been suggested some people with anorexia
have an overwhelming fear (phobia) of being fat.
Environmental
factors
Puberty seems to be an important environmental factor contributing to anorexia. It may be the combination of hormonal changes and feelings of stress, anxiety and low self-esteem during puberty that triggers anorexia.
Western culture and society may also play a part.
Girls – and, to a lesser extent, boys – are exposed to a wide
range of media messages that constantly reinforce the idea that being thin
is beautiful.
Magazines and newspapers also focus on celebrities' minor physical imperfections, such as gaining a few pounds or having cellulite. Other environmental factors that may contribute towards anorexia include:
- pressures
and stress at school, such as exams or bullying, particularly teasing about
body weight or shape
- occupations
or hobbies where being thin is seen as the ideal, such as dancing or
athletics
- a
stressful life event, such as losing a job, the breakdown of a
relationship, or bereavement
- difficult
family relationships
- physical or sexual abuse.
Anorexia often starts off as a form of dieting that gradually gets out of control.
Biological and genetic factors
It's been suggested changes in brain function or hormone levels may also have a role in anorexia, although it's not clear if these lead to anorexia or if they develop later as a result of malnutrition.
These changes may affect the part of the
brain that controls appetite, or may lead to feelings of anxiety and guilt
when eating that improve when meals are missed or after
excessive exercise.
The risk of someone developing anorexia is also thought to be greater in people with a family history of eating disorders, depression, or substance misuse, which suggests genes could play a role.
Diagnosing anorexia
When trying to determine whether you have an eating disorder, your GP will probably ask questions about your weight and eating habits. For example, they may ask:
- if
you've lost a lot of weight recently
- how
you feel about your weight and whether you're concerned about it
- if
you make yourself vomit regularly
- whether
your periods have stopped and, if so,
for how long
- if
you think you have an eating problem.
It's important to answer these questions honestly.
Your GP isn't trying to judge you or catch you out – they just need to
accurately assess your condition.
Weight
and BMI
Your GP will usually check your weight. The weight of a person with anorexia nervosa is at least 15% below average for their age, sex and height.
Your GP may also calculate your body mass index (BMI). For adults, a
healthy BMI is 18.5 to 24.9, although sometimes doctors may be concerned if a
person's BMI is below 20. Adults with anorexia generally have a BMI below 17.5.
BMI is not designed for use in those under the age of 18. Special charts known as centile charts need to be used for this group.
Other tests
Your GP may not need to carry out any tests to diagnose anorexia nervosa, but they may check your pulse and blood pressure, take your temperature, and examine your hands and feet to see whether you have signs of any complications of anorexia.
Your GP may also ask you to carry out some simple
physical exercises, such as moving between sitting, squatting and standing, to
assess your muscle strength.
If you have anorexia, you have a higher risk of
developing some heart conditions, such as an irregular heartbeat (arrhythmia). Sometimes an electrocardiogram (ECG) may be
needed. This is where a number of small, sticky patches (electrodes)
are put on your arms, legs and chest to record the electrical signals
produced by your heart.
Your GP may also carry out blood tests to check your general
health and the levels of chemicals or minerals such as potassium.
Referral to a specialist
If your GP thinks you may have anorexia, they may refer you to a specialist in eating disorders for a more detailed assessment and treatment, although they will sometimes carry out this assessment themselves.
Treating anorexia
The treatment for anorexia nervosa usually involves a combination of psychological therapy and supervised weight gain. It is important for a person with anorexia to start treatment as early as possible to reduce the risk of serious complications of anorexia, particularly if they've already lost a lot of weight.
The
treatment plan
GPs are often closely involved in ongoing treatment, although other healthcare professionals are usually involved, including:
- specialist
counsellors
- psychiatrists
- psychologists
- specialist
nurses
- dietitians
- paediatricians in cases affecting children and teenagers.
Before treatment starts, members of this multidisciplinary care team will carry out a detailed physical, psychological and social needs assessment, and will develop a care plan.
Most people with anorexia are treated as an outpatient, which means they visit hospitals, specialist centres or individual members of their care team for appointments, but return home in between.
In more severe cases, a person may need to stay in hospital or a specialist centre for longer periods during the day (day patient), or they may need to be admitted as an inpatient.
Psychological treatment
A number of different psychological treatments can be used to treat anorexia. Depending on the severity of the condition, treatment will last for at least 6 to 12 months or more.
Cognitive analytic therapy (CAT)
Cognitive analytic therapy (CAT) is based on the theory that mental health conditions such as anorexia are caused by unhealthy patterns of behaviour and thinking developed in the past, usually during childhood. CAT involves a three-stage process:
- reformulation – looking at past
events that may explain why the unhealthy patterns developed
- recognition – helping
people see how these patterns are contributing towards the
anorexia
- revision – identifying
changes that can break these unhealthy patterns.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is based on the
theory that how we think about a situation affects how we act and, in turn, our
actions can affect how we think and feel.
In terms of anorexia, the therapist will attempt
to show how the condition is often associated with unhealthy and
unrealistic thoughts and beliefs about food and diet.
The therapist will encourage the adoption of healthier, more realistic ways of thinking that should lead to more positive behaviour.
Interpersonal therapy (IPT)
Interpersonal therapy (IPT) is based on the theory
that relationships with other people and the outside world in general have a
powerful effect on mental health.
Anorexia may be associated with feelings of low
self-esteem, anxiety and self-doubt caused by problems
interacting with people. During IPT, the therapist will
explore negative issues associated with your interpersonal relationships
and how these issues can be resolved.
Focal psychodynamic therapy (FPT)
Focal psychodynamic therapy (FPT) is based on the theory that mental health conditions may be associated with unresolved conflicts that occurred in the past, usually during childhood.
The therapy encourages people with
anorexia to think about how early childhood experiences may have affected them.
The aim is to find more successful ways of coping with stressful situations and
negative thoughts and emotions.
Family interventions
Anorexia does not just impact on one individual – it can have a big impact on the whole family. Family intervention is an important part of treatment for young people with anorexia.
Family intervention should focus on the eating
disorder, and involves the family discussing how anorexia has affected
them. It can also help the family understand the condition and how
they can help.
Gaining weight safely
The care plan will include advice about how to increase the amount eaten so weight is gained safely. Physical health – as well as weight – is monitored closely. The height of children and young people will also be regularly checked to make sure they're developing as expected.
To begin with, the person will be given small
amounts of food to eat, with the amount gradually increasing as their body gets
used to dealing with normal amounts.
The eventual aim is to have a regular eating pattern, with three meals a day, possibly with vitamin and mineral supplements.
An outpatient target is an average gain of 0.5kg (1.1lbs) a week. In a specialist unit, the aim will usually be to gain an average of around 0.5-1kg (1.1-2.2lbs) a week.
Compulsory treatment
Occasionally, someone with anorexia may refuse treatment even though they are severely ill and their life is at risk. In these cases, as a last resort doctors may decide to admit the person to hospital for compulsory treatment under the Mental Health Act. This is sometimes known as sectioning or being sectioned.
Treating
additional problems
As well as the main treatments mentioned above, other health problems caused by anorexia will also need to be treated.
If you make yourself vomit regularly, you'll be given dental hygiene advice to help prevent
stomach acid damaging the enamel on your teeth.
For example, you may be advised not to brush your teeth soon after vomiting to avoid further abrasion to tooth enamel, and to rinse out your mouth with water instead.
Avoiding acidic foods and mouth washes may be recommended. You will also be advised to visit a dentist regularly so they can check for any problems.
If you have been taking laxatives or diuretics in an attempt to lose weight, you will be advised to reduce them gradually so your body can adjust. Stopping them suddenly can cause problems such as nausea and constipation.
Medication
Medication alone is not usually effective in
treating anorexia. It is often only used in combination with the
measures mentioned above to treat associated psychological problems, such
as obsessive compulsive disorder (OCD) or depression.
Two of the main types of medication used to treat
people with anorexia are:
- selective serotonin
reuptake inhibitors (SSRIs) – a type of antidepressant medication that
can help people with co-existing psychological problems such as
depression and anxiety
- olanzapine – a medication that
can help reduce feelings of anxiety related to issues such as weight and
diet in people who have not responded to other treatments.
SSRIs tend to be avoided until a person with
anorexia has started to gain weight because the risk of more serious side
effects is increased in people who are severely underweight. The drugs
are only used cautiously in young people under the age of 18.
Help and support
If you have an eating disorder or know someone who does, you may find it useful to contact a support group such as Beat for information and advice. Beat provides:
- a
confidential adult helpline on 0808 801 0677 – they also have a
designated youth helpline on 0808 801 0711 (both helplines are open
every day of the year from 4pm to 10pm)
- live chat and online support groups,
where you can talk to others in a similar situation
- a
national network of volunteer support groups.
You can also use the Beat
HelpFinder directory to find eating disorder support
services in your local area.
Complications of anorexia
If anorexia nervosa is not treated, it can lead to a number of serious health problems. In some cases, the condition can even be fatal.
Other
health problems
Long-term anorexia can lead to severe complications and health problems, often as a result of malnutrition. Some complications may improve as the condition is treated, but others can be permanent. Health problems associated with anorexia include:
- problems with muscles and bones –
including weakness, fragile bones (osteoporosis) and problems with
physical development in children and young adults
- sexual problems – including absent periods and infertility in
women, and loss of sex drive and erectile dysfunction in men
- problems with the heart and blood vessels –
including poor circulation, an irregular heartbeat, low blood pressure, heart valve
disease, heart failure and swelling in the
feet, hands or face (oedema)
- problems with the brain and nerves –
including fits (seizures) and difficulties with concentration and
memory
- other problems – kidney damage,
liver damage, anaemia and low
blood sugar (hypoglycaemia).
Some people with anorexia develop another eating
disorder called bulimia nervosa. This is where a
person binge eats and then immediately makes themselves sick, or uses laxatives to rid their body of the
food.
Pregnancy
complications
If you have anorexia and are pregnant, you'll need to be closely monitored during pregnancy and after you've given birth. Anorexia during pregnancy can increase the risk of problems such as:
- miscarriage
- giving
birth early (premature birth)
- having
a baby with a low birth weight
- needing
a caesarean section.
You are also likely to need extra care and support
during pregnancy if you previously had anorexia and recovered from it.
Source: NHS Choices