What is Anorexia?

Anorexia nervosa is an eating disorder characterized by attempts to lose weight, to the point of starvation. Anorexia nervosa, often referred to simply as anorexia, is an eating disorder that is also characterized by low weight, fear of gaining weight, and a strong desire to be thin, resulting in food restriction. Many people with anorexia see themselves as overweight even though they are in fact underweight.

Anorexia is estimated to affect 2.9 million people as of 2015. It is estimated to occur in 0.9% to 4.3% of women and 0.2% to 0.3% of men in Western countries at some point in their life. About 5% of people with anorexia die from complications over a ten-year period, a nearly 6 times increased risk.

Signs and Symptoms:

Physical signs

Fear of fatness or pursuit of thinness.
Pre-occupation with body weight.
Distorted perception of body shape or weight
Not being truthful about how much weight they have lost.
Eating only low-calorie food.
Missing meals (restricting).
Avoiding eating with other people.
Hiding food.
Obsessive behaviour and rituals around eating.
Excessive exercising.
Social withdrawal and isolation

Behavioural signs

Severe weight loss.
Lack of sexual interest or potency.
Difficulty sleeping and tiredness.
Feeling dizzy.
Stomach pains.
Constipation and bloating.
Feeling cold or having a low body temperature.
Growth of downy (soft and fine) hair all over your body (called Lanugo).
Getting irritable and moody.
Difficulty concentrating.
Low blood pressure.

Causes

Behavioural:

Low self-esteem has been commonly associated as a trigger for the onset of anorexia.⁶ Many people with anorexia report feeling worthless and not good enough. Losing weight can start to feel like a sense of achievement and can become a way for some people to feel a sense of worth.

Certain personality traits such as perfectionism have also been found to make a person more likely to be affected by anorexia. Other psychological factors which are associated with anorexia include:

Other mental health conditions, particularly depression, self-harm and anxiety.
Finding it hard to handle stress and cope with life.
Having feelings of obsession and compulsion.

Social:

We live in a society where body image is highly important. This means we are constantly being told that how we look reflects our worth which can leave us feeling increasingly ashamed of our bodies if they do not fit the model of what is a ‘good body’.

This can have an impact on our body-esteem and how we feel about ourselves. While these cultural and social pressures do not cause eating disorders, they can make those particularly vulnerable to developing an eating disorder feel more pressure to look a certain way and they can trigger an eating disorder.

Biological:

New research is looking into the genetic links that may underpin anorexia.¹⁰ There is also increasing work focusing on exploring the neurochemical and neurological make-up that may help us understand why some people develop anorexia and why some do not.

Treatments:

Treatment for anorexia usually involves a combination of talking therapy and supervised weight gain.It’s important to start treatment as early as possible to reduce the risk of serious complications, particularly if you’ve already lost a lot of weight. Treatment for anorexia is slightly different for adults and those under 18 years old.

Cognitive behavioural therapy (CBT)

If you are offered CBT, it will usually involve weekly sessions for up to 40 weeks (9 to 10 months), and 2 sessions a week in the first 2 to 3 weeks. CBT involves talking to a therapist who will work with you to create a personalised treatment plan.

They will help you to:

cope with your feelings
understand nutrition and the effects of starvation
make healthy food choices

They will ask you to practice these techniques on your own, measure your progress, and show you ways to manage difficult feelings and situations so you stick with your new eating habits.

Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)

MANTRA involves talking to a therapist in order to understand what is causing your eating disorder. It focuses on what’s important to you and helps you to change your behaviour when you are ready. You can involve your family or carers if you think it would be helpful.

Specialist supportive clinical management (SSCM)

SSCM involves talking to a therapist who will help you understand what is causing your eating disorder. You will learn about nutrition and how your eating habits cause your symptoms.

Focal psychodynamic therapy

Focal psychodynamic therapy is usually offered if you don’t feel any of the above therapies are right for you or if they don’t work. Focal psychodynamic therapy should include trying to understand how your eating habits are related to what you think, and to how you feel about yourself and other people in your life. You should be offered weekly sessions for up to 40 weeks (9 to 10 months).

Diet advice

During your treatment you will probably be given advice on healthy eating and your diet. However, this advice alone will not help you recover from anorexia, so you will need to have talking therapy as well as dietary advice. Your doctors will probably also advise you to take vitamin and mineral supplements so you get all the nutrients you need to be healthy.

Medication

Antidepressants should not be offered as the only treatment for anorexia. But you may be offered an antidepressant, such as sertraline (Zoloft), in combination with therapy, to help you manage other mental health conditions.