Anorexia

Anorexia nervosa is a serious mental health condition characterised by extreme preoccupation with pursuing as low a body weight as possible.

What is Anorexia?

People with anorexia have an intense fear of gaining weight or becoming fat and engage in a variety of behaviours to keep their weight down. They may:

• Restrict their eating severely
• Exercise excessively
• Purge
• Abuse laxatives or diet pills
• Engage in a combination of all of these

People with anorexia typically have a distorted body image, seeing themselves as fat even when at a very low weight. Their shape and weight play an excessive role in how they see themselves and they often have difficulty appreciating the severity of their condition.

For diagnostic purposes, anorexia is divided into two sub-types:

1. Binge-eating/purging type, in which restriction is accompanied by episodes of self-induced vomiting or use of laxatives or diuretics
2. Restricting type, in which there is no accompanying vomiting or laxative abuse

It has been theorized that there are marked differences in the causes and ways in which these two subtypes are experienced. The features and underlying causes of the binge-eating/purging type may closely resemble bulimia nervosa and many people shift from one diagnosis to the other.

By contrast, people with restrictive anorexia tend to have a more consistent and confined presentation.

Read more about the causes of anorexia

Anorexia nervosa – the facts

1. Anorexia is more common in women than men, with different studies indicating that females are anywhere from three to ten times more likely to have anorexia than males¹.

2. It is thought that 2/3 of people with anorexia will also suffer from an anxiety disorder at some point in their lives, with anxiety difficulties typically predating their eating disorder².

3. An often-referenced study³ that followed up patients 21 years after initial treatment found that:

• 51% were fully recovered
• 21% were partially recovered
• 10% still had full-syndrome anorexia
• 17% had died due to eating disorder-related causes

Anorexia is the most fatal of all psychiatric disorders. The mortality rate for the disorder has been estimated as 5.6%⁴ of sufferers per decade.

This is almost twice that of the next most lethal mental illness.

¹ Hudson et al., (2007)
² Kaye et al., (2004)
³ Lowe, B., et al (2001)
⁴ Sullivan, (1995)

Anorexia Symptoms

The symptoms of anorexia will differ between individuals and are likely to change over time – it’s common for people to experience some or all the following syigns of anorexia:

• Rapid weight loss
• Intense fear of gaining weight
• A distorted perception of their weight
• Preoccupation with body image and food
• Growing fine, downy body hair
• Stomach complaints (pains or constipation)
• Secretive or deceitful behaviour around food
• Feeling panicked when faced with eating all, or certain, foods
• Feeling cold much of the time
• Becoming socially withdrawn
• Depression
• Anxiety
• Obsessive and rigid thinking
• Fatigue and sleep issues
• Vomiting, using laxatives or diuretics
• Exercising excessively (often to include exercising in secret)
• Dizziness or fainting
• In women, changes to menstrual cycle (reduced frequency or stopping altogether)

People with anorexia often hide their symptoms from other people, for instance by wearing baggy clothing, picking at food or saying they have already eaten so don’t need any more. They may diminish their weight loss and are often very sensitive to conversations about their weight.

As a parent, relative or friend it can seem almost impossible to know what to do – someone with anorexia will often take huge ‘pride’ in being told they look ill or gaunt and yet as a loved one, all you will want to do is help.

Take our test for Anorexia

Treatment for anorexia

Recovery from anorexia is very challenging. Many people with the condition find it hard to see how ill their eating disorder has made them or feel that they do not need or deserve help. It may be very hard for them to imagine who they are or what their lives might be like without an eating disorder.

The right treatment for helping someone with anorexia depends on a few factors. Most importantly, if someone has a very low body weight (a BMI of 15 or below) it is likely they will need inpatient care. In this case, we always suggest going to your GP as a matter of urgency to initiate the process of referral to an eating disorder clinic.

For those who have a BMI above 15 and who are not losing weight rapidly, it is likely that outpatient care would be relevant. Treatment plans may include regular therapy (with a psychologist or psychotherapist), medication, nutrition guidance and family therapy.

Read more about getting treatment for eating disorders

Download our Adult Eating Disorder Assessment Guide

Treatments like CBT can really help overcome the initial hurdles and the right clinician will provide the right level of support and encouragement you need to embark on the recovery process.

Dr Charlie Baily

PhD, CPsychol

Clinical Psychologist

London

Dr Charlie Baily is a Clinical Psychologist currently working in the private sector. He has a PhD in Clinical Psychology and is a member of The British Psychological Society and Health and Care Professions Council.