Anorexia nervosa, or anorexia, is an eating disorder. People with anorexia have an intense fear of putting on weight and severely limit the amount of food they eat to reduce their body weight to an unhealthily low level.
 
About anorexia nervosa
Symptoms of anorexia nervosa
Complications of anorexia nervosa
Causes of anorexia nervosa
Diagnosis of anorexia nervosa
Treatment of anorexia nervosa
Help and support
 

About anorexia nervosa

The direct translation of the medical name ‘anorexia nervosa’ means loss of appetite for nervous reasons. But in fact you don't lose your appetite if you have anorexia – you just don't allow yourself to satisfy your appetite.

If you have anorexia, you develop a distorted idea of your body shape and size. You try to stop or limit eating and may over-exercise. This makes you very underweight.

Anorexia is most common in teenage girls, although you can develop the illness at any age. About one in 250 women and one in 2,000 men get anorexia at some time in their lives.

The other main eating disorder is bulimia nervosa. This involves cycles of bingeing (overeating) and purging (ridding the body of the excess food usually by vomiting or taking laxatives). Some people with anorexia may have bingeing and purging habits too.

Symptoms of anorexia nervosa

There are many different symptoms associated with anorexia, and not everyone has the same ones. But if you have anorexia, you will probably have a body weight that is much less than expected for your age and height. You may do the following:

  • eat very little, if at all, or restrict certain foods, such as those containing fat
  • be secretive about food
  • cut your food into tiny pieces to look as though you have eaten some, and become obsessed with what other people are eating
  • obsessively weigh yourself and measure and examine your body
  • be obsessed with exercise
  • be restless
  • use appetite suppressants such as diet pills
  • make yourself vomit after meals or use laxatives or pills that remove water from your body (diuretics)
  • wear baggy clothes to disguise your weight loss
  • make yourself sick.

With anorexia, you become distracted thinking about your weight or 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

Apart from 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
  • constipation
  • puffy face and ankles
  • light-headedness and dizziness
  • tiredness
  • poor sleep
  • delayed puberty (because anorexia affects your hormones)
  • 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 or boys)

 

Complications of anorexia nervosa

Over time, anorexia can cause serious long-term health problems such as:

  • osteoporosis
  • damage to your heart
  • infertility

If you have severe anorexia, it’s important that you receive appropriate treatment. If untreated, the condition can be life-threatening due to health problems such as starvation, dehydration, infections and heart failure. You are also at an increased risk of mental health problems.

Causes of anorexia nervosa

The reasons for developing anorexia aren’t understood and are probably different for everyone. They may include emotional, physical and social reasons.

People with certain personality types such as perfectionists are more commonly affected by anorexia.
The following emotional or mental health conditions are also associated with anorexia:

  • low self-esteem – this is not thinking highly about your self-worth and associating it with your body weight
  • mood conditions, particularly depression
  • obsessive-compulsive disorder – this is a condition causing anxiety due to obsessively thinking about things or doing certain actions

If you have a perfectionist personality or one of these conditions, an eating disorder may give you a sense of control and achievement.

There are certain factors that make it more likely that you will develop anorexia. For example:

  • living in a Western society
  • being influenced by media images of thinness
  • having been obese in the past
  • having a job or hobby where a very lean body type is desirable (eg running, athletics, modelling or dancing)
  • having a family history of eating disorders due to genetic factors or by copying the behaviour of other family members
  • going through an emotionally upsetting event such as divorce or abusive family relationships

 

Diagnosis of anorexia nervosa

Getting help is very important. Admitting you have a problem is the first step, though it can be the hardest. Taking that step means you should be able to find the support and treatment you need to stop anorexia and improve your life.

Talk to your GP first. He or she will ask about your life and eating habits and will examine you. He or she may refer you to a psychiatrist or psychologist who is trained in the treatment of eating disorders.

 

Treatment of anorexia nervosa

You should start treatment for anorexia as soon as you can. The aim is to re-establish a healthy attitude towards food and a consistent pattern of eating.

You can recover from anorexia but it may be a long process and, in times of stress, you may relapse. But with determination, patience and support it can be done. For treatment to work, you must want to get better.

Self-help

Keeping a diary of your eating habits and learning about healthy eating and sensible weight control may help.

Support groups may help. It can be comforting to talk to others who have had the same feelings and experiences.

Medicines

Medicines are not usually used to treat anorexia. However, they may be used to treat secondary symptoms such as anxiety and depression.
 

Talking therapies

Talking therapies (eg 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 in separate counselling sessions. This helps everyone in the family to understand the disorder properly and support each other.

Hospital treatment

Most people who have anorexia don’t need to go into hospital. But if you have lost so much weight that your life is at risk, you may need to be admitted to hospital so that the fluids and nutrients that you have lost from your body can be replaced.

Forced treatment is always a last resort, because it can be distressing to lose control of what you’re eating and drinking.
 

Help and support

It can be upsetting for loved ones to see you putting your health at risk. It’s natural that they want to help even though you may find unwanted pressure or criticism may make matters feel worse.

You may wish to make your own choices but may need much love and support. If you recognise you have a problem, others may be able to offer to help with practical matters such as finding medical help and support groups. Support groups can provide advice and information for you, friends and family.

See our answers to common questions about bulimia nervosa, including:
 
How long does it take to recover from anorexia?
I’ve heard that anorexia can stop your periods and make you infertile. I have had anorexia in the past but have since recovered. Will I be able to become pregnant?
Will I need to be admitted to hospital to be treated for anorexia?
 
 

How long does it take to recover from anorexia?

Recovery time varies from person to person.

Explanation

The time it takes to recover from anorexia varies greatly. It takes an average of five to six years after you have been diagnosed to recover. On the other hand, anorexia can last for a much shorter period of time, sometimes for only a few months.
 

Half of all people with anorexia make a full recovery. Others find that their condition improves with time. Only around two out of 10 people don't make a recovery and go on to have a long-term eating disorder.

It's important that you seek help for anorexia as early as possible. This is because the sooner you get help, the better your chances of recovery are. Recovering from an eating disorder can be a difficult process, but it can be done.

 

I’ve heard that anorexia can stop your periods and make you infertile. I have had anorexia in the past but have since recovered. Will I be able to become pregnant?

Yes. If you're having regular periods and are eating properly again, you should be able to become pregnant.

Explanation

If you have anorexia, your periods might stop. This happens because anorexia causes changes in the hormones that control your reproductive system. If your periods have stopped because of anorexia, then you probably won't be able to get pregnant because you aren't ovulating (producing eggs).
 

Many women find that their periods come back after they start to recover and are eating a healthy, balanced diet again. If your periods have started again, then you should be able to get pregnant.

However, if you're still underweight and not eating enough, then you may not be able to gain the amount of weight that you need to during pregnancy. This means there is a risk that you might have a baby with a very low birth weight, which can lead to him or her having other health problems. It's better for both you and your baby if you attempt to recover from anorexia before you try to get pregnant.

Try to eat a varied, well-balanced diet and stay at a healthy weight for several months before getting pregnant. You will need to stay at a healthy weight throughout your pregnancy to make sure that both you and your baby stay healthy.

If you have anorexia and are already pregnant, you should let your doctor know because you may require special care.

 

Will I need to be admitted to hospital to be treated for anorexia?

No, it's not likely. Anorexia is usually treated without you having to be admitted to hospital.

Explanation

You can be treated for anorexia as an outpatient. This means that you go to hospital to see your doctor but you won't have to stay overnight.
 

You only need to stay in a hospital ward or a special eating disorder unit if you're seriously ill or very weak. You may also need to stay in hospital if you have already had outpatient treatment but your anorexia hasn't improved, or if there is a risk that you might try to harm yourself.

Further information

• Beating Eating Disorders (beat)
0845 634 1414 (adult helpline)
0845 634 7650 (youthline)
www.b-eat.co.uk
 
• Mental Health Foundation
www.mentalhealth.org.uk
 

Sources

• What is anorexia nervosa? Beat. www.b-eat.co.uk, published August 2008.
• Eating disorders. Clinical Knowledge Summaries. ww.cks.nhs.uk, accessed 24 February 2010
• What is bulimia nervosa? Beat. www.b-eat.co.uk, published August 2008
• Eating disorders. Royal College of Psychiatrists. www.rcpsych.ac.uk, published January 2008
• Anorexia. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, accessed 6 March 2010
• Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. National Collaborating Centre for Mental Health. www.nice.org.uk, published January 2004.
• Morris J, Twaddle S. Anorexia nervosa. BMJ 2007; 334:894–98. doi:10.1136/bmj.39171.616840.BE

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