Anorexia nervosa

Anorexia nervosa occurs when a person severely reduces the amount of food they eat. This makes them lose more weight than is healthy for their age and height.

Those with anorexia have an obsessive fear of gaining weight. They may diet or exercise too much so they can lose weight or stay “slim”.

They are determined to do this, despite the concern of others around them. Anorexia is an eating disorder. The other eating disorders that you will hear about are:

Bulimia: Where a person eats very large amounts of food because they are starving. Then they worry about gaining weight so they make themselves vomit, takes laxatives or exercise to extremes.

Binge eating disorder: Where a person eats an excessive amount of food within a short period of time (two hours) and feels a loss of control while eating.

Other eating disorders: Where a person has signs of either bulimia or anorexia but not enough signs to definitely state they have these conditions. This category is often called eating disorder not otherwise specified (EDNOS) by doctors, and usually occurs at an early age. It is very common and doctors treat is as seriously as the other categories of eating disorder.

We will focus on anorexia here. However, it’s worth noting that any form of eating disorder is a complex mental illness that can have serious physical, emotional and social impacts.

Anorexia nervosa usually begins during adolescence

It is generally seen at an earlier age than other eating disorders, such as bulimia and binge eating disorder (these are often developed during late adolescence or early adulthood).

Females represent approximately 90% and males 10% of all eating disorders.

However, like all eating disorders, anorexia can be developed at any age or stage of life for both males and females. A person with anorexia will often say they are fine and just want everyone to leave them alone. They may suggest that it is only the unwelcome concern of others that bothers them. In reality they do not enjoy anorexia and will usually be painfully aware of how miserable and isolated they are, and of how much the anorexia controls their life.

They endure a constant struggle with negative thoughts about the self, endless thoughts about food and disgust at their body.

Talk to your doctor if you suspect yourself, or a loved one has anorexia. It is a very serious condition that can lead to death from starvation, so it's important to seek help. Effective treatment is available.

What causes anorexia?

An eating disorder has no single cause. A wide range of factors have been identified that can be considered possible “causes” of anorexia. These can be grouped into family, social and personal factors. People who exhibit a number of these are considered to be at a higher risk of developing an eating disorder than others.

Family patterns, such as a family history of:

• depression
• eating disorders
• alcoholism.

Social factors, such as:

• society’s emphasis on thinness
• society’s intolerance of fatness
• pressure to achieve.

Personal factors such as:

• having low self-esteem
• being overly sensitive to opinions of others
• being a perfectionist
• having poor problem solving skills
• being anxious
• being self-critical
• being very self-conscious.

Signs to look for (symptoms) 

One of the clearest symptoms is anxiety around food. This could include the person:

• refusing to eat with others
• having rituals around eating, such as counting mouthfuls, eating from a particular plate only, or taking only tiny mouthfuls
• lying about eating ("I've already eaten")
• constant preoccupation with food
• being moody or angry when asked about dieting. 

Other early signs of anorexia include:

• unusually thin appearance (for that person)
• increasing concern about weight and disgust with body shape
• wearing only baggy or concealing clothing
• exercising too much
• repeatedly weighing themselves
• frequent checking themselves in the mirror
• complaining about being fat, bloated or feeling full
• difficulty concentrating
• restlessness and hyperactivity
• changes in personality and mood swing
• obsessive compulsive behaviour.

As weight drops various changes occur in the body:

• The body’s functions slow down so as not to use up too much energy. A sign of this is the lowering of body temperature so the person feels cold.
• For women with anorexia, their menstrual periods stop.
• Blood flow to the arms and legs reduces, making the fingers and toes blue and cold.
• Fine hair may grow on the back, arms and face.
• With further weight loss, vital organs such as the brain and heart may be affected.
• Starvation of the brain causes loss of concentration, difficulty in thinking clearly, depression and irritability.
• Starvation of the heart muscle leads to heart failure or disturbances in heart rhythm, which can lead to sudden death. 

How the doctor determines if you have an eating disorder (diagnosis) 

If anorexia is suspected the doctor will run a number of tests and examinations to make sure there is no medical reason for the weight loss.

To be diagnosed with anorexia, a person must:

• Have an intense fear of gaining weight or becoming fat, even when they are underweight.
• Refuse to keep weight at what is considered normal for their age and height.
• Have a body image that is very distorted, be very focused on body weight or shape, and refuse to admit the danger of weight loss.
• Have not had a period for three or more cycles.

Treatment options

Eating disorders are complex. A person with an eating disorder will very often also suffer from depression, anxiety and a lack of self worth.

While your doctor may not be an expert in treating eating disorders, they will be able to assess any physical problems resulting from your eating disorder and can also help you to contact specialist eating disorder services.

However, for successful treatment, you must be at a stage where you accept that you want anorexia out of your life. Your doctor will recommend a mix of treatment options that best suit you. 

Psychosocial treatments (therapy)

These are non-medical treatments that address your emotional needs such as your thinking, behaviour, relationships and environment. This involves talking with a trained professional who uses clinically researched techniques, usually talking therapies, to assess and help you understand what has happened, and to help you make positive changes in your life. 

Psychoeducation (providing education)

Education can be extremely important to help you and your family. Your health professional will give you information about the disorder, suggest different ways to handle it, and discuss any complications that may occur.

There are also numerous self-help books available in book shops that some find to be a useful first stage in getting help. They can teach you about some of the ways of dealing with your eating disorder and they can also get you used to reading about or discussing problems that you have previously kept completely to yourself. They are generally written by medical experts but draw on the experience of people who have eating disorders. 

Medication

There are no drug treatments that are of established benefit in the treatment of anorexia. There are a few that may help deal with some of the associated problems, and these are prescribed from time to time. These include antipsychotic and antidepressant medications.

If you are prescribed medication, you’re entitled to know the names of the medicines; what symptoms they are supposed to treat; how long it will be before they take effect; how long you will have to take them for and understand the side effects.

If you are pregnant or breast feeding no medication is entirely safe. Before making any decisions about taking medication at this time you should talk with your doctor.

Complementary therapies

Complementary therapies may be used in addition to psychosocial treatments and prescription medicines. Any health-related practice that increases your sense of wellbeing or wellness is likely to be of benefit.

In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Complementary therapies can include using a number of herbal and other medicinal preparations to treat particular conditions. It is recommended that care is taken as prescription medicines, herbal and medicinal preparations can interact with each other. 

Hospitalisation

Hospitalisation may be suggested where there is extreme weight loss and concerns about your physical health. There are only a few places in New Zealand that have a specialised hospital programme for anorexia. These units all aim to restore your weight to an acceptable level as well as to begin psychotherapy. Hospital stay tends to be between three and 12 months but this can vary a lot.

Thanks to Janet Peters, Registered Psychologist, for reviewing this content. Date last reviewed: October, 2014.