Anorexia Nervosa

Anorexia nervosa is far more than just a diet gone too far; it's a severe and complex mental health condition characterised by an intense fear of gaining weight and a distorted body image, leading to extreme restriction of food intake. Affecting millions globally, this eating disorder can have profound physical and psychological consequences, often requiring long-term support and professional intervention. Living with anorexia nervosa can be incredibly challenging, not just for the individual, but also for their loved ones. This detailed guide aims to shed light on this serious illness, offering insights into its concerning condition.

Anorexia nervosa is a type of eating disorder that makes people obsess about their weight and what they eat. People with this condition often see themselves as overweight, even when they are dangerously underweight. They will go to extreme lengths to control their weight and shape, which significantly interferes with their health and daily life. This can involve severely restricting the amount of food they eat, exercising excessively, or misusing laxatives, diuretics, or enemas. 

It’s a serious condition that can have life-threatening implications if not addressed, impacting mental, emotional, and physical well-being. The desire to be thin becomes all-consuming, leading to a relentless pursuit of weight loss and a complete loss of perspective on what a healthy body looks like. The term ‘anorexia’ literally means ‘loss of appetite’, but this is a bit misleading as people with anorexia nervosa often feel hungry but try to ignore or suppress these feelings.

Anorexia nervosa is typically categorised into two main types based on the individual's behaviours over the last three months:

• Restricting Type: Individuals with this type achieve weight loss primarily through dieting, fasting, or excessive exercise. They do not regularly engage in binge-eating or purging behaviours (such as self-induced vomiting or the misuse of laxatives, diuretics, or enemas). Their focus is on extreme control over their food intake.
• Binge-Eating/Purging Type: Individuals with this type regularly engage in binge-eating (consuming an unusually large amount of food in a short period) or purging behaviours (like self-induced vomiting or the misuse of laxatives, diuretics, or enemas), or both. While they may still restrict their overall food intake, these behaviours are also present. It’s important to note that even those with the binge-eating/purging type of anorexia nervosa are typically underweight, distinguishing them from individuals with bulimia nervosa, who are usually of normal weight or overweight.

There isn't a single cause for anorexia nervosa; instead, it typically arises from a complex interplay of various factors. It's often described as a biopsychosocial condition, meaning biological, psychological, and social elements all contribute to its development.

• Biological Factors: Genetics can play a role, with research suggesting that people who have a close relative with an eating disorder may be more susceptible. Certain brain chemistry imbalances, particularly involving serotonin and dopamine, might also contribute. Some theories suggest differences in brain structure or function could make some individuals more vulnerable to developing the disorder.
• Psychological Factors: Certain personality traits, such as perfectionism, obsessive-compulsive tendencies, high anxiety levels, and a need for control, are often seen in individuals with anorexia nervosa. A low sense of self-worth and body dissatisfaction are also significant contributors. Trauma, depression, and other co-occurring mental health conditions can also increase risk.
• Social and Cultural Factors: Modern Western culture often glorifies thinness and places immense pressure on individuals, particularly young women, to conform to unrealistic body ideals. Media portrayals, social media influences, and peer pressure can contribute to body image issues and the desire to lose weight. Family dynamics, such as high expectations or overprotectiveness, can also be a factor, though families are rarely solely responsible. Bullying related to appearance can also trigger body image issues.

The symptoms of anorexia nervosa can be broadly categorised into physical, behavioural, and emotional signs. Recognising these signs is crucial for early intervention and treatment for the eating disorder.

Physical Symptoms:

• Significant weight loss or failure to gain weight during growth periods.
• Extreme thinness (emaciation).
• Fine, soft hair (lanugo) growing all over the body.
• Absent or irregular periods in females (amenorrhoea).
• Fatigue and low energy.
• Dizziness or fainting spells.
• Cold intolerance (feeling cold all the time).
• Bluish discolouration of the fingers.
• Brittle nails and hair.
• Dry or yellowish skin.
• Constipation.
• Low blood pressure and slow pulse.
• Heart problems, including arrhythmia.
• Dehydration.
• Swelling of arms or legs.

Behavioural Symptoms:

• Severe restriction of food intake, often disguised.
• Obsession with food, calories, nutrition, or cooking for others.
• Ritualistic eating behaviours (e.g., cutting food into tiny pieces, eating very slowly).
• Frequent weighing.
• Excessive exercise.
• Wearing baggy clothes to hide weight loss.
• Avoiding situations where food is present.
• Misuse of laxatives, diuretics, or enemas, or self-induced vomiting.
• Social withdrawal and isolation.
• Denial of hunger.

Emotional Symptoms:

• Intense fear of gaining weight or becoming fat.
• Distorted body image (seeing oneself as fat even when dangerously thin).
• Irritability or mood swings.
• Anxiety and depression.
• Reduced interest in sex.
• Difficulty concentrating.
• Perfectionism.
• Low self-esteem.

Diagnosing anorexia nervosa involves a comprehensive evaluation by healthcare professionals, typically including a general practitioner, a psychiatrist, or a specialist in eating disorders. The diagnostic process usually includes:

• Physical Examination: This involves measuring weight, height, blood pressure, heart rate, and temperature. Blood tests may be conducted to check for electrolyte imbalances, kidney function, and other health issues resulting from malnutrition. An electrocardiogram (ECG) might be performed to assess heart health.
• Psychological Assessment: A mental health professional will conduct a detailed interview to understand the individual's eating habits, body image, thoughts about food and weight, and any co-occurring mental health conditions like depression or anxiety. They will also inquire about family history and social factors.
• Review of Symptoms and Behaviours: The professional will look for the core features of anorexia nervosa, including significant restriction of energy intake leading to a dangerously low body weight, an intense fear of gaining weight or becoming fat (even when underweight), and a disturbance in the way one's body weight or shape is experienced.
• Exclusion of Other Medical Conditions: It's important to rule out any other medical conditions that could cause weight loss, such as gastrointestinal problems or thyroid disorders.

Treating anorexia nervosa is a complex process that requires a multidisciplinary approach, often involving a team of healthcare professionals. The primary goals of treatment are to restore a healthy weight, address the psychological issues contributing to the disorder, and promote long-term recovery. Treatment plans are highly individualised and may include:

Medical Stabilisation: For individuals who are severely underweight or experiencing life-threatening complications, hospitalisation may be necessary. This focuses on refeeding them safely and gradually, correcting electrolyte imbalances, and managing any physical health problems.

Nutritional Rehabilitation: Working with a registered dietitian is crucial to develop a healthy eating plan, gradually reintroduce a wider variety of foods, and normalise eating patterns. The dietitian helps address distorted beliefs about food and weight, working towards weight restoration. Sometimes, appetite stimulants like Cypon may be prescribed to help increase food intake. 

Psychological Therapies: This is a cornerstone of treatment.

• Family-Based Treatment (FBT) / Maudsley Approach: Often used for adolescents, FBT empowers parents to take an active role in refeeding their child and restoring their weight. As the child improves, control over eating is gradually handed back.
• Cognitive Behavioural Therapy (CBT-E - Enhanced CBT): This therapy helps individuals identify and challenge unhelpful thoughts and behaviours related to food, body image, and weight. It focuses on developing coping strategies and improving body acceptance.
• Specialist Supportive Clinical Management (SSCM): This therapy combines supportive clinical management with specific interventions for anorexia nervosa, focusing on the link between eating behaviours and their physical and psychological consequences.
• Psychodynamic Psychotherapy: This explores underlying emotional conflicts and past experiences that may contribute to the eating disorder.

Medication: While there are no specific medications for anorexia nervosa itself, antidepressants (such as Selective Serotonin Reuptake Inhibitors - SSRIs) may be prescribed to treat co-occurring conditions like depression or anxiety, which often accompany the disorder once some weight has been restored.

• Being a female.
• Adolescence or young adulthood.
• Family history of eating disorders or mental health conditions.
• Perfectionism, high anxiety, or obsessive-compulsive traits.
• Dieting history or extreme weight concerns.
• Participation in activities emphasising thinness (e.g., ballet, modelling).
• History of trauma or abuse.
• Low self-esteem or body dissatisfaction.
• Difficulty coping with stress or expressing emotions.

• Serious heart problems, including heart failure.
• Bone loss (osteoporosis), increasing fracture risk.
• Kidney failure.
• Gastrointestinal issues, like chronic constipation.
• Anaemia.
• Electrolyte imbalances, which can be fatal.
• Dental erosion from vomiting.
• Infertility in women.
• Increased risk of other mental health conditions, like depression and anxiety.
• Suicidal thoughts or attempts.
• Death due to starvation or heart complications.

Living with anorexia nervosa is a journey of recovery, and while challenging, incorporating certain strategies can help manage the condition and support healing.

• Adhere Strictly to Your Treatment Plan: Consistently follow the guidance of your doctors, therapists, and dietitians. This is non-negotiable for progress.
• Build a Strong Support Network: Lean on trusted family members, friends, or support groups who understand your struggle and can offer encouragement.
• Practice Self-Compassion: Be kind to yourself. Recovery has ups and downs; acknowledge progress and be patient during setbacks.
• Develop Healthy Coping Mechanisms: Find constructive ways to deal with stress and difficult emotions, such as journaling, engaging in hobbies, or mindfulness.
• Limit Exposure to Triggers: Identify and minimise situations, people, or media that trigger negative thoughts about body image or food.

It's Just a Phase or a Lifestyle Choice: Anorexia nervosa is a serious mental illness, not a temporary behaviour or a conscious choice. It's driven by deep-seated psychological and biological factors.

Only Teenagers or Young Women Get It: While more common in adolescents and young women, anorexia nervosa can affect anyone, regardless of age, gender, background, or socioeconomic status. Men, older adults, and children can also develop the condition.

It's All About Attention-Seeking: The restrictive behaviours are symptoms of immense distress and a desperate attempt to gain control, not a bid for attention. Individuals with anorexia often try to hide their illness.

You should see a doctor if you or a loved one:

• Are significantly underweight for your age and height.
• Are intensely preoccupied with your weight, body shape, or dieting.
• Are restricting food intake to an extreme degree.
• Are exercising excessively.
• Have a distorted body image, believing you are fat even when very thin.
• Are experiencing any of the physical symptoms associated with anorexia nervosa, such as fatigue, dizziness, or loss of periods.
• Are experiencing significant anxiety or depression related to food or body image.

• What are the immediate health risks associated with my current weight/symptoms?
• What kind of specialist treatment options are available for anorexia nervosa in my area?
• Can you recommend a registered dietitian who specialises in eating disorders?
• What psychological therapies do you think would be most helpful for me?
• How long does treatment typically take, and what does recovery look like?
• What resources are available for my family or support system?
• What steps can I take to ensure my physical health is being monitored throughout treatment?

Supporting someone with anorexia nervosa can be challenging, but your patience, understanding, and consistent encouragement are invaluable.

• Learn as much as you can about anorexia nervosa to better understand what the person is going through and dispel common myths.
• Gently but firmly encourage the person to seek and adhere to professional treatment. Offer to help them find resources or accompany them to appointments.
• Do not comment on their weight or eating habits negatively. Focus on their well-being and the illness, not the person.
• Let them know you are there for them without judgment. Listen to their fears and frustrations without trying to fix them, and remind them that recovery is possible.

Anorexia nervosa is a deeply serious and complex mental health disorder that calls for sensitive, well-rounded support. Recovery often involves a team effort—drawing on the guidance of healthcare professionals and the unwavering support of loved ones. Though the road to healing can be difficult, it is entirely possible with the right care and understanding.