Anorexia Nervosa is characterised by persistent energy intake restriction, intense fear of gaining weight and disturbance in self perceived weight or shape. For some people, restricting their food and weight can be a way of controlling areas of life that feel out of their control and their body image can come to define their entire sense of self worth. It can also be a way of expressing emotions that may feel too complex or frightening such as pain, stress or anxiety.
The reasons behind the development of AN will differ from person to person. Known causes include genetic predisposition and a combination of environmental, social and cultural factors. Restrictive dieting and excessive exercise can be contributing factors to the onset of AN. Women and girls with AN may use dieting behaviour in a bid to achieve a culturally constructed thin ideal whereas men may over exercise and control their diet to achieve a muscular body.
It is commonly accepted that AN is more frequently diagnosed in females across the ages. However, recent population studies suggest that in adolescents, there are an equal number of males and females suffering from this illness.
Defining Anorexia Nervosa
Restricted energy intake
A person with AN is unable to maintain what is considered to be a normal and healthy weight. They could also have lost a considerable amount of weight in a short period of time.
A fear of gaining weight
Even when people with AN are underweight, starved or malnourished they still possess an intense fear of gaining weight or becoming overweight.
Disturbed body image
When someone has AN the amount of attention they place on their body image can be enormous. The person’s self worth can become entirely defined by the way they think they look. A person with AN can also develop a distorted view of their body. They may see themselves as overweight when in reality they are dangerously underweight.
Sub-types of Anorexia Nervosa
There are two subtypes of AN, and both are very serious mental illnesses that require treatment.
People with this subtype place severe restrictions on the amount and type of food they consume. This can manifest in different ways including some or all of the following:
- Restricting certain food groups (e.g. carbohydrates, fats)
- Counting calories
- Skipping meals
- Obsessive rules and rigid thinking (e.g. only eating food that is one colour)
These restrictive behaviours around food can be accompanied by excessive exercise.
Binge Eating/Purging Subtype
People with this subtype also place severe restriction on the amount and type of food they consume. In addition to this the person will display purging behaviour and may also engage in binge eating. Binge eating involves eating a large amount of food and feeling a ‘loss of control’. Purging behaviour involves self induced vomiting, or deliberately misusing laxatives, diuretics or enemas to compensate for eating food.
What are the warning signs of Anorexia Nervosa?
Having awareness about AN and its signs and symptoms can make a huge difference to the duration and severity of the illness. Seeking help at the first warning sign is much more effective than waiting until the illness is in full swing. If you or someone you know is exhibiting some or a combination of these signs it is vital to seek help and support as soon as possible.
Someone with AN may display any combination of the following warning signs.
- Rapid weight loss or frequent weight changes
- Loss or disturbance of menstruation in girls and women and decreased libido in men
- Fainting or dizziness
- Feeling cold most of the time, even in warm weather (caused by poor circulation)
- Feeling bloated, constipated, or the development of intolerances to food
- Feeling tired and not sleeping well
- Lethargy and low energy
- Facial changes (e.g. looking pale, sunken eyes)
- Fine hair appearing on face and body
- Preoccupation with eating, food, body shape and weight
- Feeling anxious and/or irritable around meal times
- Intense fear of gaining weight
- Unable to maintain a normal body weight for their age and height
- Depression and anxiety
- Reduced capacity for thinking and increased difficulty concentrating
- ‘Black and white’ thinking (e.g. rigid thoughts about food being ‘good’ or ‘bad’)
- Having a distorted body image (e.g. seeing themselves as overweight when they are actually underweight)
- Low self esteem and perfectionism
- Increased sensitivity to comments relating to food, weight, body shape, exercise
- Extreme body image dissatisfaction
- Dieting behaviour (e.g. fasting, counting calories/kilojoules, avoiding food groups such as fats and carbohydrates)
- Deliberate misuse of laxatives, appetite suppressants, enemas and diuretics
- Repetitive or obsessive behaviours relating to body shape and weight (e.g. repeated weighing, looking in the mirror obsessively and pinching waist or wrists)
- Evidence of binge eating (e.g. disappearance or hoarding of food)
- Eating in private and avoiding meals with other people
- Anti-social behaviour (spending more and more time alone)
- Secrecy around eating (e.g. saying they have eaten when they haven’t, hiding uneaten food)
- Compulsive or excessive exercising (e.g. exercising in bad weather, continuing to exercise when sick or injured, and experiencing distress if exercise is not possible)
- Radical changes in food preferences (e.g. suddenly disliking food they have always enjoyed in the past, reporting of food allergies or intolerances, becoming vegetarian)
- Obsessive rituals around food preparation and eating (e.g. eating very slowly, cutting food into very small pieces, insisting that meals are served at exactly the same time everyday)
- Preoccupation with preparing food for others, recipes and nutrition
- Self harm, substance abuse or suicide attempts
Find out more about the warning signs
What are the risks associated with Anorexia Nervosa?
The risks associated with AN are severe and can be life threatening. They include:
- Anaemia (iron deficiency)
- Compromised immune system (e.g. getting sick more often)
- Intestinal problems (e.g. abdominal pain, constipation, diarrhoea)
- Loss or disturbance of menstruation in girls and women
- Increased risk of infertility in men and women
- Kidney failure
- Osteoporosis– a condition that leads to bones becoming fragile and easily fractured
- Heart problems (e.g. cardiac abnormalities, sudden cardiac arrest)
Psychological treatment has been clinically proven to reduce the severity, impact and duration of AN. The long-term aims of psychological treatment for AN are to reduce risk and to encourage weight gain, normal eating and exercise behaviours, with full psychological and physical recovery as the ultimate goal.
Ideally, the treatment of people with AN are managed on an outpatient basis, with psychological treatment and physical monitoring provided by healthcare professionals, who will possess specialised knowledge in eating disorders.
- Behavioural therapy
- Cognitive analytic therapy
- Cognitive behavioural therapy
- Ego-oriented therapy-adolescent focused individual therapy (for children and adolescents)
- Focal psychodynamic therapy
- Family interventions focused explicitly on eating disorders
- Maudsley family-based treatment (for children and adolescents)
- Interpersonal psychotherapy
- Specialist supportive clinical management
Antidepressants (specifically selective serotonin re-uptake inhibitors; e.g. SSRI) or antipsychotics can also be used to treat AN.
Please note: Medication should not be used as the sole or primary treatment for AN; rather, it should be used in conjunction with therapy appropriate for the treatment of AN.
Find out more about specific Treatment Approaches.