What Is Anorexia Nervosa?

Anorexia Nervosa is an eating disorder characterised by the deliberate refusal to eat enough to maintain a normal body weight. As a result, both the body and the mind are starved of the nutrients needed for healthy, balanced functioning. Though anorexia is a serious illness which can be fatal, full recovery is possible with appropriate support and treatment.

Although the word 'anorexia' literally means loss of appetite, this does not accurately describe what a person experiences. Appetite is suppressed rather than lost and an intense interest in food is retained. Self-starvation and weight loss/control represent an attempt to feel more in control of one's life and gives the person a much needed sense of effectiveness and achievement. Restriction of food intake often begins with the gradual elimination of high calorie foods from the diet. A sudden preference for a vegetarian diet may form part of the pattern. At first, this can resemble a normal diet or lifestyle choice but the relentless drive behind the behaviour becomes more and more obvious as the disorder progresses. Other means of maintaining low body weight might include fasting, excessive exercise, self-induced vomiting, the use of laxatives, diuretics or appetite suppressants.

Anorexia nervosa can affect both males and females of all ages. It is most common amongst girls and young women. Around 10% of people with anorexia are male (see Eating Disorders in Men). Many factors combine to make any one person more vulnerable to anorexia than another and these factors vary from person to person. Anorexia is not primarily about food and weight issues or about 'slimming'. As with all eating disorders, the psychological issues and emotional distress underlying the physical symptoms must be addressed for long-term recovery to be possible.

Anorexia

Main Features

  • Restriction of food intake.
  • Intense fear of putting on weight. This fear is not lessened by weight loss.
  • Preoccupation with body weight, size and shape. Self-evaluation and self-esteem become increasingly linked to these.
  • Perception of body shape and size are disturbed (body image distortion). Even an obviously emaciated body is experienced as fat.
  • Disruption of hormonal balance. In women and adolescent girls the menstrual cycle is upset: periods become irregular and eventually cease (amenorrhoea). In men there can be a loss of libido. In pre-pubertal children growth can be disrupted and sexual development can be delayed.

 

Other Signs & Symptoms

Physical signs and symptoms:

  • Over-activity and excessive exercising.
  • Increased sensitivity to cold.
  • Poor circulation.
  • Bloating of stomach, fluid retention.
  • Constipation and abdominal pain.
  • Restlessness, inability to settle.
  • Difficulty sleeping, tiredness.
  • Dry, thinning hair.
  • Dry, discoloured skin.
  • Growth of fine, downy hair (lanugo) on the face and body resulting from the body's efforts to keep warm.
  • Loss of periods.
  • Decreased interest in sex.
Psychological and social signs and symptoms:
  • Low self-esteem.
  • Irritability and mood swings.
  • Difficulty resolving conflict.
  • Social isolation.
  • Difficulty coping with change and frustration.
  • Inflexible 'black or white'/ 'right or wrong' thinking.
  • Depression.
  • Obsessive and/or compulsive behaviour.

Food related signs and symptoms:

  • Rigid, limited diet.
  • Frequent weighing.
  • Excessive thinking and talking about food and related issues.
  • Lying about food intake, claiming to have already eaten or to have plans to eat elsewhere.
  • Chasing food around the plate, taking a long time over meals.
  • Cooking for others.
  • Reading and collecting recipes.
  • Rituals around food and eating.
  • Increased use of spices, condiments, chewing gum.
  • Increased consumption of fluids.
  • Episodes of bingeing or perceived overeating.
  • Secret disposal of food.

Most symptoms will reverse with weight gain and normalisation of diet and eating habits.

Health Consequences Of Anorexia Nervosa

In order to deal with the effects of starvation, the body is forced to slow down all its processes and to find ways of conserving energy. The physical effects of starvation include:

  • Dehydration -> risk of kidney failure.
  • Muscle weakness -> risk of muscle loss.
  • Tiredness and overall weakness -> risk of fainting.
  • Abnormally slow heart rate and low blood pressure produces changes in the heart muscle -> risk of heart failure.
  • Loss of bone density resulting in dry, brittle bones (osteoporosis) -> risk of postural problems and risk of fracture.

Starvation also affects a person's thinking and behaviour. Poor nutrition and dehydration produce changes in brain chemistry. It is thought that these changes in brain chemistry contribute to sustain the distorted thinking, disturbed perception and obsession with food associated with anorexia. Intellectual ability can also be affected resulting in reduced concentration, poor memory, difficulties with abstract thinking, problem solving, decision making and planning. In some cases, these changes can also increase vulnerability to depression, anxiety and other psychiatric disorders such as obsessive-compulsive disorder. If the depression is severe, there is a risk of suicide.

Other means of weight control such as self-induced vomiting, use of laxatives or diuretics and excessive exercise can also have very serious health consequences and can have a significant impact on a person's capacity to function effectively.

Bone health needs to be monitored and advice should be sought from a professional on how best to manage nutrition and exercise to facilitate the restoration of bone health. A DEXA scan will give a clear assessment of bone density and indicate what kind of treatment is required and how best to protect oneself against further loss.

Anorexia

Getting Help

Anorexia is a serious disorder and should not be left untreated. Both the physical and the psychological aspects of the disorder should be assessed and monitored. Treatment will vary according to the individual. See our Treatment Options & Medical Help or Counselling & Psychotherapy sections for further information. A GP can assess and monitor physical aspects of the disorder. Individual psychotherapy and family therapy can be useful in addressing the psychological problems relating to personal effectiveness and interpersonal problems that may be underlying the disorder. Nutritional counselling can increase a person's understanding of how their diet and eating patterns are affecting them physically, mentally and socially. Support groups and other support services can help to break social isolation and encourage recovery.

Some people may require hospitalisation.

The time needed for recovery from anorexia nervosa varies according to each individual.

Because of the nature of the disorder, a person with anorexia may have difficulty admitting to the seriousness of the risks to their physical and their mental health. The prospect of recovery can be very frightening and resistance to treatment is normal. This may have the effect of delaying appropriate treatment and can cause severe distress for carers and family members. Carers should seek information and support for themselves to increase their understanding of the disorder and their ability to help. Attending a support group for family and friends can be helpful.

Further information can be found in the books listed on our Booklist and from other websites for eating disorders and related issues. See our list of Websites or contact the Bodywhys Helpline: lo call 1890 200 444