Anorexia Nervosa

What is anorexia nervosa?

Anorexia nervosa (just called anorexia from now on) is an eating disorder. It means "loss of appetite due to your nerves". Anorexia is a serious condition which affects all sorts of people. Anorexia is very common – about 1 in 20 teenagers have it. However, it affects people of all ages and has become more common in boys and men in recent years.

People with anorexia often find that they do not allow themselves to feel full after eating. This means that they restrict the amount they eat and drink. People with anorexia are underweight. Sometimes, the weight becomes so low that it is dangerous to health.

How do I know if I have an eating disorder?

If you answer yes to two or more of these questions then you may have an eating disorder and you should see your doctor.

• Do you make yourself sick because you are uncomfortably full?
• Do you worry that you've lost control over how much you eat?
• Have you recently lost more than 6kg (about one stone) in the past three months?
• Do you believe you're fat when others think you are thin?
• Would you say that food dominates your life?

What are the symptoms of anorexia nervosa?

Deliberate weight loss

This is the main symptom. You lose weight by avoiding fattening foods or even any foods. People with anorexia limit the amount they eat and drink to control how their body looks. You may often pretend to other people that you are eating far more than you actually are. You may be using other ways of staying thin, such as exercising too much. You may also have made yourself vomit, take laxatives, or even take appetite suppressant drugs or diuretics (water tablets).

People with anorexia typically weigh 15% or more below the expected weight for their age, sex and height. The BMI (body mass index) is calculated by your weight (in kilograms) divided by the square of your height (in metres). For example, if you weigh 66kg and are 1.7m tall then your BMI would be 66/(1.7x1.7) = 22.8. A normal BMI for an adult is 20-25. Above that you are overweight and below you are underweight. Adults with anorexia have a BMI below 17.5.

With anorexia, you feel very in control of your body weight and shape. However, with time, anorexia takes control of you. Chemical changes occur in your brain which then makes it very difficult to make healthy, normal choices about the amount and types of food you eat.

A wrong idea of body size

People with anorexia think that they are fat when they are actually very thin. Although other people see you as thin or underweight, it is very difficult for you to see this. You are likely to have a severe dread (like a phobia) of gaining weight. People with anorexia will do their utmost to avoid putting on weight.

Other features

It is common for people with anorexia to:

• Vomit secretly after eating.
• Try hard to hide their thinness, for example, by wearing baggy clothes.
• Tend not to be truthful about how much they eat and about everything to do with food.
• Like food and feel hungry, but it is the consequences of eating that frightens them.

You may also may find that you have become very obsessed with what other people are eating.

People with anorexia often restrict themselves to certain types of food. Eating food may even become like a ritual. For example, each time you eat you have to cut your food into very small pieces. You may think frequently about your weight and even weigh yourself most days or even several times a day. It is also common to feel cold most of the time and have irregular sleeping patterns. You might also find yourself having poor concentration.

What are the health risks with anorexia nervosa?

Health risks are caused by undereating (starvation) and by the methods used to get rid of eaten food (vomiting, excess laxatives, etc). Problems that may occur include the following:

Irregular periods. Many people with anorexia have irregular periods as hormone levels can be affected by poor diet. Your periods may even stop all together or you may find that your periods have never started, especially if you started having eating problems when you were younger. Some people with anorexia are even infertile (unable to have a baby).

Chemical imbalances in the body. These are caused by either repeated vomiting or excess use of laxatives. For example, a low potassium level which may cause tiredness, weakness, abnormal heart rhythms, kidney damage and convulsions. Low calcium levels can lead to tetany (muscle spasms).

Thinning of the bones (osteoporosis). This is caused by a lack of calcium and vitamin D and can lead to easily fractured bones.

Bowel problems. These may occur if you take a lot of laxatives. Laxatives can damage the bowel muscle and nerve endings. This may eventually result in permanent constipation and also sometimes abdominal pains.

Swelling of hands, feet and face. This is usually due to fluid disturbances in the body.

Teeth problems. These can be caused by the acid from the stomach rotting away the enamel with repeated vomiting.

Anaemia. Having a diet low in iron can lead to anaemia. This can make you feel weaker and more tired than normal. Dizzy spells and feeling faint can also occur.

Depression. It is common to feel low when you have anorexia. Some people even become depressed which can respond well to treatment. It is important to talk about any symptoms of depression you may have. Many people find they become more moody or irritable.

Loss of sex drive (libido). This can occur in both males and females with anorexia and can often be due to changes in hormone levels.

Hair and skin problems. You may find you have downy hair on your body and also the hair on your head becomes thinner. Many people with anorexia also have dry, rough skin.

What is the cause of anorexia nervosa?

The exact cause is still not fully understood. Part of the cause is a fear of getting fat but it is not just as simple as that. Different causes possibly work together to bring on the condition. These may include the following:

• The pressure from society and the media to be 'thin and beautiful' is thought to play a part. This is probably why anorexia is much more common in westernised countries.
  
  
• Personality and family environment probably play a role too. People with anorexia often have poor self-esteem (not much self-confidence) and commonly feel that they have to be perfectionists. Often there are disturbed family relationships. All sorts of emotions, feelings and attitudes may contribute to causing anorexia.
  
  
• There may be some genetic factor. We know this from studies of families with identical twins. If one twin has anorexia then the other has a 1 in 2 chance of getting it. This tells us that it has a tendency to run in some families and that the condition may have a genetic part. However, because not every twin gets it there are other factors too.

What is the outlook (prognosis)?

With treatment, anorexia can take weeks or even many months to improve. It can take several years for people with anorexia to become completely better. Many people find they still have issues with food, even after treatment, but they are more in control and can lead happier, more fulfilled lives.

Unfortunately, some people with anorexia die from causes related to anorexia. Causes of death include infections, dehydration, blood chemical imbalances (such as low potassium levels) and even suicide.

What is the treatment for anorexia nervosa?

The aim of treatment is to:

• Reduce risk of harm (and death) which can be caused by anorexia.
• Encourage weight gain and healthy eating.
• Reduce other related symptoms and problems.
• Help people become both physically and mentally stronger.

Most people with anorexia who see their GP will be referred to a specialist mental health team. Members of the team may include psychiatrists, psychologists, nurses, dieticians and other professionals. The sort of treatments that may be offered include the following:

Help with eating. Having regular meals is better. Even if you only eat small meals it is beneficial to the body to eat at least three times a day. You should try and be honest (to yourself and other people) about the amount of food you are actually eating. You should reduce the number of times you weight yourself; try to only weigh yourself once a week. It may be useful to have an eating diary to write down all the food that you eat.

Psychological ('talking') treatments such as cognitive behavioural therapy (CBT). Talking treatments help to look at the reasons why you may have developed anorexia, and aim to change any false beliefs that you may have about your weight and body and how to identify and deal with emotional issues. Talking treatments take time and usually require regular sessions over several months. Treatment may also involve other members of your family going to meetings to discuss any family issues.

Antidepressant medication may be advised in addition to talking treatments if you also develop depression.

Treatment of any physical or teeth problems that may occur. This may include taking potassium supplements, having dental care and trying not to use laxatives or water tablets.

Self help measures may be of benefit. There are a number of self help books and guides available. These provide methods on how to cope with and overcome anorexia. (The Eating Disorders Association listed at the end may be able to suggest current titles.) They are not suitable for everyone, particularly if your anorexia is severe.

Further help and information

beat - Eating Disorders Association

103 Prince of Wales Road, Norwich, NR1 1DW
Tel: 08456 341414 Web: www.edauk.com
Offers information and support.

Institute of Psychiatry/Maudsley Hospital

Web: www.iop.kcl.ac.uk/sites/edu/?id=131
This site has good information on medical complications of eating disorders and is kept up-to-date with research developments.