What is anorexia nervosa?
This serious mental illness is most common in women and usually starts in adolescence. It is the third most common chronic illness in girls and young women and affects up to 1 in 200 girls. One in 11 people who develop anorexia after puberty are male.
People with anorexia nervosa may see themselves as being heavy or large when they are actually severely underweight. They follow restrictive diets and harsh, punishing exercise routines. They control food as a way of controlling areas of their lives or dealing with negative emotions.
Anorexia falls into 2 general types:
1. Restricting type
People with this type of anorexia nervosa place severe restrictions on the quantity and type of food they consume.
This could include counting calories, skipping meals, restricting certain foods (such as carbohydrates) and following obsessive rules, such as only eating foods of a certain colour.
These behaviours may be accompanied by excessive exercise.
2. Binge eating/purging type
People with this type of anorexia also place restrictions on the food they eat. But this is accompanied by binge eating and then purging.
Binge eating means someone eats a large amount of food to cope with feelings of being out of control. The person then 'compensates' for this eating by purging the food through vomiting or misusing laxatives, diuretics or enemas.
What are the symptoms of anorexia nervosa?
The most obvious sign that someone has anorexia nervosa is that they are severely underweight, they have lost weight very quickly, or their weight fluctuates dramatically.
A BMI of less than 18.5 is considered underweight. But being very thin is not the only sign of anorexia. There are also other signs that a person may have anorexia nervosa.
- loss of menstruation in women, decreased libido (sex drive) in men
- fainting or dizziness
- always feeling cold
- bloating, constipation or developing food intolerances
- poor sleep
- lethargy and tiredness
- looking pale
- dry, yellow skin
- sunken eyes
- fine hair on the face and body
- being preoccupied with eating, food, body shape and weight
- being extremely dissatisfied with their body, or having a distorted body image
- being anxious and/or irritable at meal times
- depression and anxiety
- difficulty concentrating
- having rigid thoughts about food
- low self-esteem and perfectionism
- intense dieting (counting calories, avoiding foods)
- deliberately misusing laxatives, appetite suppressants, enemas and diuretics
- obsessive behaviour around body weight or shape (weighing themselves obsessively, pinching waist or wrists)
- binge eating
- avoiding eating with other people and secrecy around food
- wanting to be alone
- excessive exercising
- obsessive rituals around food
- preoccupation with cooking, recipes and nutrition
- self-harm, substance abuse or suicide attempts
What causes anorexia nervosa?
The causes of anorexia nervosa are not fully understood.
There may be genetic risk factors and a combination of environmental, social and cultural factors. It's likely that some people are more vulnerable to anorexia because of particular personality traits.
The causes that may contribute to a person developing anorexia nervosa include:
Psychological factors, such as a high level of perfectionism or obsessive-compulsive personality traits, feeling limited control in life and low self-esteem, a tendency towards depression and anxiety and a poor reaction to stress.
Cultural pressures to be thin stemming from media and pop culture such as magazines, TV shows and movies.
Occupations that demand a thin physique may increase the risk of anorexia nervosa, such as certain sports, ballet, or the television and fashion industries.
Brain chemistry, because extreme dieting can affect the balance of hormones in the body, affecting how the brain functions.
Genetic predisposition, which arises from the genes inherited from parents. Anorexia nervosa often runs in families, suggesting there may be a genetic cause.
When should I see my doctor?
Many people with anorexia nervosa think they’re not sick enough or thin enough to need treatment. But seriously restricting calorie intake is dangerous and can have a serious impact on health. If you have anorexia nervosa, the earlier you seek help, the better your chances of recovery.
If you are worried about your eating, it’s important to speak someone. Your doctor is a good place to start, or you could talk to someone you trust like a friend, family member or teacher. They will help you take the first steps towards treatment and recovery.
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How is anorexia nervosa diagnosed?
After ruling out that weight loss is caused by another condition, your doctor may refer you to a mental health professional. This health professional will diagnose anorexia nervosa based on your thoughts, feelings and eating behaviours. They will also check for any other mental or physical complications.
How is anorexia nervosa treated?
The first step to recovery is restoring good nutrition and a healthy weight. This allows treatments to work effectively. If the person has life threatening medical complications or is extremely low weight, they may need to spend time in hospital.
A psychologist can help a person with anorexia nervosa learn behaviours that will help them to return to and maintain a healthy weight. Someone with anorexia nervosa may also see a dietitian, family therapist, psychiatrist or other members of a healthcare team.
Antidepressants and other medicines are sometimes used to treat anorexia nervosa along with psychological therapy.
On average, people have anorexia nervosa for 5 to 7 years. It's common for people with the condition to relapse, so follow-up and treatment for anorexia nervosa is important.
Complications of anorexia nervosa
Anorexia nervosa can also cause physical complications including:
- an irregular heartbeat or other heart problems
- osteoporosis and bone problems that can increase the risk of broken bones
Unfortunately, around 1 in 5 people eventually die of the consequences of anorexia nervosa, and one in 5 will attempt suicide.
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Last reviewed: July 2020