What is anorexia nervosa?

Anorexia nervosa is an eating disorder and a serious mental illness. Eating disorders are not a choice. This can be very confusing to others looking on.

Out of a fear of gaining weight, someone with anorexia nervosa may follow a restrictive diet and do too much exercise.

A person with anorexia nervosa:

• has a very distorted body image
• has an intense and often irrational fear of gaining weight
• restricts their energy intake
• does excessive exercise

The restriction in energy intake can cause a large amount of weight loss in a short period of time. It may result in you having a very low weight.

People with anorexia nervosa often see themselves as being heavy or large when they are very underweight. Their body image can have a large influence on how they feel about themselves. Extreme weight loss can drastically change the way you think and how your brain functions.

Types of anorexia nervosa

Anorexia nervosa falls into 2 general types:

1. restricting type
2. binge eating

Restricting type

People with this type of anorexia nervosa restrict the amount and type of food they eat.

This can include:

• counting calories
• skipping meals
• limiting or avoiding certain food groups (such as carbohydrates)
• following obsessive rules, such as only eating foods of a certain colour

These behaviours may be accompanied by too much exercise.

Binge eating/purging type

People with this type of anorexia place severe restrictions on the food they eat and they also purge. Purging behaviours include vomiting (being sick) or misusing laxatives, diuretics or enemas.

Some people may also binge eat — eat a large amount of food and feel out of control.

Atypical anorexia nervosa

Atypical anorexia nervosa is a type of eating disorder called Other Specified Feeding or Eating Disorders (OSFED).

This is when you have all the behaviours of anorexia nervosa, but your body mass index (BMI) is normal or above.

What are the symptoms of anorexia nervosa?

The most obvious signs of anorexia nervosa are:

• being underweight
• losing weight very quickly
• having dramatic weight fluctuations
• controlling and restricting food intake
• being preoccupied with food and body weight

Being very thin is not the only sign of anorexia nervosa. There are other signs that you may have with anorexia nervosa.

Physical signs

Physical signs can include:

• fainting or dizziness
• feeling cold even when the weather is warm
• bloating, constipation or developing food intolerances
• feeling tired and not sleeping well
• low energy
• looking pale or having sunken eyes
• fine hair on your face and body
• loss of menstruation (your period) in females
• decreased libido (sex drive) in males

Psychological signs

Psychological signs can include:

• being preoccupied with eating, food, body shape and weight
• being extremely dissatisfied with body image and irrational ideas about body and weight
• being anxious, irritable or secretive at mealtimes
• fear of gaining weight
• depression and anxiety
• difficulty thinking and concentrating
• having rigid thoughts about food
• low self-esteem and perfectionism

Behavioural signs

Behavioural signs can include:

• intense dieting (counting calories, avoiding foods)
• deliberately misusing laxatives, appetite suppressants, enemas and diuretics
• obsessive behaviours around body weight or shape (repeated weighing, 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 are some things that can increase your risk:

• Genetic risk factors — anorexia nervosa can run in families, suggesting there may be a genetic cause.
• Cultural factors — related ideals of thinness promoted by the media and social media.
• Environmental factors — including the onset of puberty, stressful life events and relationship problems.

For some people, anorexia is a way of controlling areas of life that feel out of control. Their body image can define their entire sense of self-worth.

Psychological factors such as anxiety may also play a role in the development of anorexia.

Who gets anorexia nervosa?

Anyone can get anorexia nervosa, but it’s most often diagnosed in females. This may be because many males do not show signs that are as obvious. However, the number of males diagnosed with anorexia nervosa is growing.

Anorexia usually starts in adolescence, with 4 in 10 cases being diagnosed between 15 years and 19 years.

When should I see my doctor?

If you are worried about your eating, it’s important to speak someone. You could talk to someone you trust like a friend, family member or teacher.

Your doctor is also a good place to start. They will help you take the first steps towards treatment and recovery.

If you have anorexia nervosa, the earlier you get help, the better your chances of recovery. Seriously restricting calorie intake is dangerous and can have a serious impact on your health.

If you have signs of anorexia nervosa, it is important to get help as soon as possible.

How is anorexia nervosa diagnosed?

Your doctor will examine you and ask you questions about your health. They will also check for any other mental or physical complications.

Your doctor may diagnose anorexia nervosa based on your thoughts, feelings and eating behaviours.

How is anorexia nervosa treated?

It is possible to recover from anorexia nervosa, even if you have been living with the illness for many years. The road to recovery is often long and challenging. But with the right team supporting you and a high level of commitment, you can recover.

Psychological support

Seeing a psychologist or psychiatrist has been shown to reduce the length and impact of anorexia nervosa.

Cognitive behavioural therapy enhanced for eating disorders (CBT‐E) is usually the first treatment recommended for adults. This is typically delivered over 40 weekly sessions.

Family‐based therapy is usually the first treatment recommended for children and adolescents.

A psychologist can help you learn behaviours that will help you get to and maintain a healthy weight.

Other treatments

You may also see a:

• dietitian
• family therapist

If you have life-threatening medical complications or have very low body weight, you may need to spend time in hospital.

Antidepressants and other medicines are sometimes used to treat anorexia nervosa, along with psychological therapy.

Complications of anorexia nervosa

If you, or someone else, is at immediate risk of suicide, call triple zero (000) now for an ambulance.

Anorexia nervosa can also cause physical complications including:

• anaemia
• intestinal problems
• problems with your immune system
• an irregular heartbeat or other heart problems
• osteoporosis and bone problems that can increase the risk of broken bones
• kidney failure

Anorexia nervosa can be life threatening. This can be due to the physical or psychological impacts of the disease.

Mental health complications can include self-harm, substance abuse and suicide.

Resources and support

The National Eating Disorders Collaboration has information on evidence-informed prevention and treatment of eating disorders.

You can speak confidentially to the Butterfly National Helpline. Call 1800 33 4673, 8am to midnight AEST, 7 days a week.

Eating Disorders Families Australia (EDFA) supports the families and carers of people with an eating disorder. You can call them on 1300 195 626.

If you are thinking about suicide, you can call Lifeline on 13 11 14 or chat online.