What is anorexia nervosa?

Anorexia nervosa is a serious mental illness that pervades all aspects of an individual’s life and has profound physical and psychological effects on them, and on those around them. The illness is much more common in young women, though recent studies have identified much higher rates of anorexia in men than previously thought. Anorexia is a highly visible disorder and evokes intense emotional response from others, particularly from those closest to the individual who is ill.

People with anorexia nervosa deliberately keep themselves at a weight far below that considered to be healthy for their height and age by restricting their food intake. Some individuals also exercise excessively or “purge” after eating to control their weight even further.

People with anorexia feel fat even when they look emaciated. They have an intense fear of gaining weight despite being drastically underweight: losing weight or maintaining an abnormally low weight becomes a way of life and they will take extreme measures to avoid increasing their weight. They minimise or deny the seriousness of low body weight and the effects of starvation. They have distorted thinking patterns, and feelings of being defective and worthless – this affects not only their eating, but all parts of their life, including relationships, family life, work and leisure.

People with anorexia don’t “just grow out of it”. When the illness takes hold, they are often in such a deep state of denial about the amount of weight loss and its physical and psychological consequences, and are so afraid of gaining even the smallest amount of weight, that they are terrified of seeking treatment. They value their undernourished state and are reluctant to contemplate change. However, left untreated, anorexia can continue to dominate the life of an individual indefinitely, and in around 10 to 20 per cent of cases, it is fatal. There is also a relatively high rate of suicide among people with anorexia.

There are two types of anorexia:

  • A restricting type (person does not engage in binge-eating or purging behaviour, e. g. self-induced vomiting or misuse of laxatives, diuretics or enemas)

  • A binge-eating type or purging type (person engages in binge-eating or purging behaviour, e. g. self-induced vomiting or misuse of laxatives, diuretics or enemas)

People with anorexia have characteristic personality traits: they are perfectionists, fear making mistakes, extremely conscientious, attend to detail, and are often rigid in their thought processes. People are vulnerable to developing anorexia if they have obsessive compulsive personality traits, and have “all or nothing”, “black and white” thinking.

Many people with anorexia experience high levels of anxiety and avoid identifying and describing their own emotions. Research shows that people with anorexia avoid intense emotions and intimate interpersonal relationships, which are likely to arouse these emotions. The evidence suggests that starvation helps avoid difficult emotions, and people with anorexia see this as a benefit. They develop beliefs that starving themselves will help them stay safe and manage difficult emotions and the relationships.

What are the warning signs of anorexia nervosa?

Warning signs of anorexia include dramatic weight loss and a sudden preoccupation with weight, food, calories and dieting. A person might at first refuse to eat certain types of food and later progress to eliminating entire categories of food, e. g. carbohydrates or fat. Control of calories and food becomes a primary concern. People with anorexia often develop distinctive food rituals, like eating foods in certain orders, cutting food into small pieces or excessive chewing. They will try and make excuses to avoid mealtimes or social situations involving food. This often leads to withdrawal from friends and other social activities. People with anorexia display a huge anxiety about gaining weight or being “fat”, despite obvious drastic weight loss. They often engage in excessive and rigid exercising, disregarding weather, fatigue, illness or injury.

What are the physical symptoms of anorexia nervosa?

Anorexia commonly starts in mid-adolescence when brain development undergoes significant changes. Poor provision of nutrients and/or raised levels of stress hormones associated with starvation have a deleterious effect on the developing brain and may alter its function in a lasting way.

Food deprivation leads to constipation, abdominal pains and fluid retention – their face, stomach and ankles may become swollen. People with anorexia suffer from poor blood circulation, low blood pressure, muscle weakness and from dizzy spells and faintness. They also feel constantly cold, and can develop long, fine downy hair on face and body. Their skin becomes dry and discoloured. Low metabolism will result in their hair becoming dry and fall out. In females, the menstrual cycle may become disrupted or stop completely. People with anorexia come across as restless and have difficulty sleeping. They have a poor resistance to infections.

There will be long-term damage to bones with loss of bone mass leading to osteoporosis and possible future fertility and serious reproductive problems. Women who become pregnant have high risk pregnancies and may subsequently have difficulties feeding their babies. Men with anorexia lose their libido. Associated psychiatric problems include OCD, depression, alcohol and substance misuse, anxiety disorders and suicidal behaviour

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