Anorexia Nervosa

Anorexia is an eating disorder and serious mental health condition.

People who have anorexia try to keep their weight as low as possible by not eating enough food or exercising too much, or both. This can make them very ill because they start to starve.

They often have a distorted image of their bodies, thinking they are fat even when they are underweight.

Men and women of any age can get anorexia, but it's most common in young women and typically starts in the mid-teens.

Signs and symptoms of anorexia

The main symptom of anorexia is deliberately losing a lot of weight or keeping your body weight much lower than is healthy for your age and height.

Signs and symptoms include:

missing meals, eating very little or avoid eating any foods you see as fattening
lying about what and when you've eaten, and how much you weigh
taking medication to reduce your hunger (appetite suppressants), such as slimming or diet pills
exercising excessively, making yourself sick, or using medication to help you poo (laxatives) or to make you pee (diuretics) to try to avoid putting on weight
an overwhelming fear of gaining weight
strict rituals around eating
seeing losing a lot of weight as a positive thing
believing you are fat when you are a healthy weight or underweight
not admitting your weight loss is serious

You may also notice physical signs and symptoms such as:

if you're under 18, your weight and height being lower than expected for your age
if you're an adult, having an unusually low body mass index (BMI)
your periods stopping (in women who have not reached menopause) or not starting (in younger women and girls)
bloating, constipation and abdominal pain
headaches or problems sleeping
feeling cold, dizzy or very tired
poor circulation in hands and feet
dry skin, hair loss from the scalp, or fine downy hair (lanugo) growing on the body
reduced sex drive

People with anorexia often have other mental health problems, such as depression or anxiety.

Warning signs of anorexia in someone else

The following warning signs could indicate that someone you care about has an eating disorder:

dramatic weight loss
lying about how much and when they've eaten, or how much they weigh
avoiding eating with others
cutting their food into small pieces or eating very slowly to disguise how little they are eating
trying to hide how thin they are by wearing loose or baggy clothes

In children with anorexia, puberty and the associated growth spurt may be delayed. Young people with anorexia may gain less weight than expected and may be smaller than children of the same age.

Getting help

Getting help and support as soon as possible gives you the best chance of recovering from anorexia.

If you think you may have anorexia, even if you are not sure, see your GP as soon as you can.

If you're concerned that a family member or friend may have anorexia, let them know you're worried about them and encourage them to see their GP. You could offer to go along with them.

You can also talk in confidence to an adviser from eating disorders charity Beat by calling its adult helpline on 0808 801 0677 or youth helpline on 0808 801 0711.

Getting help for anorexia

Getting help and support as soon as possible gives you the best chance of recovering from anorexia.

If you think you may have anorexia, even if you are not sure, see your GP as soon as you can.

They will ask you questions about your eating habits and how you're feeling, and will check your overall health and weight.

They may also refer you for some blood tests to make sure your weight loss is not caused by something else.

If they think you may have anorexia, or another eating disorder, they should refer you to an eating disorder specialist or team of specialists.

It can be very hard to admit you have a problem and to ask for help. It may make things easier if you bring a friend or loved one with you to your appointment.

You can also talk in confidence to an adviser from eating disorders charity Beat by calling its adult helpline on 0808 801 0677 or youth helpline on 0808 801 0711.

Getting help for someone else

If you're concerned that a family member or friend may have anorexia, let them know you're worried about them and encourage them to see their GP. You could offer to go along with them.

Treatment for anorexia

Treatment for anorexia usually involves a combination of talking therapy and supervised weight gain.

It's important to start treatment as early as possible to reduce the risk of serious complications, particularly if you've already lost a lot of weight.

Treatment for anorexia is slightly different for adults and those under 18 years old.

Treatment for adults

A number of different talking therapies are available to treat anorexia. The aim of these treatments is to help you understand the causes of your eating problems and feel more comfortable with food so you can begin to eat more and reach a healthy weight.

You may be offered any of the following types of talking therapy. If you feel one isn't right for you or isn't helping, you can talk to your doctors about trying a different kind of therapy.

Cognitive behavioural therapy (CBT)

If you are offered CBT, it will usually involve weekly sessions for up to 40 weeks (9 to 10 months), and 2 sessions a week in the first 2 to 3 weeks.

CBT involves talking to a therapist who will work with you to create a personalised treatment plan.

They will help you to:

cope with your feelings
understand nutrition and the effects of starvation
make healthy food choices

They will ask you to practice these techniques on your own, measure your progress, and show you ways to manage difficult feelings and situations so you stick with your new eating habits.

Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)

MANTRA involves talking to a therapist in order to understand what is causing your eating disorder. It focuses on what's important to you and helps you to change your behaviour when you are ready.

You can involve your family or carers if you think it would be helpful.

You should be offered 20 sessions. The first 10 should be weekly, with the next 10 scheduled to suit you.

Specialist supportive clinical management (SSCM)

SSCM involves talking to a therapist who will help you understand what is causing your eating disorder. You will learn about nutrition and how your eating habits cause your symptoms.

You should be offered 20 or more weekly sessions. Your therapist will set you a target weight and, over the course of the 20 weeks, will help you reach it.

Focal psychodynamic therapy

Focal psychodynamic therapy is usually offered if you don't feel any of the above therapies are right for you or if they don't work.

Focal psychodynamic therapy should include trying to understand how your eating habits are related to what you think, and to how you feel about yourself and other people in your life.

You should be offered weekly sessions for up to 40 weeks (9 to 10 months).

Diet advice

During your treatment you will probably be given advice on healthy eating and your diet. However, this advice alone will not help you recover from anorexia, so you will need to have talking therapy as well as dietary advice.

Your doctors will probably also advise you to take vitamin and mineral supplements so you get all the nutrients you need to be healthy.

Treatment for children and young people

Children and young people will usually be offered family therapy. You may also be offered CBT or adolescent-focused psychotherapy. CBT will be very similar to the CBT offered to adults.

Family therapy

Family therapy involves you and your family talking to a therapist, exploring how anorexia has affected you and how your family can support you to get better.

Your therapist will also help you find ways to manage difficult feelings and situations to stop you from relapsing into unhealthy eating habits once your therapy ends.

You can have the sessions together with your family or on your own with the therapist. Family therapy is sometimes offered in a group with other families.

You will usually be offered 18 to 20 sessions over a year, and your therapist will regularly check that the schedule is still working for you.

Adolescent-focused psychotherapy

Adolescent-focused psychotherapy will usually involve up to 40 sessions, and normally lasts between 12 and 18 months. You'll have sessions more often in the beginning to give you more support.

The therapist will help you:

cope with your fears about gaining weight
understand what you need to do to be healthy
understand the effect of under-eating
understand what is causing your anorexia and how to stop it

You can have the therapy alone or with your family.

Diet advice

If you have anorexia, you may not be getting all the vitamins and energy that your body needs to grow and develop properly, which is especially important as you reach puberty.

During your treatment, your doctor will give you advice about the best foods to eat to stay healthy. They will probably also advise you to take vitamin and mineral supplements.

They will also talk to your parents or carers about your diet so they can support you at home.

Bone health

Anorexia can make your bones weaker, which can make you more likely to develop a condition called osteoporosis. This is more likely if your weight has been low for a year or more in children and young people, or 2 years or more in adults.

Because of this, you doctors may suggest you have a special type of X-ray called a bone-density scan to check the health of your bones.

Girls and women are more at risk of getting weak bones than men, so your doctor may prescribe you medicine to help protect your bones against osteoporosis.

Medication

Antidepressants should not be offered as the only treatment for anorexia. But you may be offered an antidepressant, such as fluoxetine (Prozac), in combination with therapy, to help you manage other conditions such as:

Antidepressants are very rarely prescribed for children or young people under 18.

Where treatment will happen

Most people with anorexia will be able to stay at home during their treatment. You will usually have appointments at your clinic and then be able to go home.

However, you may be admitted to hospital if you have serious health complications. For example, if:

you are very underweight and still losing weight
you are very ill and your life is at risk
you are under 18 and your doctors believe you don't have enough support at home
doctors are worried that you might harm yourself or are at risk of suicide

Your doctors will keep a careful eye on your weight and health if you're being cared for in hospital. They will help you to reach a healthy weight gradually, and either start or continue any therapy.

Once they are happy with your weight, as well as your physical and mental health, you should be able to return home.

Compulsory treatment

Occasionally, someone with anorexia may refuse treatment even though they're seriously ill and their life is at risk.

In these cases, doctors may decide, as a last resort, to admit the person to hospital for compulsory treatment under the Mental Health Act. This is sometimes known as "sectioning" or "being sectioned".

Check-ups

It is important that you receive ongoing support after your treatment is finished.

You should have checks of your weight at least once a year, as well as of your mental and physical health. This will usually be done by your GP, but it may be with an eating disorder specialist.

Further support

There are many organisations that support people with anorexia and their families, including:

Joining a self-help support group, such as the Beat online support group for people with anorexia, may also be helpful.

Health risks of anorexia

Long-term anorexia can lead to severe health problems associated with not getting the right nutrients (malnutrition). But these will usually start to improve once your eating habits return to normal.

Possible complications include:

problems with muscles and bones – including feeling tired and weak, osteoporosis, and problems with physical development in children and young adults
fertility problems
loss of sex drive
problems with the heart and blood vessels – including poor circulation, an irregular heartbeat, low blood pressure, heart valve disease, heart failure, and swelling in the feet, hands or face (oedema)
problems with the brain and nerves – including fits (seizures), and difficulties with concentration and memory
kidney or bowel problems
having a weakened immune system or anaemia

Anorexia can also put your life at risk. It's one of the leading causes of deaths related to mental health problems. Deaths from anorexia may be due to physical complications or suicide.

Causes of anorexia

We don't know exactly what causes anorexia and other eating disorders. You may be more likely to get an eating disorder if:

you or a member of your family has a history of eating disorders, depression, or alcohol or drug addiction
you have been criticised for your eating habits, body shape or weight
you are overly concerned with being slim, particularly if you also feel pressure from society or your job – for example, ballet dancers, jockeys, models or athletes
you have anxiety, low self-esteem, an obsessive personality or are a perfectionist
you have been sexually abused