What you need to know about Anorexia Nervosa

by Ellern Mede Eating Disorder Treatment

Anorexia Nervosa is a complex mental illness with physical impacts. Nobody knows exactly what causes it. It’s not always to do with a preoccupation with body weight, but the end result of Anorexia Nervosa is always a dangerously low nutrition level and usually, low body weight for height.

Maintaining an ideal body weight can be a daunting task. Most people pay attention to their weight and how it impacts their appearance at least some of the time, and most people don’t find this becomes a major problem. But for some people, and in a particular type of Anorexia Nervosa, there can be a degree of body image distortion.

A lot of how we think we look and what we think about our weight depends on our perception of ourselves when we look in the mirror. If we think we are overweight and find that our clothes are getting tighter, we try and lose weight. If we think we are too thin, then we try and eat more or perform weight training exercises to put on muscle mass.

But this sort of healthy perception can fail, and in cases of Anorexia Nervosa, this is both a symptom, a trigger and a factor in the development and continuation of the disease.

Anorexia Nervosa is not the same in every case. But take one possible example. Perhaps a person looks in the mirror and thinks they are overweight when, in reality, they are in the ideal body-weight category for their age and height. This distorted perception might prompt them to restrict their food intake continuously until this becomes a habit. Ultimately their body weight will drop to low levels, but their distorted perception will prevent them from recognising this. There are more complex mental cognitions underlying this and it is certainly one example of what leads to the clinical condition called Anorexia Nervosa.

Defining Anorexia Nervosa

Anorexia Nervosa is the most serious eating disorder in the world and has a higher death rate than any mental illness. Individuals suffering from anorexia often think they are fat when they are slim. But whether that is the reason or not, a person with this condition refuses to eat or restricts what they eat to such an extent they put themselves in danger. It is often (but not always) linked to a deliberate and conscious will to be as thin as possible without regard to their health. This eating disorder is closely associated with depression and self-harm – so if someone you know is suffering from anorexia, you should speak with an eating disorder specialist in London as soon as possible.

What are the causes?

Clinicians know many associated feelings and conditions but nobody has ever been able to define a single mental or physical cause and because every case is individual, only broad similarities permit specialists to treat this disease and develop knowledge of it. Depression, stress, and anxiety are usually co-existing, while traumatic life experiences are common triggers of anorexia. Obsessive-compulsive behaviour is also frequently found co-existing with anorexia. When you look at behavioural and personality types, being a perfectionist can be a risk factor. Because perfectionism and idealism about body image may be a factor, it is widely thought that portrayals in the media of very slim models appearing to be a social idea of beauty can also be a factor. Anorexia can also be a ‘coping mechanism’ albeit a destructive one, for a person who wants to evidence some kind of control over their life in a situation where they feel they don’t have enough independence or ability to control things.

Symptoms and signs

People with anorexia usually make every attempt to refuse calories and usually resist putting on weight. If they believe that they are fat, or worried that every meal has put on too much weight, they are likely to constantly check their weight, possibly to exercise in an attempt to burn calories. Often, parents or spouses or other relatives will supervise their meals and so they become very adept at tricks to avoid eating. For example, they will try not to finish the plate. They may play with their food, hoping to hide it when nobody is looking – by throwing it on the floor or hiding it up a sleeve, or even breaking it up and smearing it on their hair and clothes. They will avoid eating in front of other people. They are in many ways ‘addicted’ to their anorexic behaviour and they will tell lies to cover up their condition.

In some cases, (called a binge/purge type of anorexia) a person will eat a big meal, then vomit or use over-exercising to try and lose the calories. They may also use laxatives or tablets that help the body to lose water content for this purpose. Note that regular vomiting will have a very bad effect on a person’s teeth and so tooth decay can be a tell-tale sign of this behaviour.

To hide weight loss during weigh-ins at GP surgeries, in their clinics or at home, the person may hide heavy objects in pockets or in undergarments so they appear to the clinician or their relatives that they are heavier than they actually are.

More severe health complications from long term malnutrition include heart problems, liver damage, kidney damage and bone thinning (osteoporosis). Clearly, eating disorders can be life-threatening if not treated.

Treatment

Anorexia nervosa treatment requires specialist psychiatric, psychological, family therapy and dietetic input. Therapies range from cognitive behavioural therapy to motivational enhancement therapy and therapy with the family involved as well.

A person with long term malnutrition needs to be monitored as they gain weight slowly because suddenly increasing calorie intake can have health consequences. The patient has to be supervised and guided through gradual weight gain and nutritional restoration over a period of time.

In a nutshell, Anorexia Nervosa is life-threatening and, along with all eating disorders, is a problem that should be diagnosed and treated as soon as it is suspected to have the best chance of recovery.