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Anorexia nervosa

Anorexia nervosa, or anorexia, is an eating disorder. If you have anorexia, you have an intense fear of putting on weight and severely limit the amount of food you eat to reduce your body weight. This can mean it falls to an unhealthily low level.

The direct translation of 'anorexia nervosa' is loss of appetite for nervous reasons. But, in fact, you don't lose your appetite if you have anorexia – you just don't allow yourself to satisfy your appetite.

If you have anorexia, you develop a distorted idea of your body shape and size. You try to stop or limit eating and may over-exercise. This makes you very underweight.

Anorexia is most common in teenage girls, although you can develop the illness at any age – it has been reported in children as young as six to people in their seventies. It’s thought that anorexia affects seven girls in every 1,000 and one boy in every 1,000, and is most likely to start at the age of 16 to 17.

The other main eating disorder is bulimia nervosa. This involves cycles of bingeing (overeating) and purging (ridding the body of the excess food, usually by vomiting or taking laxatives). If you have anorexia, you may also do these things.

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Details

  • Symptoms Symptoms of anorexia nervosa

    There are many symptoms associated with anorexia and these can vary from person to person. Some of these are connected to how you behave and think, and some are physical. Behavioural symptoms include:

    • eating very little, if at all, or restricting certain foods, such as those containing fat
    • being secretive about food
    • obsessively weighing yourself, and measuring and examining your body
    • being obsessed with exercise
    • being restless
    • using appetite suppressants, such as diet pills
    • making yourself sick after meals or using laxatives or diuretics (water tablets)
    • wearing baggy clothes to disguise weight loss
    • punishing yourself if you don’t lose enough weight or eat something you wouldn’t usually eat
    • lying about eating

    With anorexia, you become preoccupied with your weight and body size. You may:

    • have a distorted body image
    • deny being underweight or having a problem with food
    • have mood swings
    • feel depressed
    • lose interest in other people
    • go off sex
    • find it difficult to concentrate
    • worry more and more about your weight
    • carry on losing weight, even when you’re below a healthy weight

    If you have anorexia, you will probably have a body weight that is much lower than expected for your age and height – in adults, this is usually a body mass index (BMI) of less than 17.5. BMI is commonly used to work out whether you’re a healthy weight – it takes into account your weight and height. You’re a healthy weight if your BMI is between 18.5 and 24.9 – a BMI much above or below this means you may be at risk of serious health problems.

    As well as weight loss, the physical signs of anorexia can include:

    • fine, downy hair on your body and face
    • feeling cold all the time
    • red or purple hands and feet
    • constipation
    • light-headedness and dizziness
    • stomach pains
    • hair falling out
    • tiredness
    • poor sleep
    • dry, yellowish skin
    • heartburn (indigestion)
    • delayed puberty (because anorexia affects your hormones) and not growing to your full height
    • missing three or more monthly periods (in women or girls who aren't pregnant or using certain types of hormonal contraceptive, such as the pill)
    • not being able to get or keep an erection (in men and boys)
  • Diagnosis Diagnosis of anorexia nervosa

    Anorexia is a serious medical condition, so getting help is very important. Admitting you have a problem is the first step, though it can be the hardest. Making that move means you’re more likely to be able to find the support and treatment you need to overcome anorexia and improve your life.

    Talk to your GP first – he or she will ask about your life and eating habits and examine you. Your GP may refer you to a psychiatrist or psychologist who is trained in the treatment of eating disorders.

  • Treatment Treatment of anorexia nervosa

    You should start treatment for anorexia as soon as you can. The aim is to re-establish a healthy attitude towards food and a consistent pattern of eating.

    You can get better from anorexia but it may be a long process and in times of stress, you may relapse. It takes an average of five to six years to recover after diagnosis, but up to a third of people with anorexia never fully recover. However, with determination, patience and support, it can be done. For treatment to work, you must want to get better. See our frequently asked questions for more information.

    Self-help

    Keeping a diary of your eating habits and learning about healthy eating and sensible weight control may help.

    You may find that support groups are useful. It can be comforting to talk to others who have had the same feelings and experiences. Family members may also find it useful to attend self-help meetings for relatives and carers.

    Talking therapies

    Talking therapies (for example, counselling) are often used to treat anorexia. They can help you to identify the feelings and fears that caused you to stop eating, and develop a healthier attitude towards food and your body.

    There are various types of talking treatment that can help with anorexia, such as cognitive behavioural therapy (CBT). You may need to continue with these for months or years.

    You may also find it helpful to have therapy that involves your family, either together with you or having separate counselling sessions. This helps everyone in the family to understand the disorder properly and support each other.

    Medicines

    Medicines aren’t usually used to treat anorexia. However, they may be used to treat secondary symptoms, such as anxiety and depression.

    Hospital treatment

    Most people who have anorexia don't need to stay in hospital and will be treated on an outpatient basis. But if you have lost so much weight that your life is at risk, you may need to be admitted to hospital so that the fluids and nutrients that you have lost from your body can be replaced.

    Forced treatment is always a last resort, because it can be distressing to lose control of what you're eating and drinking. This only happens if you’re very unwell, your life is in danger or you can’t make proper decisions for yourself any longer and need to be protected.

    See our frequently asked questions for more information.

    Dietary advice

    You may see a dietitian to get help and advice with healthy eating and weight gain. The aim is to get you back to regular eating, without starving yourself or vomiting.

    You can only get back to a healthy weight through eating more, which can be very difficult to cope with at first. A dietitian will help you set achievable goals for weight gain, and can give you advice about eating on a regular basis and managing the worry you feel about eating. It’s possible that you will need to take vitamin supplements in addition to regular meals to help you gain vital nutrients.

  • Private GP appointments

    With our GP services, we aim to give you an appointment the next day or sooner if it’s urgent. Find out more today.

  • Causes Causes of anorexia nervosa

    The causes of anorexia aren't fully understood and are probably different for everyone. They may include emotional, physical and social reasons.

    Having certain personality traits, such as perfectionism or being overly sensitive, may mean you’re more likely to be affected by anorexia. This may be because limiting how much you eat and managing your weight give you a sense of control and achievement. Other things that are also associated with anorexia include:

    • low self-esteem
    • mental illness, particularly depression

    There are certain factors that make it more likely that you will develop anorexia. For example:

    • an emotionally upsetting event, such as divorce or an abusive family relationship
    • a family history of eating disorders or other mental health problems, such as depression
    • living in a Western society
    • being influenced by media images of thinness
    • being overweight or obese in the past
    • having a job or hobby where a very lean body type is desirable (for example, running, athletics, modelling or dancing)
  • Complications Complications of anorexia nervosa

    Over time, anorexia can cause serious long-term health problems.

    • You’re at an increased risk of osteoporosis (your bones become weakened), which means you’re more likely to break a bone. The more weight you lose, the more severe the condition will become, and the longer you have anorexia, the less likely it is that your bones will recover.
    • There is a great risk of damage to your heart, including abnormal heart rhythms and heart failure. These are the most common causes of death in people with anorexia – an abnormal heart rhythm can quickly become life-threatening, even in teenagers.
    • You’re likely to have problems with fertility and pregnancy. If your periods have stopped, it’s likely that you won’t be able to get pregnant and if you do, you’re at a greater risk of miscarriage and postnatal depression. Your baby is also more likely to have a low birth weight. See our frequently asked questions for more information.
    • If you have anorexia, you’re more likely to develop mental health problems, such as anxiety and depression, and also to abuse alcohol or illegal drugs. People with anorexia are at a much greater risk of attempting suicide – it’s thought that up to one in five people with anorexia try to kill themselves.

    If you have severe anorexia, it's important that you receive appropriate treatment. If left untreated, the condition and its complications can be fatal.

  • Help and support Help and support

    It can be upsetting for loved ones to see you putting your health at risk. It's natural that they will want to help, even though you may find unwanted pressure or criticism make matters feel worse.

    You may wish to make your own choices but may need a great deal of support. If you recognise you have a problem, others may be able to assist with practical matters such as finding medical help and support groups.

  • FAQs FAQs

    How long does it take to recover from anorexia nervosa?

    Answer

    The time it takes to recover from anorexia varies greatly from person to person.

    Explanation

    Anorexia can last for years and, on average, it takes five to six years after you have been diagnosed to recover. However, some people never fully recover from the condition and may relapse during times of stress.

    About half of all people with anorexia make a full recovery. Others find that their condition improves with time. Only about two out of 10 people don't recover and go on to have a long-term eating disorder.

    It's important that you seek help for anorexia as early as possible. This is because the sooner you get help, the better your chances are of recovery. Getting better from an eating disorder can be a difficult process, but it can be done. To recover, you will need to start eating more food, put on weight and change how you think about yourself and food. For most people being treated as outpatients, the aim is to put on 0.5kg of weight per week.

    I've heard that anorexia nervosa can stop your periods and make you infertile. I have had anorexia in the past but have since recovered. Will I be able to get pregnant?

    Answer

    Yes. If you're having regular periods and are a healthy weight, you will probably be able to become pregnant.

    Explanation

    If you have anorexia, your periods might stop. This happens because anorexia causes changes in the hormones that control your reproductive system. If your periods have stopped because of anorexia, you probably won't be able to get pregnant because you aren't ovulating (producing eggs).

    Many women find that their periods come back after they start to recover and are a healthy weight. If your periods have started again, you should be able to get pregnant.

    However, if you're still underweight and not eating enough, you may not be able to gain the amount of weight that you need to during pregnancy. If you aren’t eating enough, you won’t have the nutrients needed to sustain both you and your unborn baby. As well as putting your health in danger, this means there is a risk that you might have a baby with a very low birth weight, which can lead to him or her having other health problems. Therefore, it's better if you attempt to recover from anorexia before you try to get pregnant.

    Try to eat a varied, well-balanced diet and stay at a healthy weight for several months before getting pregnant. You will need to stay at a healthy weight throughout your pregnancy to make sure that you stay well and your baby develops properly.

    If you have anorexia and are already pregnant, let your GP and midwife know because you may require special care. For example, you may need extra appointments to monitor the growth and development of your baby. It’s also a good idea to speak to your GP if you’re thinking of getting pregnant and have had anorexia in the past.

    Will I need to be admitted to hospital to be treated for anorexia nervosa?

    Answer

    No, it's not likely. Anorexia is usually treated without you having to be admitted to hospital.

    Explanation

    You can be treated for anorexia as an outpatient. This means that you go to hospital to see your doctor but you won't have to stay overnight.

    You only need to stay in a hospital ward or a special eating disorder unit if you're seriously ill or very weak. You may also need to stay in hospital if you have already had outpatient treatment but your anorexia hasn't improved, or if there is a risk that you might try to harm yourself.

  • Resources Resources

    Further information

    Sources

    • Anorexia nervosa. Beat. www.b-eat.co.uk, accessed 29 May 2012
    • Bulimia nervosa. Beat. www.b-eat.co.uk, accessed 29 May 2012
    • Eating disorders: key facts. Royal College of Psychiatrists. www.rcpsych.ac.uk, published 2009
    • Facts and figures. Beat. www.b-eat.co.uk, accessed 29 May 2012
    • Eating disorders. Prodigy. www.prodigy.clarity.co.uk, published October 2009
    • Morris J, Twaddle S. Anorexia nervosa. BMJ 2007; 334:894–98. doi:10.1136/bmj.39171.616840.BE
    • Eating disorders and pregnancy: some facts about the risks. National Eating Disorders Association. www.nationaleatingdisorders.org, published 2005
    • Eating disorders. Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. National Institute for Health and Clinical Excellence (NICE), 2004. www.nice.org.uk
    • Eating disorders. Royal College of Psychiatrists. www.rcpsych.ac.uk, published January 2008
    • Anorexia nervosa. BMJ Best Practice. www.bestpractice.bmj.com, published August 2012
    • Eating disorders – complications of anorexia. University of Maryland Medical Center. www.umm.edu, published January 2009
    • Anorexia nervosa fact sheet. Womenshealth.gov. www.womenshealth.gov, published June 2009
  • Related information Related information

  • Author information Author information

    Produced by Polly Kerr, Bupa Health Information Team, October 2012.

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