Anorexia nervosa

Published by Bupa's Health Information Team, September 2010.

This factsheet is for people who have anorexia nervosa, or who would like information about it.

Anorexia nervosa, or anorexia, is an eating disorder. People with anorexia have an intense fear of putting on weight and severely limit the amount of food they eat to reduce their body weight to an unhealthily low level.

About anorexia nervosa

The direct translation of the medical name 'anorexia nervosa' means 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. About one in 250 women and one in 2,000 men get anorexia at some time in their lives.

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). Some people with anorexia may have bingeing and purging habits too.

Symptoms of anorexia nervosa

There are many different symptoms associated with anorexia, and not everyone has the same ones. But if you have anorexia, you will probably have a body weight that is much less than expected for your age and height. You may do the following:

• eat very little, if at all, or restrict certain foods, such as those containing fat
• be secretive about food
• cut your food into tiny pieces to look as though you have eaten some, and become obsessed with what other people are eating
• obsessively weigh yourself and measure and examine your body
• be obsessed with exercise
• be restless
• use appetite suppressants such as diet pills
• make yourself vomit after meals or use laxatives or pills that remove water from your body (diuretics)
• wear baggy clothes to disguise your weight loss
• make yourself sick.

With anorexia, you become distracted thinking about your weight or 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

Apart from 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
• puffy face and ankles
• light-headedness and dizziness
• tiredness
• poor sleep
• delayed puberty (because anorexia affects your hormones)
• 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 or boys)

Complications of anorexia nervosa

Over time, anorexia can cause serious long-term health problems such as:

• osteoporosis
• damage to your heart
• infertility

If you have severe anorexia, it's important that you receive appropriate treatment. If untreated, the condition can be life-threatening due to health problems such as starvation, dehydration, infections and heart failure. You are also at an increased risk of mental health problems.

Causes of anorexia nervosa

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

People with certain personality types such as perfectionists are more commonly affected by anorexia.

The following emotional or mental health conditions are also associated with anorexia:

• low self-esteem - this is not thinking highly about your self-worth and associating it with your body weight
• mood conditions, particularly depression
• obsessive-compulsive disorder - this is a condition causing anxiety due to obsessively thinking about things or doing certain actions

If you have a perfectionist personality or one of these conditions, an eating disorder may give you a sense of control and achievement.

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

• living in a Western society
• being influenced by media images of thinness
• having been obese in the past
• having a job or hobby where a very lean body type is desirable (eg running, athletics, modelling or dancing)
• having a family history of eating disorders due to genetic factors or by copying the behaviour of other family members
• going through an emotionally upsetting event such as divorce or abusive family relationships

Diagnosis of anorexia nervosa

Getting help is very important. Admitting you have a problem is the first step, though it can be the hardest. Taking that step means you should be able to find the support and treatment you need to stop anorexia and improve your life.

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

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 recover from anorexia but it may be a long process and, in times of stress, you may relapse. But with determination, patience and support it can be done. For treatment to work, you must want to get better.

Self-help

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

Support groups may help. It can be comforting to talk to others who have had the same feelings and experiences.

Medicines

Medicines are not usually used to treat anorexia. However, they may be used to treat secondary symptoms such as anxiety and depression.

Talking therapies

Talking therapies (eg 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 in separate counselling sessions. This helps everyone in the family to understand the disorder properly and support each other.

Hospital treatment

Most people who have anorexia don't need to go into hospital. 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.

Help and support

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

You may wish to make your own choices but may need much love and support. If you recognise you have a problem, others may be able to offer to help with practical matters such as finding medical help and support groups. Support groups can provide advice and information for you, friends and family.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.