Anorexia

What is anorexia?

Anorexia, also known as anorexia nervosa, is a serious eating disorder and mental health condition. It causes you to restrict how much you eat, often because of an intense fear of gaining weight, which can seriously harm both your physical and mental health.

Symptoms of anorexia

Anorexia can affect both your mind and your body. The signs can be emotional and behavioural, as well as physical.

Emotional and behavioural signs

• Spending a lot of time thinking about food, calories or dieting, and steering clear of anything you consider fattening
• Seeing yourself as overweight, even when you're actually a healthy weight or below it
• Criticising your own body or weight, or getting on the scales frequently
• Taking exercise to extremes, particularly straight after a meal
• Making yourself sick, or misusing medicines such as appetite suppressants, laxatives or water tablets, to control your weight
• Becoming more withdrawn or losing interest in activities and hobbies you used to enjoy.

Physical signs

• Losing a noticeable amount of weight, or not gaining weight as expected if you're still growing
• Appearing extremely underweight or frail
• Feeling dizzy or lightheaded, and feeling cold more often than usual
• Low energy, poor concentration, or finding it hard to think clearly
• Dry skin, hair loss, or hair and nails that become dry and brittle
• Periods becoming irregular or stopping altogether, in women and girls who've started their periods.

Causes of anorexia and who's at risk

Doctors don't know exactly what causes anorexia, but they believe several factors play a part together. These include differences in brain chemistry, such as the levels of chemicals that affect your mood and appetite, and a genetic link, since anorexia is more likely if a parent or sibling has had an eating disorder.

Pressure to be thin, whether from friends, social media, or a job or hobby where appearance matters, such as dancing, gymnastics, modelling or athletics, can also contribute. So can low self-esteem and perfectionism, along with past experiences of being criticised about your eating or appearance, or of abuse.

Who's at risk

• Women and teenage girls are most at risk, though anorexia can affect men and boys, and people of any age
• You have a close family member with an eating disorder, depression, or a drug or alcohol problem
• You have a history of anxiety, low self-esteem, or a perfectionist personality
• You've experienced bullying, or physical, emotional or sexual abuse
• Your career or hobby puts a strong focus on body shape or weight.

Types of anorexia

Doctors recognise a few different patterns of anorexia:

• Restrictive anorexia: severely limiting the amount of food you eat, sometimes alongside excessive exercise, to avoid gaining weight
• Binge-purge anorexia: limiting food, combined with episodes of binge eating, being sick, taking laxatives, or exercising to an extreme, to compensate
• Atypical anorexia: having the psychological features of anorexia without being underweight, which can make it harder to recognise.

How is anorexia diagnosed?

There's no blood test for anorexia. Instead, doctors base a diagnosis on three things: whether you're restricting your food enough to cause significant weight loss (or a failure to gain weight in a growing child), whether you have an intense fear of gaining weight or becoming 'fat', and whether you have a distorted view of your own body that stops you seeing how serious things have become.

To reach this diagnosis, a doctor will examine you and ask about your medical and mental health history, your eating and exercise habits and any weight-loss medicines you might be using. They'll also want to know how you feel about food, weight and your body.

Your doctor may also weigh you and check your heart rate, blood pressure and temperature, and might arrange tests such as a bone density scan, blood tests, a heart tracing (ECG) or a urine test, to see how anorexia may have affected your body.

How is anorexia treated?

Recovery from anorexia is possible, though it can take time and looks different for everyone. Your treatment plan will be built around you and will usually combine support for your eating with support for your mental health.

Talking therapies

If you're an adult, you'll usually be offered a talking therapy to help you manage your thoughts and feelings about food and eating. If you're under 18, family therapy is usually offered first, sometimes alongside another talking therapy.

• Cognitive behavioural therapy (CBT): helps you change unhelpful thought patterns and behaviours around food, weight and body shape
• Family-based therapy (FBT): involves your family closely in your recovery, and is often used for teenagers
• Specialist approaches such as MANTRA (the Maudsley Anorexia Nervosa Treatment for Adults), specialist supportive clinical management (SSCM), dialectical behaviour therapy (DBT) or interpersonal psychotherapy (IPT), depending on what suits you best.

Nutrition support

There's no medicine that treats anorexia itself. Instead, a dietitian will help you build up a healthy, balanced way of eating again, gradually and safely.

If you've been malnourished for a while, starting to eat again needs careful medical supervision, because your body can react badly if nutrients are reintroduced too quickly. This is called refeeding syndrome, and it's the most serious risk during treatment.

Hospital or specialist treatment centres

If your physical or mental health is severely affected, you may need to stay in hospital or at a specialist eating disorder clinic for a while. This allows your medical team to monitor you closely, and, for some people, provide nutrition through a feeding tube or a drip.

When should I see a doctor?

See a GP as soon as you can if you think you might have anorexia, even if you're not completely sure. It can help to bring a friend or family member with you, since it isn't always easy to talk about.

Getting help early gives you the best chance of a full recovery, so it's worth speaking to someone even if you're not sure how serious things are. You can also speak in confidence to Beat, the UK's eating disorder charity, by calling their helpline on 0808 801 0677.

If you're worried about a family member or friend, gently let them know, and encourage them to see a GP, perhaps offering to go along with them. It's common to feel shame or fear about asking for help, but reaching out is an important, positive step.