Anorexia nervosa

What is anorexia nervosa?

Anorexia nervosa is a psychological illness that has serious physical, emotional and social consequences.

People who develop anorexia nervosa:

• commonly have an unhealthy focus on food, weight or body shape, leading to significant weight loss and malnourishment
• can severely restrict their diet or food intake and may exercise compulsively
• may also engage in binge eating
• have an intense fear of gaining weight, even though they may be significantly underweight
• can experience atypical anorexia nervosa, where they have significant weight loss and other symptoms but are not considered underweight.

Anorexia nervosa can be experienced by people of all genders and all ages, including children. It commonly begins in adolescence.

Professions or activities that emphasise particular body sizes and shapes are at increased risk of developing an eating disorder (for example elite sports, modelling).

Recognising the signs early and getting help can reduce the impact of anorexia nervosa and support a faster and full recovery. It is possible to recover from this eating disorder with the right support, even if you have been living with it for many years.

What causes anorexia nervosa?

The causes of anorexia nervosa are complex and differ from person to person. There is no single cause of an eating disorder.

Risk factors for the development or re-emergence of the condition may include:

• biological – some people may have a genetic predisposition to developing an eating disorder
• body dissatisfaction
• sociocultural messages that emphasise a particular ‘ideal’ body size or shape
• dieting – this is a significant risk factor for the development of an eating disorder
• changes in life circumstances or significant life transitions such as school, work, pregnancy and parenthood
• low self-esteem
• social isolation, relationship difficulties
• anxiety or depression
• traits such as perfectionism, obsessive thinking
• trauma.

Symptoms of anorexia nervosa

An awareness of the signs and symptoms of anorexia nervosa can help early detection and treatment. Treatment is more effective if it begins early, but you can start recovery at any stage of an eating disorder.

Physical symptoms of anorexia nervosa

Physical signs and symptoms may include:

• considerable weight loss, in a short period of time
• body weight that is not in the healthy range for the person’s age and height
• development of bloating, constipation and food intolerance
• for women, loss of periods or failure to begin a menstrual cycle – although you can still have your periods and experience anorexia nervosa
• loss of libido (sex drive)
• feeling tired or not sleeping well
• cold, mottled hands and feet due to poor blood flow, intolerance to the cold
• muscle loss or weakness
• heart problems, poor circulation, low blood pressure, irregular heartbeat, low iron levels
• dehydration, kidney failure
• fainting, dizziness without reason (such as another medical condition)
• dry skin, brittle nails, thin hair
• loss of bone calcium, osteoporosis
• an increase in dental decay
• fine hair appearing on the face and body.

Psychological symptoms of anorexia nervosa

Psychological signs and symptoms may include:

• fear of gaining weight or ongoing behaviour that prevents weight gain
• preoccupation with food, calories, exercising
• rules about dieting, body shape and weight
• irritability around meal times
• depression and anxiety
• slowed thinking and decreased ability to concentrate
• body dissatisfaction or distorted body image (for example, perceiving that they are in a much larger body than they are)
• low self-esteem or expressions of low self-worth.

Behavioural symptoms of anorexia nervosa

Behavioural signs and symptoms may include:

• dieting behaviour – dieting, counting kilojoules, reporting new food allergies and avoiding food groups that were once enjoyed
• binge eating (or reporting experiences of having ‘binged’ on what would be considered a normal portion size of food)
• hiding food
• misusing laxatives, appetite suppressants, diuretics and enemas
• behaviour related to body image – constantly checking body in the mirror, pinching parts of the body to measure fat
• withdrawal from social interactions, recreational activities and interests
• secrecy around eating – saying they have eaten when they haven’t
• excessive and compulsive exercise even when sick or injured, or exhibiting distress if they can’t exercise
• obsessive rituals around food – cutting food into very small pieces or eating very slowly
• self-harm, use of substances and suicide attempts.

Diagnosis of anorexia nervosa

If you think you (or someone you know) might have anorexia nervosa, it is important that you see your doctor as soon as possible. The health risks associated with anorexia nervosa are severe and can be life threatening. The sooner you seek help, the sooner you can start to recover, and the more effective treatment can be.

Other healthcare professionals, such as dieticians, psychologists or psychiatrists, can recognise an eating disorder, but may not be able to give you a full physical health check-up. This is why seeing your GP (doctor) is important.

To diagnose anorexia nervosa, a GP:

• will need to do a full physical examination
• may complete blood tests
• may ask questions about your health, including your emotional health and wellbeing, medical history and current lifestyle.

Eating disorder symptoms can sometimes be explained by another medical condition or physical illness Your doctor will need to make sure that you are not losing weight or experiencing other symptoms because of another medical reason.

Types of anorexia nervosa

There are two types of anorexia nervosa:

• Restriction of food intake – emphasises the restriction of food intake.
• Binge eating and purging – includes engaging in periods of binge eating, followed by compensatory behaviours such as self-induced vomiting, overexercising, or use of laxatives, diuretics or enemas.

Restriction of food intake

People with the ‘restricting’ subtype of anorexia nervosa tend to severely reduce their energy intake or restrict the type of food they will eat. The signs can be different in each person, but may include:

• restricting certain types of food, such as carbohydrates or high-fat foods
• obsessively counting kilojoule intake
• skipping meals
• excessively exercising.

Binge eating and purging

People with the ‘binge eating and purging’ subtype of anorexia nervosa have similar symptoms to the restricting type, but also engage in behaviours that include:

• Binge eating – eating subjectively large quantities of food in a short period of time and feeling distressed and a sense of a loss of control.
• Compensatory behaviours – such as self-induced vomiting or using laxatives, enemas or diuretics.

This type of anorexia nervosa shares some similarities to bulimia nervosa. People with anorexia nervosa, however, tend to strongly emphasise weight control by restricting energy intake, rather than primarily through purging behaviours.

In addition, people with this type of anorexia nervosa have a lower body weight; whereas people with bulimia nervosa may experience a fluctuating body weight closer to the healthy weight range for their age and height.

Long-term risks of ongoing anorexia nervosa

Untreated and ongoing anorexia nervosa can cause problems including:

• weakened bones (osteoporosis)
• slowed growth (in young people)
• infertility
• gastrointestinal issues
• problems with concentration and thinking
• problems with decision-making
• social, emotional and educational problems.

Treatment of anorexia nervosa

Once anorexia nervosa is diagnosed, your doctor will organise a team to help you on your way to recovery. This might involve establishing a healthcare team of different professionals, including:

• psychiatrist
• psychologist
• dietitian
• family therapist
• social worker
• occupational therapist.

Treatment needs to address both physical and psychological health.

Common approaches include:

• Family Based Treatment (FBT) – FBT has been shown to be the most effective treatment for children and adolescents. FBT is an approach in which the whole family works together to fight against the eating disorder, and to support you in regaining control of your life.
• Cognitive Behaviour Therapy (CBT) – CBT works on helping a person to overcome the unhelpful thoughts and behaviours that are causing and maintaining the eating disorder. This is the most researched and recommended treatment for adults. Your healthcare professionals will work with you to help you work out the links between your thinking, your emotional response and your eating behaviours.
• Support groups – can be helpful but do not replace treatment from healthcare professionals.
• Other treatment options – such as medications and supplements to help strengthen your bones and, in some cases, medication prescribed by a doctor to support your mental health (for example, antidepressants).

The aims of treatment include:

• making sure you have adequate nutrition
• restoring your healthy weight
• reversing any effects of malnutrition
• making sure you are physically safe and healthy
• making sure you are mentally healthy.

Most people with anorexia nervosa are treated outside a hospital setting. However, if the condition is severe, temporary treatment in a hospital might be needed. Outpatient treatment and day programs can also be very helpful in supporting people as they make changes to behaviour, thinking and eating patterns.

People with anorexia nervosa who have also experienced physical, emotional or sexual abuse are encouraged to seek help for the trauma they have experienced, as well as their eating disorder.

Where to get help

• In an emergency, always call triple zero (000)
• A GP (doctor) with experience supporting people with an eating disorder
• Eating Disorders Victoria Hub Tel. 1300 550 236 – support from Monday to Friday 9:30 am to 4:30 pm
• Community health centre
• Lifeline Tel. 13 11 14
• Suicide Line Tel. 1300 651 251
• Kids Helpline Tel. 1800 55 1800
• Butterfly Foundation for Eating Disorders – National Helpline Tel. 1800 ED HOPE (1800 33 4673) – support from Monday to Friday, 8 am to midnight (except public holidays)