Anorexia nervosa

Anorexia nervosa (AN) is defined by the persistent restriction of energy intake, intense fear of gaining weight and disturbance in self-perceived weight or shape.

Individuals may control food and weight as a means of controlling areas of life that feel out of control, or as a way of expressing complex or concerning emotions.

Anorexia nervosa is characterised by:

  • Restricted energy intake, leading to lower than normal body weight and, often, the loss of a considerable amount of weight in a short period of time

  • An intense fear of gaining weight, even when the individual is already underweight, starved or malnourished

  • Disturbed body image, including extreme emphasis on their appearance and the perception that they are overweight despite being considerably underweight

There are two subtypes of anorexia nervosa:

  • People with the restricting subtype place severe restrictions on the amount and type of food they consume, including through the restriction of certain food groups (e.g. carbohydrates, fats), calorie counting, skipping meals, and/or obsessive rules and rigid thinking (e.g. only eating food that is one colour). These restrictive behaviours around food may be accompanied by excessive exercise

  • People with the binge eating/purging subtype also place severe restriction on the amount and type of food they consume, but additionally display purging behaviour and may also engage in binge eating. Binge eating involves eating a large amount of food and feeling a ‘loss of control’. Purging behaviour involves self-induced vomiting, or deliberately misusing laxatives, diuretics or enemas to compensate for eating food

What are the warning signs of anorexia nervosa?

Someone with anorexia nervosa may display a combination of the following symptoms:

Physical signs

  • Rapid weight loss or frequent weight change; unable to maintain normal body weight

  • Loss or disturbance of menstruation in girls and women and decreased libido in men

  • Fainting or dizziness

  • Feeling cold most of the time, even in warm weather (caused by poor circulation)

  • Feeling bloated, constipated, or the development of food intolerances

  • Low energy, feeling tired and not sleeping well

  • Facial changes (e.g. looking pale, sunken eyes)

  • Fine hair appearing on the face and body

Psychological signs

  • Having a distorted body image (e.g. seeing themselves as overweight when they are actually underweight)

  • Preoccupation with eating, food, body shape and weight

  • Increased sensitivity to comments relating to food, weight, body shape, exercise

  • Low self-esteem and perfectionism

  • Intense fear of gaining weight and extreme body image disatisfaction

  • Depression and anxiety, particularly around meal times

  • Reduced capacity for thinking and increased difficulty concentrating

  • ‘Black and white’ thinking (e.g. rigid thoughts about food being ‘good’ or ‘bad’)

Behavioural signs

  • Dieting behaviour (e.g. fasting, counting calories, avoiding certain food groups)

  • Preoccupation with preparing food for others, recipes and nutrition

  • Radical changes in food preferences (e.g. suddenly disliking food they have always enjoyed in the past, reporting of food allergies or intolerances, becoming vegetarian)

  • Obsessive rituals around food preparation and eating (e.g. eating very slowly, cutting food into very small pieces, insisting that meals are served at exactly the same time every day)

  • Secrecy around eating (e.g. saying they have eaten when they haven’t, hiding uneaten food, eating in private and avoiding meals with other people)

  • Antisocial behaviour (spending more and more time alone)

  • Repetitive or obsessive behaviours relating to body shape and weight (e.g. repeated weighing, looking in the mirror obsessively and pinching waist or wrists)

  • Evidence of binge eating (e.g. disappearance or hoarding of food)

  • Compulsive or excessive exercising (e.g. exercising in bad weather, continuing to exercise when sick or injured, and experiencing distress if exercise is not possible)

  • Deliberate misuse of laxatives, appetite suppressants, enemas and diuretics

  • Self-harm, substance abuse or suicide attempts

What are the risks associated with anorexia nervosa?

The risks associated with anorexia nervosa are severe and can be life threatening. They include:

  • Anaemia (iron deficiency)

  • Compromised immune system (e.g. getting sick more often)

  • Intestinal problems (e.g. abdominal pain, constipation, diarrhoea)

  • Loss or disturbance of menstruation in girls and women

  • Increased risk of infertility in men and women

  • Kidney failure

  • Osteoporosis– a condition that leads to bones becoming fragile and easily fractured

  • Heart problems (e.g. cardiac abnormalities, sudden cardiac arrest)

  • Death

Treatment  

Psychological treatment has been clinically proven to reduce the severity, impact and duration of anorexia nervosa. Evidence-based therapies to consider for the treatment of anorexia nervosa in young people include:

  • Maudsley family-based treatment

  • Specialized outpatient treatment

Evidence-based therapies to consider for the treatment of anorexia nervosa in adults include:

  • Cognitive behavioural therapy

  • Psychodynamic or psychoanalytic therapy

Find out more about specific treatment approaches.

Getting help

If you suspect that you or someone you know has anorexia nervosa, it is important to seek help immediately. The earlier you seek help the closer you are to recovery. Contact your GP for a referral to a practitioner with specialised knowledge in health, nutrition and eating disorders.

 

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