Anorexia nervosa

Last updated on 25th April, 2013

Anorexia nervosa is an eating disorder characterised by extreme dieting, severe weight loss and resulting malnourishment. Anorexia nervosa occurs when a person experiences intense fear and anxiety in relation to food and weight gain. Often, a sufferer will have a warped idea of what they really look like and will often purge, exercise excessively or vomit regularly in order to lose weight.

Anorexia is commonly associated with deep-seated emotional and psychological issues, with the sufferer often searching for an element of stability and control in their lives. Controlling what they eat and what their body looks like can help to satisfy this need.

Anorexia can have a multitude of adverse effects on the body, from wasted muscles and bones to cardiovascular problems and organ failure. It is also emotionally exhausting for both Anorexia sufferers and for the people who care about them.

Symptoms of anorexia 

People suffering from anorexia tend to be extremely concerned about their weight, to the point of obsession. They may spend a lot of time talking about food and taking a great interest in the eating habits of other people.

Often, they may enjoy cooking, reading recipes, looking at pictures of food and getting other people to eat. They may also count calories excessively, hide food in strange places, cut food into small pieces to make it appear as if they have eaten more, and feel uncomfortable about eating in front of others.

For those suffering from anorexia, eating is very much tied in with emotions. Often an anorexic person will believe that their worth as a person depends entirely on how much or how little they weigh, and they may feel that other people are more likely to accept or like them if they are thinner.

Deliberately vomiting

Anorexia sufferers may try to get rid of food by vomiting immediately after meals. Signs of regular forced vomiting may include:

  • Tooth decay or bad breath - caused by the acid in vomit, which corrodes the teeth
  • Getting down from the table immediately after finishing a meal
  • Hard skin on the knuckles - caused by repeatedly sticking their fingers down their throat

Taking unnecessary medicine

Another technique used by people suffering from anorexia is to try to make food pass through the body before nutrients can be absorbed. They may try to take:

  • Diuretics - known as ‘water tablets’, which work to reduce the water content in the body by stimulating the kidneys to make more urine.
  • Laxatives - these help to empty the bowel.

Neither of these medications actually have much of an effect on the calories absorbed from food.

Treating anorexia

Often people with anorexia will be reluctant to admit to their problem due to embarrassment or trepidation about what the treatment might involve. It can also feel like they are relinquishing the control they fought so hard to obtain.

If you suspect that a close friend or family member has anorexia, it is advisable to try to get help as soon as possible. A GP will conduct an assessment and possibly refer the sufferer to a specialist care team (a care team can include a specialist counsellor, a psychologist, a psychiatrist, a dietician and a nurse). Once any psychological or physical factors have been assessed, a course of treatment can be established.

Nutritional management

For an anorexic sufferer, gaining weight is an incredibly delicate process. The long periods of starvation could have caused any number of biochemical abnormalities such as deficiencies in proteins, micronutrients and fatty acids.

This usually means that specialist dietary plans must be made in order to correct the imbalances and not cause additional problems. Experts believe that weight should not be gained until these deficiencies have been corrected. Aggressive attempts to boost weight gain during the early stages of treatment could be extremely hazardous.

Any course of treatment for anorexia is usually considered within a wider psychological context. This means that emphasis will be placed on speaking with the patient and understanding their needs. A person suffering from anorexia may find the treatment challenging and upsetting. This is because their connection with food is more personal and complex than most outsiders can understand, and may be connected to underlying psychological issues.

Nutritionists who can help with anorexia

Where are anorexia patients treated?

Depending on the severity of the condition, the patient may be treated via the following methods:

1. As an inpatient

If weight loss symptoms are severe and health is critical, the patient will be admitted to a specialist recovery unit in hospital. If the patient is in a critical state and refuses to comply, then treatment may be forcedly administered without permission. Under the Mental Health Act (1983), this is known as being ‘sectioned’, and will only occur if the patient is probably going to die without medical help.

2. As a day patient or in a day unit

Daycare treatment can benefit patients who have been discharged from inpatient treatment but still require support and monitoring. Daycare is usually recommended when an outpatient suffers from a slight relapse.

3. As an outpatient

Outpatient treatment (treatment at home) is the most common method of treatment if the patient’s symptoms are less severe or improving greatly. Each individual will undergo a unique course of treatment, with certain personal factors taken into account such as current weight, level of motivation and condition of health. Psychological treatment should last for about six months and a physical check-up will be offered annually. 

Recovering from anorexia

Because each course of treatment will be unique to the patient, there are few standardised rules for safely recovering from anorexia. The NHS recommends that patients:

  • Start by eating very small amounts of food and increase intake very gradually over time.
  • Make sure nutritional experts correct any biochemical imbalances before beginning the weight gain process (supplements, vitamins etc).
  • Get into a routine when it comes to food- eat regularly at particular times throughout the day (three balanced meals per day).
  • Set a target weight so there is a goal to work towards. A gain rate of 0.5-1kg per week (but no more) is widely recommended by experts. This can be achieved by eating 3,500-7000 extra calories per week.

Along with weight gain and physical monitoring, the anorexia patient will receive psychological and emotional support throughout their recovery.

Recovering from anorexia requires drastic lifestyle changes. These changes can have a severe impact on the emotional well-being of the patient, especially when the route of anorexia is usually psychological anyway. A number of experts will offer psychological support that could help anorexic patients change their unhealthy relationship with food. Types of support could include:

1. Cognitive analytic therapy (known as CAT)

Cognitive analytic therapy (CAT) works on the premise that anorexia is caused by unhealthy patterns of behaviour and thinking. These patterns are thought to develop throughout childhood. CAT therapist will work with anorexia sufferers in three different stages:

  • Reformulation - A therapist will ask questions in order to locate a situation or period of time from the patient’s past that might have triggered the condition. For example, the eating disorder may have developed during a particularly stressful or traumatic time.
  • Recognition - Once the patient has admitted to their abnormal behavioural patterns, they are encouraged to recognise the impact these patterns may be having on their relationship with food.
  • Revision - After admitting to the problems, the patient can then work towards changing and breaking their unhealthy behavioural patterns and habits.

2. Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) works on the premise that how we think about a situation determines how we act. In turn, the actions we take determine how we think and feel. In order to change behaviour then, it is essential to change the way we think.

A therapist will demonstrate how many anorexia symptoms are associated with unrealistic thoughts regarding food. For example, many anorexia sufferers have the following thoughts:

  • “There is nothing in the world that could be worse than me putting on weight.”
  • “Everyone secretly thinks I’m fat.”
  • “If I finish all of the food on my plate, people will think I am greedy and worthless.”

A therapist will talk through these thoughts and help a patient to realise how unrealistic and unhealthy the thoughts really are.

3. Interpersonal therapy (IPT)

Interpersonal therapy (IPT) works on the premise that our relationships with other people and the outside world have significant power over our mental health.

Interacting with other people can cause feelings of self-doubt, anxiety and low self-esteem that can induce symptoms of anorexia. During IPT, a therapist will try to understand how the patient interacts with the outside world. They will try to combat these underlying problems in order to improve the patient’s relationship with food.

Although psychological therapy can be effective and supportive, there is little scientific evidence to suggest that it can help people suffering from anorexia.

If you are suffering from anorexia and your symptoms are mild or moderate, the path of treatment taken is entirely up to you. Experts emphasise the gradual nature of recovery from anorexia. There is no one ‘cure’, just a process with stages of improvement. Anorexia is not a medical condition that can clear up with antibiotics. It can change in severity from week to week and relapse or improve according to the emotional health of the sufferer.

How can a nutritionist help with anorexia?

If you have been diagnosed with anorexia, it is likely that you will have been referred to a specialist care team by your GP. This team will consist of nurses, psychologists, counsellors and dieticians. They will closely monitor your physical and psychological health during the gradual weight-gain process.

Once you have gone some way towards tackling initial health problems and underlying psychological issues, you may want to consult a nutritionist who can help you to devise a plan for the future.

Nutritionists never aim to preach or lecture their clients about healthy eating - they aim to educate.

A nutritionist will talk to you about the nutritional value of certain foods with the aim of interesting and enlightening you. The nutritionist may invite you to use your knowledge to create your own eating plan, or they may offer to devise a plan for you while taking your preferences into account.

A lot of people suffering from anorexia know that restricting what they eat is a way of administering control. Some may feel that if they consult a nutritionist, they will be relinquishing this control.

In truth, consulting a nutritionist can be a way of taking responsibility and demanding control over anorexia. With a nutritionist’s guidance, you can maintain a healthy weight happy in the knowledge that the steps you are taking are perfectly safe, and entirely your choice.

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