Anorexia nervosa

Anorexia is an eating disorder that affects the way you eat and the way you feel about food and your body. People with anorexia severely restrict how much they eat, leading to weight loss that can be life-threatening, and may also exercise excessively, binge eat or purge (e.g., by vomiting).  

You may want to read this article on eating disorders first, and then come back here for anorexia nervosa in particular. The article explains that eating disorders are much more than an extreme focus on diet and exercise. They are not a ‘phase’ or a ‘choice’, and it is extremely hard to recover from them without professional help. However, with the right treatment and support, you can make a full recovery.

These symptoms are usually present in people with a diagnosis of anorexia nervosa:

• Restricting how much you eat
• Weighing less than is considered healthy for your age, sex and height 
• Intense fear of gaining weight, or persistent behaviour that stops you from gaining weight or leads to ongoing weight loss
• A perception of your body/weight that doesn’t match how others see you, a strong belief that your body size or shape impacts your value as a person, or a lack of recognition that your low body weight is negatively impacting your health

As well as restricting how much you eat, you may have binge episodes, where you eat large amounts and feel that you have no control, usually followed by purging (vomiting or using laxatives, enemas or diuretics) to compensate for the food you have eaten. This can make you feel very guilty and lead to more severe food restriction and/or compulsive, excessive exercising.

If you are experiencing anorexia, you – or the people around you – may also notice some of the following behaviours, feelings and physical symptoms.

• The way you eat: Skipping meals, preferring to eat alone or secretly, hiding or secretly throwing away uneaten food, having rituals around eating, following strict rules about what you eat, weighing or measuring your food, developing new ‘intolerances’, eating only ‘diet’ or ‘low-fat’ products, paying close attention to calorie content, being dishonest about what you’ve eaten, drinking water or chewing gum instead of eating, feeling anxious or irritable during mealtimes, having a strong interest in cooking/cookbooks/what other people are eating but not eating yourself
• Your attitude towards your body: Low self-esteem, feeling dissatisfied with your body, thinking or talking a lot about losing weight or being ‘fat’, wearing baggy or layered clothes to disguise weight loss, asking people for reassurance about your body size, weighing/pinching/looking in the mirror obsessively, strong interest in images and information about weight loss/thin people.
• The way you exercise: Exercising in secret, exercising intensely with no pleasure, developing rituals around exercise, exercising to compensate for eating.  
• Signs of purging: Sore throat, tooth decay, bad breath, a rounder face from swollen glands, swollen/red marks on fingers or knuckles, using diet pills/laxatives/diuretics/enemas, going to the bathroom straight after meals, running water in the bathroom to cover vomiting sounds, using mints or gum to cover the smell of vomit.   
• Physical symptoms: Fluctuations in weight, weight change after illness/travel/increased involvement in sport or exercise, brittle nails, hair thinning/breaking/falling out, dry skin, downy hair on body, abnormal blood count, irregular heart rhythms, low pulse, low blood pressure, constipation, stomach pains, periods stopping/becoming irregular/delayed in starting, dehydration, loss of bone mass, feeling cold (especially hands and feet), fainting/dizziness, skin problems, lethargy/tiredness. 
• Other behaviours: Struggling to sit still, having rigid (black-and-white) thinking, increased perfectionism, seeing other people as judgmental, becoming more isolated and socially withdrawn, difficulty talking about emotions.

Risks

Losing weight rapidly and not getting the nutrition you need can lead to low blood pressure, a low heart rate and many other risk factors, which can be life-threatening. Purging can lead to electrolyte imbalances that stop your heart from functioning properly. Treatment for anorexia nervosa will include regular visits to the GP, for medical monitoring, and sometimes admission to hospital.

There are several types of therapy and treatment settings that can be used in treating eating disorders. Largely, treatment consists of specialist evidence-based psychological treatments. This includes individual therapy and family therapy. It can at times also include group therapy, provision of nutritional advice and meal planning with a dietician, and education for you and your family/whānau.

Depending on how severe the eating disorder is, you may attend a clinic for residential or day treatment for a number of weeks to provide a more structured setting for support. You may be admitted to hospital for medical stabilisation as an in-patient if you are at risk and medically compromised.

There is no specific medication to treat eating disorders, but you may be prescribed medication to assist with treatment. Some medications may make your eating disorder thoughts less intense and help with depression or anxiety symptoms.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and which may be used to complement and support it.
Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress. However, you should not rely on these therapies alone to treat eating disorder symptoms.

Family/whānau support and involvement

If someone you love is experiencing anorexia, you are likely feeling many emotions: fear, sadness, worry, frustration and more. It’s important to remember that eating disorders are strongly influenced by biology: it is not your fault that your loved one has anorexia, and it’s not something they can change or recover from without professional help.

As a family/whānau member, you have an important role to play. Learning as much as you can about anorexia and its treatment will reassure you and help you support both their recovery and your own wellbeing. Reach out to your own support network for practical help, seek counselling for yourself, and remember to care for your own physical and mental health. The groups listed below, under ‘Resources and links’, offer valuable support to parents and caregivers of people with anorexia.