Anorexia nervosa, often referred to as anorexia, is an eating disorder characterised by the deliberate refusal to eat due to the irrational fear of putting on weight and the relentless pursuit of thinness. Key features of anorexia nervosa include the following:

• Refusal to sustain a normal safe healthy weight
• Intense fear of putting on weight despite previous weight loss.
• Distorted view of body image
• Disruption of hormonal balance
• Excessive exercise to burn off calories

Signs of anorexia nervosa

People with anorexia nervosa often hide their condition so it is not always easy to spot the signs. However, as the condition progresses the signs of anorexia become more obvious. The signs of anorexia can be sub divided into different categories.

1. Food-related signs
   - A very restrictive diet
   - Preoccupation with food and calories
   - Secretive eating habits and rituals
   - Increased consumption of fluids
   - Secret disposal of foods
   - Frequent weighing
   - Lying about food intake
2. Body image-related signs
   - Significant weight loss
   - Self-criticism of body image
   - Complaining of weight even
     though very underweight
3. Purging-related signs
   - Use of diuretics laxatives or diet pills
   - Obsessive exercising
   - Throwing up after eating
4. Physical related signs
   - Dry discoloured skin
   - Loss of menstrual periods
   - Decreased interest in sex
   - Growth of fine downy hair on the face and body
   - Dry thin hair
   - Poor circulation
   - Constipation
   - Brittle bones
   - Increased sensitivity to cold
5. Psychological-related signs
   - Low self-esteem
   - Depression
   - Mood swings
   - Obsessive behaviour
   - Withdrawal
   - Difficulty sleeping

What causes anorexia?

The cause of anorexia can be different for everyone. There are a number of factors related to the development of anorexia. Some of these include the following:

Cultural pressures i.e. the perception that being thin equals beauty, success and happiness is a factor that is often emphasised in the media.
Psychological issues such as low self-esteem, poor body image, depression, , difficulty expressing feelings.
Life stresses such as a death in a family, relationship break up, beginning of adolescence.
Family history of eating disorders, alcoholism or mood disorders

Effects of anorexia

Anorexia has a significant effect on the body. The calorie restriction causes the body to go into starvation mode and slow down its usual bodily function in order to conserve energy. The physical effects of anorexia include the following:

• Loss of menstrual periods
• Constipation and abdominal pain
• Muscle weakness and muscle loss
• Feeling cold all of the time
• Dizziness
• Growth of fine hair all over the body
• Dry discoloured skin
• Loss of bone density
• Slow heart rate
• Low blood pressure
• Kidney stones, risk of kidney failure

Anorexia also affects a person's thinking and behaviour. A person experiencing anorexia experiences changes in brain chemistry which contribute to altered thinking, perception and behaviour. Concentration, memory, problem-solving and decision-making can also be affected. The use of laxatives and diuretics can also seriously alter body minerals such as potassium, magnesium and sodium which also affects bodily functions.

How is anorexia treated?

Anorexia is a condition that seriously affects your health but it can be treated. Treatment combines approaches that address physical and psychological issues. The aim is to restore a healthy body weight, treat psychological issues relating to the condition and reduce or eliminate behaviours and thoughts that lead to disordered eating.

The first step for treating anorexia is a visit to your GP who will do an assessment to confirm anorexia as the cause of the weight loss. The next step is the treatment of urgent physical health concerns. If the weight loss has resulted in critical health concerns you may need to go to hospital to address these issues and regain a normal body weight for your age, height and gender. This may be a difficult time for people experiencing anorexia as fear of weight gain can still be an existing issue. They may be forced to regain weight against their will.

A second element of treatment involves nutritional counselling where a dietician will educate the person about healthy eating, Body Mass Index and the regaining and maintenance of a healthy body weight.

Counselling also plays a part in the treatment of anorexia. Counselling is required to help identify the root cause behind the anorexia. The counselling also aims to identify negative thoughts, feelings and coping strategies and replace them with more positive coping strategies. The types of counselling for anorexia include the following:

• Cognitive Behavioural Therapy
• Family Therapy
• Group Therapy

What should I do if I have an eating disorder?

Overcoming an eating disorder is not just about gaining weight or giving up unhealthy eating patterns. Overcoming an eating disorder is about learning to listen to your body, to your feelings, learning to trust, accept and love yourself. In order to do that the following steps are useful.

Find an eating disorder specialist. Contact Bodywhys (1890 200 444) for a list of GPs with a special interest in eating disorders.

Address urgent health problems first then tackle underlying emotional issues.

Contact an eating disorder support group for peer support on dealing with your condition and emotional support in the form of understanding and advice.

Learn new coping skills - eating disorders are more about emotional issues than food. Disordered eating is a coping mechanism to deal with painful emotions such as anger, self-loathing, fear, guilt and vulnerability. You can learn new coping strategies when you feel painful emotions. Pick a healthier coping strategy that suits you such as writing your thoughts in a diary, having a healthy amount of exercise, painting or listening to music.

Try to improve your self image - when you base your self-worth on physical appearance and body size alone you fail to see the other qualities that make you who you are. In order to positively influence your self-worth:

• Make a list of your positive qualities; ask your friends and family to help you.
• Challenge negative self-talk. See the module on noticing unhelpful thinking in the Selfhelp section of this website to help with this task.
• Focus on what you like about yourself and your body.

Learn healthy eating habits - this may be difficult if you have spent a good amount of time focussing on calories and weight but is a very important step in recovery from eating disorders. Try to eat foods that you like and make meals an enjoyable part of the day by spending them with family or friends or in a location you enjoy.

Identify your triggers - if possible learn to identify situations that make you want to revert back to unhealthy eating patterns. Once you notice these triggers, have a plan in place that gives you extra support. This could be attending a support group more often, talking with family or friends or writing your thoughts in a diary.

How can you help a friend or family member who has an eating disorder?

Learn about eating disorders so you can understand the struggles and difficulties your friend or family member is going through. Have patience and compassion; there is no quick fix for eating disorders but encouragement will impact positively.

Be a good role model for healthy living and eating

Accept your limitations

Take care of your own health

For more information on eating disorders and support, contact Bodywhys on 1890 200 444