A Guide to Mental Disorders

Anorexia Nervosa

Anorexia nervosa (commonly referred to as anorexia) is an eating disorder and a serious mental health problem. Someone with anorexia often has an intense fear of gaining weight and may have a distorted view of their body, thinking they're fat even when they're underweight.

People often think anorexia is about dieting, but it's more complicated than that. It's linked to low self-esteem, negative body image and many other factors.

Anyone can be affected by anorexia. While young women more commonly report it, anorexia is increasingly being reported by men and boys, women over the age of 40, and children as young as seven.

The idea of recovery might feel difficult or scary if you're afraid of putting on weight or worried about losing control. You might not feel ready to think about it yet. Just remember that it's possible to feel better, even if it takes a while to get there.

What are the symptoms of Anorexia?
The mental signs of anorexia includes:
- Feeling afraid of putting on weight or being fat
- Being preoccupied with your weight
- Thinking that food dominates your thoughts
- Feeling as though your body is bigger or a different shape than it really is
- Feeling anxious, especially around mealtimes
- Lacking in confidence and self-esteem
- Being irritable and moody
- Feeling that you have very high standards for yourself or you are a perfectionist

You may also underestimate or deny that you have a problem, even after you've been diagnosed.

The physical signs of anorexia include:
- weight loss
- lack of sexual interest
- difficulty sleeping
- dizziness
- hair loss
- constipation, bloating and stomach pains
- feeling cold and weak
- soft downy hair (lanugo) growing all over your body
- difficulty concentrating
- low blood pressure
- periods stopping or becoming irregular

Anorexia can affect your behavior. You might:
- reduce your food intake or stop eating altogether
- spend a lot of time counting calories
- avoid food you think is fattening
- skip meals
- hide food or throw it away
- cut food into tiny pieces to make it less obvious you haven't eaten much or to make it easier to swallow
- develop rules and rituals around eating, such as listing 'good' and 'bad' foods
- eat very slowly
- exercise a lot
- take pills that claim to reduce your appetite or speed up your metabolism
- make yourself sick or use laxatives
- withdraw from other people and shut yourself off from the world

With other people, you may lie about what you've eaten, make excuses about why you're not eating or pretend you've eaten earlier. You might also lie about how much weight you've lost.

What causes Anorexia?
There is no single cause of anorexia. It usually develops because of a combination of factors.

People with anorexia often have common traits, including:
- low self-esteem, feeling worthless or like you're not good enough. Losing weight can start to feel like a sense of achievement or a way to feel a sense of worth
- perfectionism
- having other mental health conditions, particularly depression, self-harm and anxiety
- finding it hard to handle stress and cope with life
- obsessive or compulsive behaviors

Society places a lot of importance on body image, meaning we're constantly told that how we look reflects our worth. This can leave us feeling ashamed if we don't fit the model of a 'good body'.

While these pressures don't cause eating disorders, they can make us feel we're not good enough or negatively affect our self-esteem. This can trigger an eating disorder in people already vulnerable to developing one.

Research also shows there may be genetic links to anorexia as well. The brain chemicals that control our hunger, appetite and digestion can also make us more likely to develop anorexia. If we have too much or too little of these brain chemicals or are particularly sensitive to them, our appetite and mood can be affected.

What help is available?
Living with anorexia can be incredibly difficult, but so too can the idea of recovery. If anorexia has become a big part of your identity, you might wonder who you'll be without it. You might be afraid of not being in control of your food or of how your body might change. It can take time to feel ready to try to recover. Think about what recovery might look like to you and what the benefits could be. Change is possible, even if it doesn't feel like it right now.

If you think you have anorexia, start by talking to your GP. They may not be an expert in treating eating disorders, but they will be able to assess any physical symptoms and then refer you to specialist eating disorder services.

Talking therapies can help you identify the feelings and fears that triggered your anorexia and help you develop a healthier attitude towards food and your body.

Cognitive analytical therapy (CAT) looks at past experiences and events to help you understand why you think, feel and behave the way you do now. Your therapist will then help you develop new tools to cope in a healthier way.

Cognitive behavioral therapy (CBT) focuses on identifying and changing the thoughts and beliefs that may trigger your anorexia. Your therapist will help you understand and change disordered thoughts such as 'everyone thinks I am fat'. You may set homework and goals around challenging any unhealthy rules you have around food.

The 'Maudsley Approach' is a type of therapy to help children and young people with anorexia. It involves parents taking an active role in helping to get their child's weight to a normal level, giving control of eating choices back to the child and then encouraging them to develop healthy independence.

You may be offered antidepressants too, alongside self-help or therapy to manage other conditions such as depression, anxiety or obsessive-compulsive disorder (OCD). However, antidepressants shouldn't be the only treatment you're offered.

Most people with anorexia won't need to go to the hospital, thankfully. However, if your weight is very low, you may be admitted. Your treatment could involve counseling, group and family therapy, and working with a dietician and mental health team.

Ways you can look after yourself
It's difficult to recover from an eating disorder on your own, but there are things you can try alongside treatment and support. Beat has many tips for recovery, and Mind has ideas for self-care, including managing relapses, changing unhealthy routines and being careful online.

You may find that support groups are useful. It can be comforting to talk to others with the same feelings and experiences. You could join Beat's online support group for people with anorexia.

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