Anorexia: a factsheet

What is anorexia nervosa?
Anorexia nervosa is a type of eating disorder. Eating disorders refer to a group of illnesses where someone has a distorted view of body shape and weight and they have extreme disturbances in their eating behaviour. People who have eating disorders generally have a very low sense of self-esteem and poor sense of self. Anorexia nervosa, bulimia nervosa, compulsive overeating, eating disorder not otherwise specified (EDNOS) and binge eating disorder are all types of eating disorders.

Anorexia is characterised by:

• Extreme concerns about weight
• Intense fear of gaining weight or becoming fat
• Deliberate maintenance of a very low body weight
• Often absent menstrual cycles

People with anorexia have an intense desire for weight loss and be thin (often unhealthily so). Although people with anorexia are usually underweight, they generally believe that they are "fat." Food, weight and appearance often become the main focus for someone who has anorexia. Concentrating on food and weight becomes a (conscious or unconscious) way of dealing with or managing intense emotions or emotional difficulties that they are experiencing.

Both males and females, from any social or economic background, can suffer from anorexia. Although the disorder usually begins in the late teenage years it can manifest at any age, and its onset is often associated with a stressful event or a period of dieting.

Some of the common signs of anorexia may be:

• Being afraid of putting on weight
• Calorie counting and/or obsessively avoiding of high fat food
• Marked weight loss
• Not wanting to eat
• Being hungry but not wanting to admit it
• Over exercising
• Obsessive weighing
• Getting cold easily
• Irregular (or absent) menstrual cycle
• Feeling like they are too fat even though they may be very thin
• Nails and hair become brittle
• Dry and yellow skin
• Preference to eating alone or only eating around other people
• Feeling depressed and irritable
• Lanugo, or fine body hair, on the trunk and face

If you are experiencing a number of these things, it may be helpful to talk with someone you trust, like a family member, teacher, psychologist or local doctor.

What causes anorexia nervosa?
Eating disorders such as anorexia are a combination of physical and mental health difficulties and there are usually a number of factors that contribute to its development. These factors could include any or all of the following:

• Physical, emotional, or sexual trauma
• Cultural emphasis or preoccupation with body image ideals
• Relationships with peers and family
• Loss and grief
• Brain chemistry
• Physiological effects of dieting
• Stress or coping styles
• Genetic factors
• A feeling of lack of control over one's life
• An inability to cope with and manage emotions/feelings in a more positive way

It is often impossible to identify one single cause of a person's eating disorder. Rather, eating disorders are usually a result of a combination of factors working together. For some people it will be easy to identify what some of the reasons may be, but for others in may be very difficult. Regardless of the causes or reasons, it is important to remember that people with anorexia can and do recover.

Difference between anorexia and bulimia
Both anorexia and bulimia are eating disorders, however the characteristics of each are different. Anorexia is characterised by a desire to lose weight and self-starvation (severe restriction of the amount of food consumed). People who experience bulimia also usually share the intense desire to lose weight and be thin, but instead of starving themselves they are prone to episodes of eating large amounts of food in short spaces of time (bingeing), which they then feel the need to rid themselves of via various means of purging (such as vomiting, starving, or over-exercising). People who suffer from anorexia often have episodes of binge eating and purging; however, unlike bulimics, their body weight is well below the "healthy" range.

Suggestions for getting help for anorexia
Many people with eating disorders feel that they are not "sick enough" or "thin enough" to warrant receiving help for their disorder. It is important to remember and keep reminding yourself that eating disorders are psychological disorders that cause great suffering; the bodily effects of an eating disorder are merely a symptom of deeper issues. Anybody whose life is being affected by an eating disorder, regardless of its perceived severity, deserves access to support and treatment. Everyone with and eating disorder deserves to have their eating disorder taken seriously, regardless of what they weigh or of how much or little they eat.

It is a good idea to try and find help sooner rather than later. The longer someone has experienced anorexia the more difficult it is to start the recovery process. It may also be a good idea to remember this if you are starting treatment. If you are having difficulties reaching the goals set, try not to be too hard on yourself. It is important to keep trying. Persistence and courage are the keys to recovery. Remember that recovery is possible!

Everybody with anorexia is different, thus the same treatment approach won't be suited to everyone. What works for one person might not work for you, so it is worth investigating and trying out various options and approaches. Your local doctor, or eating disorders association should be able to help you find out about what options are available and which you may benefit from the most. Some options available include counsellors, nutritionists, psychologists, psychiatrists, or other health professionals. And remember, if you try one thing and it hasn't worked, it doesn't mean that you have failed; it just means that you might need to try a different approach!

What you talk about with the people you seek help from with vary depending on the individual you see and the training that they have had. However, common things that are often talked about are what your beliefs and behaviours about food and weight are, how you feel about yourself, and about how you came to develop these things. You will also be helped to learn better ways of managing your feelings and difficulties, and to have a healthier and more positive approach to yourself, food and weight.

Sometimes, to help you get better, you may spend some time in hospital so that your nutritional or psychological needs can be looked after in an environment that offers a more intense level of support. This may include having your weight returned to a level that will not cause immediate danger to your health. Some people also find it easier to learn to eat healthily again in the more structured and supportive environment that a hospital can provide, regardless of whether they are at a medically unstable weight or not.

Asking for help with an eating disorder can be a daunting prospect and requires a lot of courage but it is worth it.

Trust and honesty
Speaking to someone about your eating habits honestly and openly may be hard and it is particularly important to trust the person you are speaking with. If there is a family member you feel comfortable telling, the simplest way may be to sit down with them and just say it (eg "I need to tell you something - I think I have anorexia/eating disorder"). It's likely they will already be worried about you and will be relieved at having the opportunity to listen and help. If you don't get a positive response though, try to remember that it is not because you have done something wrong, but because the person you have told may not know how to respond to what you have told them or may not understand much about eating disorders. Don't give up - either try again or maybe speak to someone else who you think you might receive a more supportive response from.

You might find it easier to talk to a counsellor, psychologist or psychiatrist (someone who is not a family member or friend). Like any relationship, building up this trust may take time and it is important you find someone you feel comfortable with (this may mean seeing several people before finding one that you "click" with!). If talking about it with someone is too overwhelming, an alternative is to email or write down what you want to say.