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Published by Bupa's health information team, June 2008.
This factsheet is for people who have anorexia nervosa, or who would like information about it.
Anorexia nervosa, often abbreviated to anorexia, is an eating disorder where you have an intense fear of putting on weight. If you are affected you severely limit the amount of food you eat to reduce your body weight to an unhealthily low level. Anorexia is most common in teenage girls, although anyone can develop the illness at any age.
About anorexia nervosa
Anorexia nervosa means loss of appetite for nervous reasons but in fact you don't lose your appetite if you have anorexia - you just don't allow yourself to satisfy your appetite.
If you have anorexia you develop a distorted idea of your body shape and size. You try to stop or limit eating and may also over-exercise. This results in you becoming very underweight.
About one in 250 women and one in 2,000 men get anorexia at some time in their lives. Eating disorders in boys and men appear to be increasing.
The other main eating disorder is bulimia nervosa, when you have cycles of bingeing (overeating) and purging (ridding the body of the excess food usually by vomiting or laxatives). For more information, see Related topics. Some people with anorexia may have bingeing and purging habits too.
Symptoms of anorexia nervosa
There are a range of symptoms associated with anorexia. If you have anorexia, you may:
- have a body weight that is much less than expected for your age and height
- eat very little, if at all, or restrict types of food, such as any containing fat
- be secretive about food
- cut your food into tiny pieces to look as though you have eaten some, and become obsessed with what other people are eating
- deny being underweight or having a problem with food
- obsessively weigh, measure and examine your body
- have a distorted body image
- be obsessed with exercise
- use appetite suppressants such as diet pills
- make yourself vomit after meals or use laxatives or pills that remove water from your body
- wear baggy clothes to disguise your weight loss
Apart from weight loss, the physical signs of anorexia can include:
losing hair from your head
- having fine, downy hair on your body and face
- feeling cold all the time
- altered sleeping patterns and insomnia
- constipation, bloating (feeling full) and abdominal (tummy) pain
- puffy face and ankles
- light-headedness and dizziness
- tiredness with aching muscles
- difficulty concentrating
- mood swings and restlessness
- delayed puberty (as anorexia affects hormones)
- missing three or more monthly periods (in women or girls who aren't pregnant or taking the contraceptive pill)
- a loss of sexual interest and potency (in men or boys)
If you vomit after you have eaten, you may have other problems such as bad or discoloured teeth and bad breath.
Complications of anorexia nervosa
Over time, anorexia can cause serious long-term health problems such as:
osteoporosis (brittle bones that break easily)
damage to your heart
It's important that people with severe anorexia receive appropriate treatment. If untreated, there is a chance that they may die from related health problems. These include starvation, dehydration, infections and heart failure. There is also an increased risk of suicide.
Causes of anorexia nervosa
The cause of anorexia isn't fully understood at present. It may develop due to a combination of emotional, physical and social reasons. The precise reasons for developing anorexia are probably different for each person.
Certain personality features are common in people with eating disorders. These include:
- low self-esteem, where how you think about your body shape affects your self-worth
- a loss of interest in other people
- trying to be perfect
- mood problems, especially depression
- mental health problems such as obsessive compulsive disorder (where you can't stop thinking about or doing certain actions) - for more information, see Related topics
If you have these personality features, an eating disorder may give you a sense of control and achievement.
There are certain factors that make it more likely that you will develop anorexia.
- Eating disorders are more common in white people in western societies and are rare in developing countries.
- Some people believe that media images of thinness may have some influence on eating disorders.
- If you have type 1 diabetes you are more likely to develop anorexia.
- If you have been overweight in the past you have an increased risk of developing anorexia.
- Certain jobs or sports where a very lean body type is desirable may also encourage anorexia; for example, running or athletics, modelling and dancing.
- A family history of eating disorders increases the risk of developing anorexia. This could be due to genetic factors or copying behaviour from other family members.
- An emotionally upsetting event such as divorce, or abusive family relationships, may cause anorexia to develop.
Diagnosis of anorexia nervosa
Getting help is very important. Admitting that you have a problem is the first, yet hardest, step. If you can take that step, you will find the support and treatment you need to stop anorexia taking over your life.
Your GP is the first point of contact for help. He or she will ask about your life and eating habits and will examine you to check for any physical problems resulting from anorexia. He or she may refer you to a psychiatrist or psychologist who is trained in the treatment of eating disorders.
Treatment of anorexia nervosa
Anorexia can be helped much more easily if the problem is identified and treated early. However, for treatment to be successful, you must be ready to get better.
The aim of treatment is to re-establish a healthy attitude towards food and a consistent pattern of eating.
Keeping a diary of eating habits and learning about healthy eating and sensible weight control may be helpful. For more information about maintaining a healthy diet, see Related topics.
Support groups may also be helpful. It's often comforting to talk to other people who have been through the same thing, and who can offer understanding and acceptance without blame or guilt.
There are no medicines that can cure anorexia. Your doctor may prescribe medicines to treat other health problems caused by anorexia, such as oestrogen hormone supplements if your bones are weak because of anorexia.
Psychotherapy (counselling) is frequently used in the treatment of anorexia. Psychotherapy helps you to identify the feelings and fears that caused you to stop eating, and helps you develop a healthier attitude towards food and your body.
A course of psychotherapy usually lasts six months, but if you need a more long-term therapy, motivational enhancement therapy is an option. This also aims to change your attitude towards food into a more healthy and positive one.
You may also find it helpful to have therapy that involves your family. This helps everyone in the family to understand the disorder properly and support each other.
Most people who have anorexia can be successfully treated without being admitted to hospital. But if you have lost so much weight your life is at risk, you may need to be admitted to hospital so that fluids and nutrients that you have lost from your body can be replaced.
Forced treatment is always a last resort, because it's distressing for people with anorexia to lose control over what they eat and drink.
Help and support
It can be upsetting to see loved ones putting their health at risk and it's natural to want to help. But unwanted pressure or criticism from others usually makes matters worse.
Try to let the person make his or her own choices and let the person know that love and support is always there. Once the person has recognised they have a problem, offer to help with practical matters such as finding medical help and support groups. Support groups also provide advice and information for families and friends of people with eating disorders.
Recovering from anorexia nervosa
It's possible to recover from anorexia, but it can be a long process and you may have relapses in times of stress. You may find anorexia difficult to overcome, but with determination, patience and support it can be done.
Anorexia nervosa Q&As
See our answers to common questions about anorexia nervosa, including:
- Eating disorders. NHS Library for Health. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 2 January 2008
- Eating disorders. The Royal College of Psychiatrists. www.rcpsych.ac.uk, accessed 2 January 2008
- Eating disorders - core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. National Collaborating Centre for Mental Health. 2004. National Clinical Practice Guideline CG9. www.nice.org.uk
- What is anorexia nervosa? Beating Eating Disorders (beat). www.b-eat.co.uk, accessed 2 January 2008
- World Health Organisation (WHO). The ICD-10 Classification of Mental and Behavioural Disorders - Diagnostic criteria for research. Switzerland: WHO, 1993
- Morris J, Twaddle S. Anorexia nervosa. BMJ 2007; 334:894-898. www.bmj.com
- Collier J, Longmore M, Scally P. Oxford Handbook of Clinical Specialities. 6th ed. Oxford, 2003
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr W H Simpson, MBBS, General Practitioner, and by Bupa doctors. It has also been reviewed by Beating Eating Disorders (beat). The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: June 2008.