Anorexia

What is Anorexia Nervosa?

Anorexia is characterised by the introduction of weight reduction measures which lead to a dangerously low body weight. These changes most often include a reduction in food intake, but also may include other behaviours that aim to increase energy expenditure, such as exercise or consuming stimulants. These changes to lifestyle in combination with a low body weight, lead to impairment of physical, social and/or mental functioning.

Commonly, people living with anorexia often have a distorted experience of their body shape and/or weight.
Low body weight is defined as less than 18.5 kg/m2 in adults and less than the 5th percentile in children and young people.
The condition affects men and women of all ages but is most common in young women, usually starting in the mid-teenage years.

What Causes Anorexia?

It is not known why a person develops anorexia or other eating disorders. However, it is clear that there is a complex relationship between predisposing traits, triggering factors, and recurring negative or positive feedback in relation to habits intended to provide weight loss. Observational research shows people may be predisposed to developing anorexia if:

• They or a family member has a history of an eating disorder, depression or addiction to alcohol or drugs
• They have been subjected to negative comments on their body size or shape, or subject to criticism or remarks on their eating habits
• They have external pressure or influence due to their job
• They suffer from anxiety or low self-esteem
• They have an obsessive personality or strive for perfection (even when unrealistic)
• They have suffered sexual abuse

Exposure to Western media is thought to be a risk factor, with the prevalence of anorexia being highest in North America and Western Europe. It has been shown that where immigrants move into Western-influenced cultures they also experience a higher incidence of anorexia.

Symptoms of Anorexia Nervosa

Before weight loss becomes noticeable, friends and family may notice lifestyle changes that could be indicative of an eating disorder such as anorexia. These include:

• Diet restrictions in terms of eliminating certain food types or a reduction in portion size.
• An obvious and obsessive fear of gaining weight.
• Avoiding eating with others.
• Cutting food into small pieces and/or eating very slowly.
• Binge eating and/or causing themselves to be sick.
• Taking medications and/or supplements with the intention of losing weight.
• Suggestions that they are ‘fat’ or overweight when the opposite is obvious.
• Wearing clothing that disguises their weight loss.
• Denying they have lost weight or that severe weight loss is a serious issue.

The physical symptoms of anorexia include:

• Extreme weight loss.
• Muscle wasting, physical weakness and fatigue/tiredness
• Hair and nails that become brittle
• Yellowing and dryness of the skin
• Soft hair growth all over the body (lanugo – the body’s way of providing warmth and insulation when there isn’t enough body fat to do so)
• Constipation
• Low blood pressure
• Slowed breathing and pulse rate
• Damage to the structure of the heart which affects its function
• Consistently feeling cold
• Infertility
• Irregular or complete absence of periods in women who have not yet reached menopause, or periods not starting in younger women and girls
• As the illness progresses and causes more damage to the body, the sufferer may succumb to brain damage and multiple organ failure.

Types of Anorexia

Anorexia nervosa is one condition, and there are no different types of anorexia.
In the United States, anorexia can be assigned different severity categories according to underlying body mass index, but the UK classification system does not utilise this.
There are many ways in which individuals with anorexia, may try and lose weight and therefore there may be similar features with bulimia nervosa, binge eating disorder, or atypical eating disorders. One of the key features of anorexia that can help distinguish it from the other conditions is a low body mass index, below 18.5 kg/m2.

Anorexia Treatment

Treatment for anorexia nervosa will depend on several factors. These include the age of the patient (treatment plans are different for those under the age of 18) and the stage of the disease.

Anorexia Treatment for Adults

For adults, talking therapies will normally be the first step. Talking therapies include:

• Cognitive behavioural therapy
  • (CBT)CBT is the chosen therapy for a range of mental health conditions as it helps people cope with and manage their feelings. In cases of anorexia, CBT therapy can help with gaining a better understanding of nutrition and the effects starvation has on the body and mind. In addition, the aim is to help people living with anorexia make healthy food and lifestyle choices.
• Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
  • MANTRA helps with understanding the underlying cause of the disease. The focus of MANTRA sessions is to pinpoint what is important to the sufferer of the disease and allow them to begin changing their behaviour when they feel ready to do so. MANTRA sessions can include family or caregivers if the patient so wishes and feels it may help.
• Specialist supportive clinical management (SSCM)
  • SSCM takes a guided approach to therapy, whereby the therapist will help their client understand the underlying cause of their anorexia. They will learn about nutrition and gain a better understanding of how their current eating habits are affecting the body and causing symptoms.
• Focal Psychodynamic Therapy
  • Focal psychodynamic therapy is usually tried if the above therapies have not worked for the patient, or the patient doesn’t feel they are right for them.

structured eating plan will also be provided along with the chosen talking therapy, however, this is not a standalone treatment.
People with very low body weight and/or physical health complications of anorexia may require admission to hospital for specialist guidance and monitoring when changes to diet are made to help increase weight.

Anorexia Treatment for Children and Young People

Usually, anorexia in children and young people under the age of 18 will involve family therapy. This involves discussing how the issue is affecting the family as a whole and gives family members the tools and understanding to better help their loved one recover.

Coping techniques to manage difficult feelings or situations will also be provided to prevent a relapse once the therapy sessions have stopped.
Family sessions may involve just one family or might be held in a group session, but this will be agreed upon before commencing the course of therapy.
CBT may also be offered to young people living with anorexia and will be very similar to the CBT offered to adults.

Adolescent-Focused Therapy

Adolescent focused therapy can be undertaken alone or with family. It usually lasts between a year and 18-months, and will help the sufferer:

• Cope with the fear of gaining weight
• Learn healthy habits and gain a better understanding of the effects of undereating
• Understand the underlying cause of their anorexia