All About Anorexia

5/20/2018 All About Anorexia

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All AboutAnorexia Nervosa

A booklet for those wanting to

know more about anorexia nervosa


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This booklet w as w ritten by

C harlotte S tark, Inform ation

O fficer.

Published by:

The M ental H ealth Foundation

U K O ffice

83 Victoria S treet

London SW 1H 0H W

Tel: 020 7802 0300

Fax: 020 7802 0301

Scotland O ffice

24 G eorge S quare

G lasgow G 2 1EG

Tel: 0141 572 0125

Fax: 0141 572 0246

E-m ail: m hf@ m hf.org.uk

W eb: w w w .m entalhealth.org.uk

R eg C harity N o: 801130

C opyright 1997, 2000

C artoons draw n by

Sim on W hitem an

The M ental H ealth Foundation

ISBN : 090 1944 79 3

Price 1.00

The Mental Health Foundation has

published two booklets on eating

disorders. This one looks at anorexia

nervosa and its companion booklet

covers bulimia nervosa. We have

produced two separate booklets

because there are some very important

differences between the two. There is

however inevitably some overlap,particularly in the discussion about

causes. There are also people who

have experience of some or all of the

symptoms of both conditions or who

alternate between the two at different

times.

If you would also find it useful to have

a copy of the bulimia nervosa booklet,

please call us on 020 7802 0300.


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What is anorexia nervosa?

A norexia nervosa is a disorder w hich m akes eating very

distressing. It m akes people obsessively anxious to m aintain

or reduce their body w eight through rigid control of their calorie

intake. People w ith anorexia nervosa often have a very

distorted perception of how they look and continue to feel the

need to lose w eight even w hen they are so thin that their

health is very seriously at risk. They have an intense fear of

gaining w eight and feel that their value as a person is directly

affected by their body shape.

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Who has anorexia nervosa?

C urrent estim ates suggest that up to 1% of w om en in the U K

betw een the ages of 15 and 30 suffer from anorexia nervosa.

G irls under 15 can also be affected and it seem s that anorexia

nervosa is becom ing an increasing problem in these younger

children. Som e w om en over 30 also have anorexia nervosa,

although the condition generally rst occurs earlier than this.

90-95% of people w ith anorexia are w om en, but it is im portant

to realise that it is a condition w hich can occur in young m en as

w ell as w om en. There is also evidence to suggest that in the

younger age group (7-14 yrs) up to 25% of cases are boys.

It is difficult to judge exact num bers of people w ho have

anorexia nervosa as m any cases are not reported or not

diagnosed. Som e people experience m any of the sym ptom s

of the condition but w ould not be form ally diagnosed. This

m ay be because their w eight has not fallen below the level

identi ed by eating disorder experts (usually 15% below

norm albody w eight) or because they do not t the

diagnostic m odels in som e other w ay.

What causes anorexia nervosa?

There is a lot of uncertainty about the causes of all form s of

eating disorder. M any people still think of them as slim m ers

diseases. W hile it is true that both anorexia and bulim ia

nervosa can develop from a strict diet, the reasons for a diet

turning into an eating disorder involve m ore than just the w ish

to lose w eight. The nam e anorexiais confusing as literally it

m eans loss of appetite. People w ith anorexia nervosa do not

lose their appetite, they still feel hungry, but fear w eight gain

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so m uch that they lose the ability to eat a norm al diet.

Som e people attribute anorexia nervosa to m edia and fashion and

it is clear that they both play their part. M any people w ho do not

conform to the ideals presented by the fashion industry and the

m edia feel that they need to diet. For som e people this presents

no problem w hile for others it can turn into anorexia nervosa.

The m edia can also perpetuate problem s for people w ho have an

eating problem as it is very difficult to break aw ay from the dieting

cycle if you are constantly being presented w ith im ages of

desirable thin m odels.

People w ith anorexia nervosa develop a fear of fatness w hich

goes far beyond that w hich m ost dieters feel. For som eone w ith

anorexia nervosa, the need to m ake them selves thinner

dom inates all other em otions. Som e people w ith the condition

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lose their ability to see them selves as they really are, and instead

becom e terri ed that they are fat even w hen they have becom e

seriously m alnourished and underw eight. O thers are able to see

that they are thinner than m ost other people, but still strive to losew hatever body fat they feel rem ains. In m any cases, they feel

driven to continue to lose w eight because they feel that their

value as a person depends on their w eight and body shape and

that they w ill only be liked and appreciated if they are able to

m ake them selves increasingly thinner.

People w ho develop anorexia nervosa often have em otional

needs w hich are not being m et in their lives. They m ay not havea stable fam ily background, m ay have trouble m aking friends

socially or at w ork or feel uncom fortable about sexual

relationships. It is im portant to realise though that anorexia

nervosa is not anyones fault. It cannot be seen to hinge entirely

on relationships, this is sim ply one factor w hich m ay play a part.

People can develop anorexia nervosa even if they have very

supportive fam ilies and partners and a w ide circle of friends.

Anorexia nervosa often starts in teenage years and can be a

m echanism for dealing w ith all the com plicated em otions

connected w ith becom ing an adult. Som e teenage girls are

terri ed of becom ing w om en. This m ay be because they have

been abused as children, because they have seen their m other

or other fem ale relatives being unhappy, because they are

concerned about their sexuality or sim ply because they are

anxious about all the changes w hich they can feel taking place

w ithin them . Anorexia nervosa can offer them a w ay of delaying

som e of the physical signs that they are becom ing w om en.

Teenage girls w ith anorexia nervosa do not have such developed

breasts or hips as other girls their age because they have so little

body fat. They m ay also delay the start of their periods. This can

be very com forting for girls w ho do not feel ready for these

physical developm ents.

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People w ho have anorexia nervosa often feel that they are

underachievers in academ ic or w ork life. This is usually not the

case and evidence has show n that m any people w ith anorexia

nervosa are in fact very high achievers. They are, how ever, oftenpeople w ho set them selves standards w hich are sim ply

im possible to achieve and leave them w ith feelings of

inadequacy.

For a person w ith little con dence, their eating problem s m ay

seem to be the only thing about them w hich is special or

different. Their ability to feel hungry and yet refuse to eat can feel

like a special talent that m ost people are unable to achieve andcan give a real sense of pride. It feels very disciplined to be able

to count calories and to be able to im pose strict lim its on how

m uch you consum e. For people w ho have low self-esteem and

w ho can see virtually no other area in their lives in w hich they are

successful, this can suddenly offer them a sense of purpose.

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Anorexia nervosa can also be a w ay of coping w ith difficult

em otions. The am ount of tim e and energy spent thinking about

food and w eight loss can leave very little room to deal w ith any

other em otions. A norexia nervosa can therefore act as a kind ofprotective barrier against the difficulties and em otional pressures

of everyday life.

It is im portant to understand that anorexia nervosa can ful l som e

needs and not to expect som eone to give it up w ithout having

their needs m et in som e other w ay.

What are the effects of anorexianervosa on someones health?

A signi cant num ber of people w ith anorexia nervosa die as a

result of the condition, either as a direct physical consequence

of the w eight loss or through suicide.

People w ith anorexia nervosa have very low body w eight and

this can cause serious m edical problem s. The m ost com m on of

these are:

Poor circulation

Low blood pressure

B rittle bones

Increased facial hair

Loss of periods/infertility

Fainting and dizziness

H air loss

D ehydration

Kidney dam age

Low body tem perature

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Som e of these problem s w ill get better w hen the person

recovers from anorexia nervosa. O ther problem s, particularly

dam age caused to bones, m ay never im prove. It is im portant to

seek help as early as possible as m any of the m ore seriousm edical consequences of anorexia nervosa are only associated

w ith long-term eating problem s.

Will someone with severe anorexia

nervosa have to go into hospital?O ccasionally w hen w eight loss becom es so severe that it is a

threat to som eones life, hospital m ay need to be considered as

an option. D octors need to be very careful about taking people

into hospital, how ever, as the im m ediate physical need for

m edical intervention can im pact on the m ore long-term need for

autonom y. W hat people w ith anorexia nervosa generally need

above all else is to feel that they are in control of their ow n lives.B eing adm itted to hospital and having responsibility for their

intake of food or uids m anaged by others can be extrem ely

distressing.

If doctors feel that som eones life is in im m ediate danger, and

they see no other option, they can force som eone to go into

hospital for treatm ent - this is allow ed under the M ental H ealth

A ct. C om pulsory treatm ent is alw ays seen as a last resort and

w ill only be continued for as long as doctors and other

professionals see it as the only solution. If hospital treatm ent

is going to be effective, then it m ust be seen as part of a m uch

w ider approach to the anorexia nervosa w hich includes looking

at the reasons w hy the condition rst started and w hy it is so

difficult to give up.

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How can I help if I suspect someonehas anorexia nervosa?

If you suspect that som eone you know has anorexia nervosa or

is show ing signs of developing it, you should try to talk to them

about your w orries and urge them to seek help. If they seem

unw illing to discuss their eating problem s w ith you, or becom e

aggressive, try suggesting that they at least read about the

condition. This w ill help to get them used to being confronted

w ith som e of the term inology as w ell as alerting them to som eof the dangers. They m ay not realise that they have such a

serious a problem or m ay be anxious about giving up

som ething w hich they feel helps them to cope.

Try to learn as m uch as you can about the condition and be

prepared to offer w hatever support your friend or relative

needs. B e guided by w hat they say they need rather than by

w hat you think they should be doing. You m ust realise that it

can be very frightening to give up a regim e w hich is at the verycentre of som eones life. Talk to your friend about w hy they

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think they need their anorexia nervosa and w hat they fear about

giving it up. It m ay be that they need som ething to feel proud

of, or som ething over w hich they have com plete control. If this

is the case, then you m ay be able to help them to think of otherareas in their lives in w hich this can be achieved.

You m ay nd it helpful to use som e of the self-help books listed

at the end of this booklet. They are generally w ritten by m edical

professionals w ith m any years experience in treating eating

disorders but m ost of them also have input from people w ho

have lived w ith the condition them selves. These books can be

very helpful in show ing you how you can structure the recoveryprocess, giving practical suggestions for w ays forw ard and

explaining w hy people m ay act as they do. You and your friend

or relative m ay also nd it very reassuring to see that the w ay

they are feeling is a recognised condition and that there are

effective w ays of dealing w ith these feelings.

O nce you have got som eone to talk about their condition, you

should try to stress the im portance of getting professional help.There are effective treatm ents for anorexia nervosa, and the

earlier your friend or relative has access to these treatm ents,

the better their chance of recovery (see G etting help below ).

What should I do if I have anorexia

nervosa?The rst thing you should try to do is to talk to som eone about

your anorexia nervosa. If you are already very underw eight, you

m ay not need to tell anyone that you have a problem , but you

should try to talk to som eone about w hy you think you are

starving yourself. U nlike bulim ia nervosa, anorexia nervosa is

a difficult condition to keep secret because there are very

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obvious changes in your appearance. Your friends and fam ily

w ill have noticed that you are losing w eight and w ill alm ost

certainly be w orried about you.

Try to explain to som eone you trust w hat you get from having

anorexia nervosa. If you feel you need to starve yourself in

order to m aintain control over your life, or to suppress other

em otions you m ay not feel able to deal w ith - then tell

som eone this. The people close to you w ill be able to

understand the dangers associated w ith your extrem e w eight

loss. Those w ho have been on diets or w ho struggle to control

their ow n w eight m ay also be able to understand howfrightened you feel about gaining any w eight. W hat people m ay

need help w ith is understanding that in som e w ays your

anorexia nervosa can help you to cope w ith other pressures

you face. Try to be honest w ith yourself about your condition

and share your thoughts w ith som eone else if you can.

You probably feel very afraid of putting on any w eight. You

m ust try to begin to understand that this fear is part of yourcondition and try to listen to people w hen they tell you that you

should not be losing any m ore w eight.

You m ay also nd it helpful to read m ore about anorexia

nervosa or talk to other people w ho live w ith it. The Eating

D isorders A ssociation can send you inform ation and has self

help groups you can join. There are useful books and leafl ets

listed at the back of this booklet.

Getting help

B efore you decide to get help, you m ust be honest w ith

yourself about w hether you are ready. N obody w ill be able to

help you get better unless you are able to accept that you w illhave to at least m aintain your current body w eight. There are all

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sorts of w ays you can approach your condition and you m ust

chose one w hich suits you. R em em ber that if you have

m anaged to open up to som eone and started to think and talk

about your anorexia nervosa, you have already taken a big stepforw ard. D o not try to rush your recovery, but feel proud of

each advance you m ake.

Professional help

If you decide that you are ready to seek professional help, you

should rst approach your ow n doctor (G P) for advice. N ot all

G Ps are expert in eating disorders, but they can help you toaccess specialist services. They can also be very helpful in

discussing your physical needs and in helping you to adjust to

a healthier w ay of eating. If you have been fasting for a long

tim e you m ay nd that you have problem s w ith certain food.

Your digestive system w ill not be used to coping w ith norm al

am ounts of food and you m ay need to start by eating sm all

portions of easily digested foods until your system catches up.

Your G P can tell you w hich foods should cause you least

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problem s w hilst still providing you w ith the nourishm ent you

need. H e/she m ay also w ant to w eigh you regularly as a m eans

of m onitoring your progress. D o not be afraid of this - try to see

it as a challenge and aim to have m aintained your body w eightor even have gained a few pounds each tim e.

Your G P should also refer you to a psychiatrist or therapist

specialising in eating disorders. This can be very helpful as

they w ill have experience of treating m any people w ith anorexia

nervosa and w ill be used to the challenges. If you are sent

for specialist help, see this as a valuable opportunity and try

to be open to the suggestions they m ake. You should alsobe prepared to tell them w hat you feel w orks best for you

or w hat your particular fears are - after all, w e are all different.

If you are very thin, your doctor m ay w ant to adm it you to

hospital for a short tim e (see previous section - w ill som eone

w ith severe anorexia nervosa have to go into hospital?).

This m ay be frightening and m ake you feel as if you are losing

control. M ake sure you keep as m uch control as you can- ask questions, m ake sure you understand w hat is happening

and w hy and challenge anything you are not happy about.

Your tim e in hospital should only be a sm all part of your overall

treatm ent and you should try to see it in this context.

Self help

There are a num ber of very good self help books available.Som e of these are listed at the back of this booklet. These

books can tell you about w ays other people have found to

get better, can suggest som e of the reasons w hy you m ay

be feeling as you do and can give practical suggestions of

m easures you can take in your life to try to recover. They

are alm ost alw ays w ritten w ith the help of people w ho have

anorexia nervosa them selves and so do not m ake unrealistic

claim s.

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You w ill probably nd that as w ell as providing you w ith som e

practical w ays forw ard, these books w ill also be very

com forting as they w ill show you that others think and act as

you do. The books are m ost effective w hen used by you andsom eone else together. If you can get som eone to read

through the advice and help you apply it to your ow n set of

circum stances, then you should be able to develop a w orkable

plan for getting better. If you do not have a friend or relative

that you feel can help you w ith this, then your G P or practice

nurse m ay be able to help.

Friends and family

D o not underestim ate the effect of friends and fam ily on your

recovery. Their support can be invaluable. N ot only can they

help w ith practicalities, they can also support you through the

bad tim es and help you celebrate your successes.

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R ecovering from anorexia nervosa is difficult. M any people only

seek help w hen they have been living w ith the condition for

years. A ny w ay of thinking and behaving w hich has been

established for a long period of tim e is difficult to overcom e.People trying to recover from anorexia nervosa should be

prepared for the process to take som e tim e and be really

com m itted to achieving results. A norexia nervosa can be

beaten and there are a range of very effective treatm ents

w hich can be tried. O n the next page you w ill nd are

addresses w here you can get further help, inform ation and

support.

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15

Eating Disorders Association

First Floor

W ensum H ouse

103 Prince of W ales R oad

N orw ich

N orfolk N R 1 1D W

H elpline: 0845 634 1414

(8.30am -8.30pm M on-Fri)

Youth H elpline - 18yrs and under:

0845 634 7650

(4.00pm -6.30pm M on-Fri)R ecorded m essage about

eating disorders: 0906 302 0012

(m essage lasts approx 10

m inutes and costs 50p per

m inute)

w w w .edauk.com

The EDA provides telephone

helplines, information sheets,

leaflets and newsletters and runsa national network of self-help

groups. They are able to advise

on both bulimia and anorexia

nervosa.

MIND

G ranta H ouse

15-19 B roadw ay

Stratford

London E15 4BQTel: 020 8519 2122

Inform ation Line: 0845 660163

w w w .m ind.org.uk

National charity which offers

information on all mental

illnesses. MIND have leaflets and

information sheets on eating

disorders and sell some of the

self-help guides listed below.

The Samaritans

Tel: 0845 909090

w w w .sam aritans.org.uk

UK Helpline for anyone

experiencing emotional distress.

Someone to talk to in confidence

24 hours a day.

The Womens Therapy Centre

6-9 M anor G ardens

London N 7 6LATel: 020 7263 6200

(M on-Fri 10am -12pm and 2-4pm )

Individual and group

psychotherapy for women.

Where to get further help


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Further reading aboutanorexia nervosa

The follow ing list is intended as a guide to seeking further inform ation

and the M ental H ealth Foundation does not necessarily endorse or

support the content of the publications listed.

General reading

Anorexics on Anorexia

R osem ary S helley. Jessica Kingsley, 1997

The Anorexic Experience

M arilyn Law rence. The W om ens Press, 1995.

Eating Disorders: the facts

Suzanne A braham and D erek Llew ellyn-Jones.

O xford U niversity Press, 1989.

Talking About Anorexia

M M onro. Sheldon, 1996.

Self-help books

Anorexia and Bulimia: your questions answered

Julia B uckroyd. Elem ent B ooks Ltd, 1996.

Anorexia Nervosa: a guide for sufferers and their families

PL Palm er, Penguin, 1989.

Leaflets

Anorexia and Bulimia. Help is at Hand Guide

R oyal C ollege of Psychiatrists - call 020 7235 2351.

Understanding Eating Distress

M IN D - call 020 8519 2122

The Eating D isorders A ssociation also produces a range of lea ets on

eating disorders - call them on 0870 770 3256 for further details.

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A s the U Ks only charity concerned w ith both m ental health and

learning disabilities, the M ental H ealth Foundation plays a vital

role in pioneering new approaches to prevention, treatm ent and

care. The Foundations w ork includes: allocating grants for

research and com m unity projects, contributing to public

debate, educating and infl uencing policy m akers and health

care professionals.

All About Anorexia

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